Fatigue in patients with inflammatory bowel disease in remission one year after diagnosis (the IBSEN III study)

Kristina A Holten; Tomm Bernklev; Randi Opheim; Bjørn C Olsen; Trond Espen Detlie; Vibeke Strande; Petr Ricanek; Raziye Boyar; May-Bente Bengtson; Tone B Aabrekk; Øyvind Asak; Svein Oskar Frigstad; Vendel A Kristensen; Milada Hagen; Magne Henriksen; Gert Huppertz-Hauss; Marte Lie Høivik; Lars-Petter Jelsness-Jørgensen

doi:10.1093/ecco-jcc/jjae170

Fatigue in patients with inflammatory bowel disease in remission one year after diagnosis (the IBSEN III study)

J Crohns Colitis. 2024 Nov 11:jjae170. doi: 10.1093/ecco-jcc/jjae170. Online ahead of print.

Authors

Kristina A Holten^{1

2}, Tomm Bernklev^{1

3}, Randi Opheim^{4

5}, Bjørn C Olsen^{1

6}, Trond Espen Detlie^{1

7}, Vibeke Strande^{1

8}, Petr Ricanek⁹, Raziye Boyar¹⁰, May-Bente Bengtson¹¹, Tone B Aabrekk^{1

11}, Øyvind Asak¹², Svein Oskar Frigstad¹³, Vendel A Kristensen^{1

5}, Milada Hagen¹⁴, Magne Henriksen², Gert Huppertz-Hauss⁶, Marte Lie Høivik^{1

5}, Lars-Petter Jelsness-Jørgensen^{2

4}

Affiliations

¹ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
² Department of Gastroenterology, Østfold Hospital Trust, Sarpsborg, Norway.
³ Research and Development Department, Vestfold Hospital Trust, Tønsberg, Norway.
⁴ Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
⁵ Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.
⁶ Department of Gastroenterology, Telemark Hospital Trust, Skien, Norway.
⁷ Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway.
⁸ Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway.
⁹ Department of Gastroenterology, Lovisenberg Diaconal Hospital, Oslo, Norway.
¹⁰ Department of Medicine, Diakonhjemmet Hospital, Oslo, Norway.
¹¹ Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway.
¹² Department of Medicine, Innlandet Hospital Trust, Lillehammer, Norway.
¹³ Department of Medicine, Vestre Viken Hospital Trust, Bærum, Norway.
¹⁴ Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.

PMID: 39527064
DOI: 10.1093/ecco-jcc/jjae170

Abstract

Background and aims: Fatigue is commonly observed in Crohn's disease (CD) and ulcerative colitis (UC), but its association to achieving remission is not clearly established. In this study we describe the odds for fatigue in patients with CD/UC one year after diagnosis based on different definitions of remission and identified factors associated with chronic fatigue (CF) among patients in endoscopic/radiological remission.

Methods: Patients ≥18 years with CD/UC were recruited from the IBSEN III cohort. Using the Fatigue Questionnaire, and dichotomizing the score, CF was defined as the presence of substantial fatigue (SF) for ≥6 months. Remission was divided into symptomatic (CD: HBI score<5/UC: SCCAI score<3), biochemical (faecal calprotectin ≤250µg/g), endoscopic/radiological (CD: normal intestinal MRI/CT combined with normal endoscopy/UC: Mayo endoscopic score 0) and histological (normal mucosal biopsies). Both the likelihood of SF/CF, depending on the definition of remission, and associations between CF and selected factors for CD/UC in endoscopic/radiological remission, were evaluated using binary logistic regression analysis.

Results: In total, 711/1416 patients were included. For both CD and UC, symptomatic remission significantly reduced the odds for SF and CF. Additionally, the odds for SF were significantly reduced for UC in biochemical remission. Among those in endoscopic/radiological remission (n=181), CF was independently associated with sleep disturbances (OR=10.40, 95%CI [3.28;32.99], p<0.001) and current treatment with infliximab (OR=4.31, 95%CI [1.15;16.17], p=0.03).

Conclusions: Stricter definitions of disease remission were not associated with a decreased likelihood of fatigue. For patients in endoscopic/radiological remission, CF was independently associated with sleep disturbances and current treatment with infliximab.

Keywords: Inflammatory bowel disease; epidemiology; fatigue.