Fatigue In Inflammatory Bowel Disease Research Articles

P421 Real-world effectiveness and safety of vedolizumab induction therapy for Crohn’s disease in Poland – a prospective, observational POLONEZ II study considering patients reported outcomes

Abstract Background Vedolizumab (VDZ) is a gut-selective anti-lymphocyte trafficking drug, used to treat ulcerative colitis (UC) and Crohn’s disease (CD), lifelong conditions with unknown aetiology with frequent relapses and remitting course which are a burden for patients and a challenge for health care systems. We aimed to evaluate the real-world effectiveness of VDZ induction therapy for Polish patients with CD. Methods This was a multicenter, observational, prospective study involving patients with moderately to severely active CD qualified for reimbursed treatment with VDZ in 10 Polish centers between Apr 2020 and Nov 2021. The primary endpoints were clinical response (≥ 70-point reduction in Crohn's Disease Activity Index, CDAI) and remission rate (CDAI ≤ 150) at week 14. Other endpoints included changes from baseline (week 0, first dose of VDZ) to week 14 for patient-reported outcomes (PROs): quality of life (Inflammatory Bowel Disease Questionnaire, IBDQ), fatigue (Inflammatory Bowel Disease-Fatigue Self-assessment Scale, IBD-F), stool frequency (SF score) and abdominal pain score (APS). Results A total of 98 patients with CD were enrolled in the study. At baseline, the most common disease location in the cohort was ileocolonic CD (n=70/98, 72.9%). Fifty patients (51%) were on corticosteroids at week 0. Nine patients discontinued VDZ therapy before or at week 14, mainly due to lack of response (n=6/9, 66.7%). At week 14, 63.3% of patients (n=62/98) achieved clinical remission and 30% (n=15/50) steroid-free remission. Clinical response rate in overall study population was 90.8% (n=89/98). Median CDAI score decreased from 336.5 to 108.0 (p<0.001) at week 14 (Fig. 1). Declines from baseline were also observed in median CDAI sub-scores: SF score (38.0 vs 10.0; p<0.001) and APS (18.0 vs 2.0; p<0.001) (Fig. 1). At week 14, median changes from baseline scores on the IBDQ (total and all subscales) were statistically significant (p<0.001) (Fig. 2). Improvement was also observed after the VDZ 14-week treatment period in fatigue severity and frequency (p<0.01) as well as its impact on daily activities (p<0.001) based on IBD-F (Fig. 3). The percentage of patients without concomitant corticosteroids increased more than 1.5-fold from week 0 (49.0%) to week 14 (76.3%). Conclusion VDZ is effective in induction therapy and has significant impact on disease activity and Health-Related Quality of Life (HRQL) including fatigue in patients with CD.

The impact of Inflammatory Bowel Disease related fatigue on Health-Related Quality of Life: a qualitative semi-structured interview study.

Fatigue is a frequently reported symptom of Inflammatory Bowel Disease (IBD), having a negative impact on Health-Related Quality of Life (HRQoL). Patients' experiences of this have not been researched in IBD. Semi-structured interviews were conducted with adults with Crohn's Disease from out-patient clinics in the United Kingdom. Interviews were audio-recorded and transcribed verbatim, then analysed using thematic analysis. Fourteen participant interviews were conducted. Three key themes were identified: 1) 'The new normal' established through adaptation and acceptance; 2) 'Energy as a resource' describing attempts to better manage fatigue through planning and prioritising tasks; 3) 'Keeping healthy' encompasses participants' beliefs that 'good health' allows better management of fatigue. Participants establish a 'new' normality, through maintaining the same or similar level of employment/education activities. However, this is often at the expense of social activities. Further research is required to explore patient led self-management interventions in IBD fatigue.

A Novel Digital Self-management Intervention for Symptoms of Fatigue, Pain, and Urgency in Inflammatory Bowel Disease: Describing the Process of Development.

BackgroundEmpirical studies and systematic reviews have demonstrated the role of biological, cognitive, behavioral, and emotional factors in fatigue, pain, and urgency in inflammatory bowel disease (IBD). Behavioral management that addresses the cognitive, behavioral, and emotional factors offered alongside medical treatment is seldom available to people with IBD. Digital interventions provide a potentially scalable and cost-effective way of providing behavioral support to patients.ObjectiveThis paper aimed to describe the process of developing a supported digital self-management intervention for fatigue, pain, and urgency in IBD using theory and evidence-based approaches and stakeholder input.MethodsThe Medical Research Council framework for complex health interventions and a person-based approach were used to guide intervention development, consulting with 87 patients with IBD and 60 nurses. These frameworks informed the selection and use of a theoretical model that subsequently guided cognitive behaviorally based intervention content. They also guided the design of tailored digital intervention pathways for individuals with IBD that matched the predominant symptoms.ResultsA transsymptomatic cognitive behavioral framework of symptom perpetuation was developed for the symptoms of fatigue, pain, and urgency in IBD. A logic model was used to define the intervention techniques. Patient feedback and qualitative interviews refined the website content and functionalities, including the use of visual aids, email reminders, and graphical tracking of symptoms. Nurse focus groups informed the volume and delivery model of the therapist facilitator support. Ratings of acceptability out of 10 following feasibility testing (31/87, 36%) demonstrated accessibility (scoring 9.43, SD 1.040), ease (scoring 8.07, SD 3.205), clarity, and the relevant tone of the intervention. The final intervention comprised 12 web-based sessions (8 core and 4 symptom-specific), with one 30-minute facilitator phone call following session 1 and subsequent on-site messaging.ConclusionsThe use of theory and integration of stakeholders’ views throughout informed the development of an evidence-based digital intervention for fatigue, pain, and urgency in IBD. This is the first web-based self-management intervention designed to address these multiple symptoms with the aim of improving the quality of life and reducing the symptom burden of IBD. The intervention is being tested in a large multicenter randomized controlled trial.Trial RegistrationISRCTN Registry ISRCTN71618461; https://www.isrctn.com/ISRCTN71618461

Self-Worth Beliefs Predict Willingness to Engage in Psychotherapy for Fatigue in Inflammatory Bowel Disease

BackgroundFatigue in inflammatory bowel disease (IBD) is poorly controlled, with few existing interventions. Psychotherapy interventions for IBD fatigue show promise; however, due to mixed findings in efficacy and attrition, current interventions need improvement. Some research shows beliefs about psychotherapy and stigma toward psychotherapy may impact engagement in psychotherapy interventions.AimsThis study aimed to examine the effects of IBD activity, fatigue, mental health status, previous experience with psychotherapy, and stigma toward psychotherapy on willingness to use psychotherapy as a fatigue intervention.MethodsAn online cross-sectional survey was conducted, and linear regression models were used to examine willingness to engage in psychotherapy for fatigue.ResultsOverall, 834 participants completed the survey. Regression analysis examining demographics, mental health status, IBD activity, fatigue, pain, antidepressant use, psychotherapy experience, and self-worth intervention efficacy belief significantly explained 25% of variance in willingness to use psychotherapy for fatigue. Significant factors included antidepressant use (b = .21, p < .01), pain (b = − .05, p < .001), and self-worth intervention belief (b = − .27, p < .001), which uniquely explained 18% of variance in the outcome.ConclusionsWillingness to engage in psychotherapy for fatigue in IBD appears to be driven by expectations related to specific self-worth beliefs, rather than stigma, IBD activity, or any prior experience with psychotherapy. Clinicians should directly address these expectations with their patients.

P571 The Nordic diet as a tool to improve the activity of disease and psycho-emotional wellbeing in patients with mild and moderate Ulcerative Colitis – the pilot study

Abstract Background The Nordic diet (ND) has been associated with reduced inflammatory markers and improved anxiety and stress symptoms. Our aim was to evaluate the effect of the ND on the activity of ulcerative colitis (UC), symptoms of anxiety, depression, and fatigue. Methods Patients (N=12) with mild and moderate UC were included (excluding severe UC, UC proctitis, infections). The activity of UC was evaluated with partial Mayo score (pMS) and fecal calprotectin (FC), psycho-emotional wellbeing – using hospital anxiety and depression scale (HADS) and inflammatory bowel disease – fatigue (IBD-F) questionnaire. The patients were evaluated at 3 consecutive visits at week 0, 6 and 10. During the first visit, the patients were consulted by a nutritionist to adjust their diets, received written recommendations and were able to contact the nutritionist later. At every visit HADS, IBD-F scores, and BMI, pMS and FC were registered. The ND score was calculated as described by Bjørnarå et al., 2015. Patients were considered compliant if the ND score increased by at least 2 points and unhealthy snacks were absent or almost excluded. Related samples Wilcoxon signed rank test and independent samples Kruskal-Wallis test were used to assess statistical significance. The ND score was described as low (0–3), medium (4–5) or high (6–10). Results The characteristics of all patients are summarised in Table 1. One patient had mild exacerbation of UC during the study managed with increased dose of mesalamine. Changes of the ND score (Fig.1) differed significantly in visit 2 (p=0.01). After exclusion of non-compliant patients, the data of 8 patients was analysed. The pMS, FC, HADS, IBD-F (level and impact) did not show significant changes at visit 2. BMI was significantly reduced at visit 2 (p=0.018), median at visit 1 was 28.55 (IQR: 24.16 – 32), visit 2 - 27.65 (23.2 – 30.16) kg/m2. We also found lower FC levels in patients with high ND score, but the difference was not statistically significant (Fig. 2). No significant differences were found regarding the psycho-emotional wellbeing but the impact of fatigue on everyday life was higher in low ND score group (Fig. 3). Conclusion We were not able to show improved FC nor psycho-emotional symptoms after 6 weeks of the ND. The adherence decreased after visit 2, therefore another consultation with the nutritionist could be beneficial to improve the understanding and motivation of the patients. Compliance with the ND reduced BMI and high adherence might be associated with lower FC levels. Further studies with larger patient groups would improve reliability of the results. This pilot study is part of the project financed by BIOCODEX MICROBIOTA FOUNDATION 2020.

P062 31P MRS and MRI phenotyping of muscle metabolic quality in IBD fatigue

Abstract Background Fatigue perception and exercise intolerance are common in inflammatory bowel disease (IBD). The mechanisms are unknown, although physical deconditioning is greater in fatigued relative to non-fatigued patients, suggesting an aetiological role for deconditioning. To assess peripheral muscle quality in Crohn’s disease (CD), we quantified the time-course of muscle phosphocreatine (PCr) recovery, which is wholly mitochondrial dependent, following ischaemic high-intensity exercise in fatigued CD and HV. Methods Participant body mass and regional body composition was assessed by DEXA. All MR data was collected using a 3T Philips Achieva scanner and a 14cm 31P coil on the medial gastrocnemius muscle. 1H mDIXON scans were acquired to image the calf prior to ischaemic plantar flexion exercise at 50% maximum voluntary contraction (MVC) using an MR-compatible ergometer (Trispect, Ergospect) during non-localized pulse-acquire 31P-MRS. 31P spectra were analysed using jMRUI Beta 6.0 using the AMARES function with prior knowledge. Cytosolic pH was estimated using the chemical shift difference between Pi and PCr peaks. Post exercise PCr recovery was quantified after reinstating limb blood flow. PCr recovery was expressed relative to baseline (non-ischaemic) signal amplitude and fit to a mono-exponential function in GraphPad prism. (PCr(t) = PCrinitial+(PCrend – PCrinitial)(1-exp(-k.t)) where t is the time from the start of non-ischaemic recovery, PCrinitial and PCrend is the PCr signal at the initial and end of recovery phases. An FSL and Matlab pipeline was used to obtain calf muscle volume and fat fraction from 1H mDIXON images. Results 13 quiescent CD patients (7 female, HBI 1±2, CRP &amp;lt;5) and 9 HVs (4 female) were matched for age (P = 0.986) and BMI (P = 0.845). General fatigue score was greater in CD (13 ± 4) relative to HV (8 ± 3) (t19=3.08, P = 0.006) (Table 1.) End-exercise muscle PCr depletion (%) (85.25 ± 10.12 vs 83.28 ± 7.8%, P = 0.639) and estimated end-exercise muscle pH (6.6 ± 0.2 vs 6.5 ± 0.2, P = 0.320) was consistent between HV and CD. The mean rate constant of PCr resynthesis (kPCr min-1) in CD (0.76 ± 0.23) was significantly less (t20 = 2.6, P = 0.016) than HV (1.03 ± 0.23). PCr recovery curves were well described using a mono-exponential function in CD (R2=0.98 ± 0.01, R2value) and HV (R2=0.96 ± 0.03) (Table 3). Conclusion The PCr resynthesis rate following intensity matched ischemic exercise was less in fatigued CD patients relative to HV. This points to peripheral muscle deconditioning and associated loss of mitochondrial mass as a driver of exercise intolerance in IBD. This may be amenable to exercise training intervention.

Relationship Between Endoscopic and Clinical Disease Activity With Fatigue in Inflammatory Bowel Disease.

Fatigue is a prevalent symptom among individuals with inflammatory bowel disease. Yet, few studies have examined the relationship between fatigue and endoscopic disease activity. A retrospective chart review was conducted to determine the prevalence of fatigue based on endoscopic inflammation and clinical disease activity and describe the factors associated with fatigue among adults with inflammatory bowel disease. One hundred sixty patients were included. The majority had Crohn disease (72.5%), with an average age of 40.5 years. Sixty-one percent reported fatigue. Both endoscopic (p = .03) and clinical disease activities (p = .001) were significantly associated with fatigue. Among participants reporting fatigue, 52% had inactive disease and 48% had active disease based on endoscopy whereas 63% reported clinically active disease and 37% reported clinically inactive disease. In the multivariate regression model, clinical disease activity (odds ratio [OR] = 8.5; 95% CI [3.9, 18.6]) and anxiety (OR = 2.8; 95% CI [1.0, 7.6]) were significantly associated with fatigue. The prevalence of fatigue is high among individuals with active and inactive disease. Clinical disease activity and anxiety, but not endoscopic disease activity, were associated with fatigue.

Physical Activity in Patients With Inflammatory Bowel Disease: A Narrative Review.

Despite advancement in the treatment of inflammatory bowel disease (IBD), induction and maintenance of remission remain challenging to achieve in many patients and a significant proportion of patients with IBD experience mental health conditions, including anxiety, depression, and fatigue, which impair their quality of life (QoL). We aim to describe the available evidence regarding the effects of physical activity (PA) on the onset of IBD, its disease course, and important patient-reported outcome measures (PROMs), such as QoL, fatigue, and mental health. A literature search was performed using electronic databases to identify original articles that assessed the effects of PA in patients with IBD using PROMs. Prospective cohort and case-control studies demonstrate inverse relationships between PA and new-onset IBD in Crohn's disease but not in ulcerative colitis; however, they have small sample sizes and caution must be taken in considering associations versus causation. Small randomized controlled trials suggest promise for PA and beneficial outcomes, such as maintenance of clinical remission and improvement in QoL, fatigue, depression, and anxiety. However, these studies were small and underpowered, and limited by outcome measurements and durations of follow-up. Physicians may consider discussing PA interventions with their patients on an individual basis, especially if they report impaired QoL, fatigue, depression, or anxiety, until disease-specific guidelines are available. Including PA as part of a primary prevention strategy in high-risk patients could be considered.

Sarcopenia, severe anxiety and increased C-reactive protein are associated with severe fatigue in patients with inflammatory bowel diseases

Patients with inflammatory bowel disease (IBD) report fatigue more frequently than healthy population, but the precise mechanisms underlying its presence are unknown. This study aimed to evaluate the prevalence of fatigue in IBD and its relation with potential causative factors. A survey on fatigue, depression, anxiety, sleep disorders, and the presence of sarcopenia and malnutrition, was sent by email to 244 IBD outpatients of the Gastroenterology Unit of Academic Hospital of Padua. Demographics and clinical data, including the levels of fecal calprotectin (FC) and C-reactive protein (CRP), and current pharmacological treatments were obtained from patients’ medical records. Ninety-nine (40.5%) subjects answered the survey. Ninety-two (92.9%) patients reported fatigue, with sixty-six having mild to moderate fatigue and twenty-six severe fatigue. Multivariate analysis showed that abnormal values of CRP (OR 5.1), severe anxiety (OR 3.7) and sarcopenia (OR 4.4) were the factors independently associated with severe fatigue. Fatigue has a high prevalence in subject affected by IBD. Subjects with altered CRP, sarcopenia and severe anxiety appear more at risk of severe fatigue.

Review article: The aetiology of fatigue in inflammatory bowel disease and potential therapeutic management strategies.

Fatigue is the inability to achieve or maintain an expected work output resulting from central or peripheral mechanisms. The prevalence of inflammatory bowel disease (IBD) fatigue can reach 86% in active disease, persisting in 50%-52% of patients with mild to inactive disease. Fatigue is the commonest reason for work absence in IBD, and patients often report fatigue burden to be greater than that of primary disease symptoms. Relatively few evidence-based treatment options exist, and the aetiology is poorly understood. To review the available data and suggest a possible aetiology of IBD fatigue and to consider the efficacy of existing management strategies and highlight potential future interventions. We reviewed fatigue-related literature in IBD using PubMed database. Disease related factors such as inflammation and pharmacological treatments negatively impact skeletal muscle and brain physiology, likely contributing to fatigue symptoms. Secondary factors such as malnutrition, anaemia, sleep disturbance and psychological comorbidity are potential determinants. Immune profile, faecal microbiota composition and physical fitness differ significantly between fatigued and non-fatigued patients, suggesting these may be aetiological factors. Solution-focused therapy, high-dosage thiamine supplementation and biological therapy may reduce fatigue perception in IBD. The effect of physical activity interventions is inconclusive. A multimodal approach is likely required to treat IBD fatigue. Established reversible factors like anaemia, micronutrient deficiencies and active disease should initially be resolved. Psychosocial intervention shows potential efficacy in reducing fatigue perception in quiescent disease. Restoring physical deconditioning by exercise training intervention may further improve fatigue burden.

‘It's just part of the disease’: a qualitative study exploring help-seeking behaviours for fatigue in inflammatory bowel disease

Background: Fatigue is the most burdensome aspect of inflammatory bowel disease (IBD). Despite this, people tend not to discuss fatigue or seek help. Aims: To uncover the reasons people do or do not seek help for fatigue in IBD. Methods: A qualitative approach was employed, underpinned by the Theory of Planned Behaviour. Semi-structured interview questions were posed to a voluntary sample of 12 participants with self-reported diagnosis of IBD fatigue, recruited from the Irish Society of Colitis and Crohn's. The sample included individuals who had and had not sought help in the past. Findings: The availability of management options, symptom perception, symptom impact, knowledge of sources of help and inferiority of fatigue as a symptom can influence help-seeking behaviour. Fatigue is viewed as inferior to other symptoms of IBD, which influences help-seeking behaviour and help-seeking experiences. Conclusions: Health professionals can increase help-seeking by informing patients about the symptom and identifying a specific source of help for fatigue.

N01 Does physical activity positively impact fatigue in individuals with Inflammatory Bowel Disease?

Abstract Background Patients with Inflammatory Bowel Disease (IBD) often experience the problematic and burdensome symptom of fatigue, both during periods of relapse and remission. The optimal management of fatigue in IBD is uncertain, however there is evidence suggesting that physical activity is likely to be a beneficial way of managing the symptom. The aim of this study is to explore the relationship between fatigue and objective measurements of both physical activity metrics and varying intensities of physical activity for individuals with IBD. Methods A multi-centred, European, cross-sectional, correlational study was employed. A consecutive sample of 187 patients with Crohn’s disease (59%) or ulcerative colitis (41%) were recruited from six IBD centres in the Republic of Ireland (42%), United Kingdom (40%) and Denmark (18%). Fatigue was measured using the IBD-Fatigue (IBD-F) scale, including both the level of fatigue (IBD-F, Section 1) and impact of fatigue (IBD-F, Section 2). Physical activity was objectively measured using scientifically validated triaxial accelerometers (ActiGraph wGT3X-BT) during seven consecutive days. Results A moderate level of fatigue (IBD-F Section 1 Md (IQR) = 10 (6 – 13)), predominantly intermittent in nature (72%) was reported by participants (57.4% female; 59% Crohn’s disease; 43% active disease). Participants self-reported sleeping an average of 8.7 hours over the seven nights. During the week, the intensity of activity was predominantly sedentary (Md 5 days, 22 hours, 20 minutes) or light (Md 19 hours, 35 minutes). The median moderate-to-vigorous intensity of physical activity per day was 32.2 minutes and step count over the week was 47052 steps. There was no evidence of a unique linear or non-linear relationship between each of the objective measurements of physical activity with IBD-related fatigue. This lack of evidence extended separately to patients in remission and to patients with active disease. These findings are in the context of a statistically significant moderately-strong relationship between disease activity (measured using both HBI and SCCAI) and level of fatigue for both patients of Crohn’s disease (rs = .327, p = .001, n = 96) and ulcerative colitis (rs = .353, p = .003, n = 71). Conclusion This large multi-centred study shows no association between objective measurements of physical activity and IBD-fatigue. These findings suggest that engaging or not engaging in physical activity has no differential impact on self-assessment of fatigue.

P550 Short term effects of a combined lifestyle intervention in patients with Inflammatory Bowel Disease

BackgroundDiet and physical activity might help to improve quality of life and maintain remission in patients with inflammatory bowel disease (IBD). In other conditions, interventions in which diet and physical activity are combined seem to be more effective than separate interventions. Therefore, we assessed the effect of a combined lifestyle intervention on the impact of disease on daily life, clinical disease activity, fatigue and quality of life in patients with Crohn’s disease (CD) or ulcerative colitis (UC).MethodsA single arm intervention study was performed in IBD patients in remission or with mildly active disease. Participants received personal advice to improve their diet and level of physical activity by a dietician and a physiotherapist in one face-to-face and one telephone consult. These advices were supported by guidelines based on the Dutch dietary and physical activity guidelines, a recipe app and a booklet with physical activity exercises. IBD disability index (IBD-DI) to assess impact of disease on daily life, clinical disease activity questionnaires (P-HBI or P-SCCAI), IBD fatigue (IBD-F) patient self-assessment scale and IBD quality of life questionnaire (IBDQ) were completed. The Eetscore Food Frequency Questionnaire (Eetscore FFQ) and Short Questionnaire to Assess Health-enhancing physical activity (SQUASH) were used to assess diet and physical activity. Changes from baseline to 5 weeks after start were investigated by paired samples t-tests or Wilcoxon signed rank tests.ResultsWe included 29 participants. At time of this preliminary analysis, 25 participants completed baseline and 5-week assessments (11 males, 11 CD, median age 36 years [IQR 29–53], median BMI 25 kg/m2 [IQR 24–28]). After 5 weeks, diet quality had significantly improved (p<0.001), but level of physical activity had not (p=0.509). Impact of disease on daily life (IBD-DI) decreased with 2.5 points (95%CI -5.5-0.4; p=0.09). Disease activity did not change significantly. There was a significant decrease in fatigue (median IBD-F 20 [IQR 8–29] to 15 [IQR 3–24; p=0.03]) and a significant increase in quality of life (median IBDQ 194 [IQR 179–206] to 196 [IQR 186–209; p=0.03]).ConclusionThese preliminary results suggest that a combined lifestyle intervention is effective to reduce fatigue and to increase quality of life in patients with IBD, at least in the short term. Impact of disease on daily life and clinical disease activity did not improve significantly. Participants reported their level of physical activity to be restricted due to COVID-19 measures, which could explain the lack of effect on this outcome. This study is still ongoing and we expect follow-up data up till 1 year after start.

P209 Prevalence and risk factors for fatigue in chronic inflammatory bowel disease

Abstract Background Fatigue is one of the most common symptoms reported by patients with chronic inflammatory bowel disease (IBD), being in flare or in remission. Thus, several fatigue measurement tools have been developed. The objective of our work was to assess the prevalence of fatigue in patients with IBD and its impact on daily life, and to determine its risk factors. Methods This is a cross-sectional study of patients followed for IBD who presented to our consultation during the three months preceding the study. Fatigue assessment was performed by IBD-F score (The Inflammatory Bowel Disease Fatigue Self-assessment Scale). The higher the score, the more disabling the fatigue. The activity of Crohn’s disease (CD) was assessed by the Harvey-Bradshaw index (HBI), that of ulcerative colitis (UC) by the clinical Mayo score. Results One hundred patients were included. Thirty-two patients (32%) had UC and 68 patients (68%) had CD. The mean age was 42.18 years [16–81 years], with a predominance of men (sex ratio = 1.5). Severe disease activity was noted in 14 patients (20.6%) with CD and 10 patients (31.3%) with UC. Extra-intestinal manifestations, particularly articular, were noted in 20% of cases. 36% of patients were in clinical remission. The prevalence of fatigue was 94.11% in MC and 93.75% in RCH. Fatigue was noted in 83.3% of patients in remission.Fatigue was severe (section I score between 11 and 20) in 40% of patients. We found a significant association and a linear correlation between the presence and severity of fatigue and CD activity (p &amp;lt;0.001, r = 0.84), as well as UC activity (p &amp;lt;0.001, r = 0.74). A significant association was found with extra-intestinal manifestations (p = 0.028), as well as with the presence of other chronic diseases (p = 0.014). In 30% of cases, fatigue was responsible for a functional handicap (section II score between 61 and 120). This effect was also strongly correlated with disease activity: MC (p &amp;lt;0.001, r = 0.74) and RCH (p &amp;lt;0.001, r = 0.73). Conclusion Assessing the severity of fatigue and its impact on the daily activities of patients is a crucial pillar in the management of patients with IBD. In our series, the prevalence of fatigue was 94%. It was associated and correlated with the degree of disease activity.

Influencing Factors of Inflammatory Bowel Disease-Fatigue: A Path Analysis Model.

Fatigue is a common symptom in adults with inflammatory bowel disease (IBD) and is influenced by many physiological, psychological, and situational factors. However, the influencing factors of fatigue associated with IBD have not been evaluated. This study aims to examine factors associated with fatigue during IBD and develop a parsimonious model that describes the influencing factors of fatigue. The study was a secondary analysis of cross-sectional data obtained from IBD Partners, an online cohort of adults with the disease, including 12,053 eligible participants. Data were collected using the Patient-Reported Outcomes Measurement Information System short-form scales measuring fatigue, sleep disturbances, pain interference, anxiety, depression, and satisfaction with social roles. Physical activity was measured using a single question. Demographic and clinical variables were collected. Path analysis was computed to identify the direct and indirect effects of situational, physiological, and psychological factors on IBD-fatigue based on the middle range theory of unpleasant symptoms' conceptual framework. Most of the participants were White females. The data best fit a model with situational factors (physical activity and satisfaction with social roles as the mediators). The direct effect of IBD activity, age, sleep disturbances, pain interference, anxiety, and depression on IBD-fatigue was significant. Significant indirect effects were noted on IBD-fatigue from sleep disturbances, pain interference, and depression via physical activity and satisfaction with social roles. The study identified two important intervening variables from the tested model. In addition, other symptoms such as sleep, pain, anxiety, and depression are essential and also influence IBD-fatigue.

Translation and validation of the inflammatory bowel disease fatigue (IBD-F) patient self-assessment questionnaire.

IntroductionInflammatory bowel disease (IBD) is a group of chronic gastrointestinal diseases with frequent systemic complications that are incurable according to current knowledge. These diseases adversely affect various areas of life, lowering patients’ quality of life. One of the most frequently reported symptoms is fatigue.AimTranslation and validation of the IBD-F patient self-assessment scale with a Polish IBD population.Material and methodsAfter consent from the author of the questionnaire had been obtained, the questionnaire was translated using the forward- and back-translation method. After arriving at the final Polish version of the questionnaire and ensuring that the questions and statements were comprehensible, the questionnaire was validated with a group of 129 IBD patients.ResultsHigh values of intraclass correlation coefficient (ICC) were achieved for overall results in both parts of the IBD-F questionnaire between test and retest (values exceeding 0.75). A high Cronbach’s α consistency coefficient was achieved for the entire IBD-F questionnaire, both in the test and in the retest (0.968 and 0.975, respectively). Broken down into parts, Cronbach’s α coefficient for Section I (presence and severity of fatigue) of the IBD-F questionnaire was 0.883, and for Section II (impact of fatigue on the person’s life) it was 0.966. All patients evaluating the Polish version of the IBD-F questionnaire deemed the content of the questions comprehensible.ConclusionsThe analysis of the results obtained, the Polish version of the IBD-F questionnaire was considered valid, reliable, and clinically useful.

Randomised clinical trial: high-dose oral thiamine versus placebo for chronic fatigue in patients with quiescent inflammatory bowel disease.

Fatigue is a burdensome symptom for patients with inflammatory bowel disease (IBD). Few pharmacological interventions have documented effect on fatigue in patients with IBD. A pilot study indicated a 20-day effect with high-dose thiamine. To investigate the effect and safety of high-dose oral thiamine (600-1800mg/d) based on gender and weight on chronic fatigue in patients with quiescent IBD. This was a randomised, double-blinded, placebo-controlled crossover trial. Patients had quiescent IBD, severe chronic fatigue and no other explanation for fatigue. Patients were allocated 1:1 to either 1) high-dose oral thiamine for 4weeks, 4weeks of washout, 4weeks of oral placebo or 2) oral placebo for 4weeks, 4weeks of washout, 4weeks of high-dose oral thiamine. Fatigue was measured using the Inflammatory Bowel Disease-Fatigue Questionnaire. The primary outcome was improvement (≥3 points) of fatigue after 4weeks on thiamine. Forty patients were enrolled between November 2018 and October 2019. Crossover analysis showed a mean reduction of 4.5 points (95% CI 2.6-6.2) in fatigue after thiamine compared with a mean increase of 0.75 point (95% CI -1.3-2.8; P=0.0003) after placebo. Furthermore, 55% of group 1 and 75% of group 2 showed an improvement≥3 points while on thiamine compared with 25% of group 1 and 35% of group 2 while on placebo. Only mild side effects were detected. We showed a significant beneficial effect of high-dose oral thiamine on chronic fatigue in IBD. The treatment was well tolerated. NCT03634735.

Fatigue in inflammatory bowel disease and its impact on daily activities.

Fatigue is a common symptom of chronic inflammation, including inflammatory bowel disease (IBD), resulting in significant impairment in quality of life. To identify the prevalence of fatigue in a large IBD cohort compared to the general population, address risk factors, and evaluate its impact on daily life. We evaluated 1208 IBD patients from the Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS) and 414 healthy controls. Significant fatigue was defined as a visual analogue scale (VAS-F, range 0-10) score≥4. Secondary endpoints were severity of fatigue and its impact on daily activities with the Fatigue Severity Scale (FSS), with a score≥4 indicative of fatigue. Demographic, IBD-related and psychiatric symptoms were assessed with a multivariate analysis of variance (MANOVA) model optimised for prediction of VAS-F (primary outcome) and FSS scores. Overall, 672 IBD patients (55.6%) reported significant fatigue compared to 145 (35%) controls (OR 2.71; 95% CI 2.08-3.54; P<0.001). In IBD, fatigue also significantly affected daily activities (FSS≥4; 405 (33.5%) IBD patients vs 81 (19.6%) controls, P<0.001). In the MANOVA model, fatigue levels were associated with female gender (coefficient 0.839; 0.556 - 1.123; P<0.001), younger age at diagnosis (-0.031 per year; -0.042- -0.019; P<0.001), shorter disease duration (-0.036 per year; -0.050- -0.022; P<0.001), nocturnal diarrhoea (0.718; 0.295-1.141; P=0.001), low educational level (P=0.034) and symptoms of depression and anxiety. Fatigue is both more frequent and more severe in patients with IBD than in the general population.

Nurse and patient perspectives on participating in research: experience of an inflammatory bowel disease fatigue study

The challenges, priorities and benefits of running and volunteering in clinical research studies, according to a specialist nurse and patient volunteer in a Nottingham-based study on fatigue in Crohn's disease

Mental Health Factors Associated With Fatigue in Mexican Patients With Inflammatory Bowel Disease.

The aim of this study was to describe mental health factors associated with the development of fatigue in inflammatory bowel disease (IBD) patients. IBD includes ulcerative colitis and Crohn's disease. Patients with chronic diseases can present fatigue differently and qualitatively more severely than those typically represented by healthy populations. This was a cross-sectional study in which 200 Mexican patients were attending the Inflammatory Bowel Disease Clinic at the National Institute of Medical Sciences and Nutrition. All patients answered 3 instruments: the first IBD-fatigue, HADS (Hospital Anxiety and Depression Scale), and PSQI (Pittsburgh Sleep Quality Index). The statistical analysis was carried out in the statistical program SPSS v 24. The percentage of fatigue in our patients was 55.5% (n=111) for mild-moderate fatigue, 31.5% (n=63) for severe fatigue, and only 13% (n=26) had no fatigue. Sleep disturbance and sleep latency were the most important predictors of fatigue in IBD patients. Sleep quality and depression have an impact on fatigue in Mexican patients with IBD. It is important for multidisciplinary management to reduce these symptoms and improve the quality of life of patients with IBD.