Introduction

Chronic fatigue (CF) is prevalent among patients with ulcerative colitis (UC) and Crohn's disease (CD), but the influence of the disease activity is not established.

Aims & Methods

The primary aim of this study was to evaluate the prevalence and probability of chronic fatigue (CF) in patients with CD and UC one year after diagnosis, stratified by different measures for disease remission (symptomatic, biochemical, endoscopic, and histological). Additionally, we aimed to evaluate factors associated with chronic fatigue among patients in endoscopic/radiological remission.

Patients ≥18 years with CD and UC were recruited from the Inflammatory Bowel Disease South-Eastern Norway (IBSEN III) study, a population-based, observational inception cohort. Fatigue was assessed using Fatigue Questionnaire (FQ), and CF was defined as a dichotomized score of ≥4 with a duration of ≥6 months. Only patients with complete FQ data, without history of colectomy, were eligible for inclusion. Binary logistic regression analyses were used to examine the probability of CF for various indicators of remission, including i) symptomatic remission (Harvey–Bradshaw index score <5 for CD and Simple Clinical Colitis Activity Index score <3 for UC), ii) biochemical remission (Fecal calprotectin ≤ 250 µg/g), iii) endoscopic/radiological remission (Mayo endoscopic score 0 in UC, and endoscopically verified absence of inflammation combined with normal intestinal MRI/CT in CD), and iv) histological remission (normal histology in all mucosal biopsies). Additionally, in patients with endoscopic/radiological remission, associations between CF and selected clinical factors were evaluated using binary logistic regression analysis.

Results

In total, 711/1416 patients with CD or UC diagnosis were included (CD: 33.8%, UC: 66.2%). Among them, 619 (87.1%) underwent colonoscopy, intestinal MRI/CT and/or fecal calprotectin testing. Prevalence of CF stratified by different indicators of remission is presented in table 1. In univariate binary logistic regression analysis regarding measures for disease remission, the probability of CF was only significantly reduced in patients with UC in symptomatic remission (OR: 0.48 (0.30, 0.77), p=0.003). Among patients with CD and UC in endoscopic/radiological remission (n=181), CF was independently associated with current biological treatment (OR: 2.92 (1.002, 8.49), p=0.05) and sleep disturbance (OR: 6.23 (2.03, 19.14), p=0.001) in multivariate logistic regression.

Conclusion

The probability of CF one year after diagnosis was not associated with either low fecal calprotectin level, normal endoscopic/radiological examinations, or normal histology. Among patients with UC, but not CD, symptomatic remission was associated with a reduced probability of CF. For patients in endoscopic/radiological remission, CF was independently associated with sleep disturbances and current biological treatment.

Disclosure

All authors report no conflict of interest.