P653 Prevalence and factors associated with fatigue in patients with inflammatory bowel disease: a multicentre study
C. Chavarría-Herbozo*1, M. J. Casanova1, M. Barreiro-de Acosta2, M. Chaparro1, E. Ezquiaga1, L. Bujanda3, M. Rivero4, F. Arguelles-Arias5, M.D. Martín-Arranz6, M. P. Martínez-Montiel7, M. Valls8, R. Ferreiro2, J. Llao9, I. Moraleja-Yudego10, F. Casellas11, B. Antolín-Melero12, X. Cortés13, R. Plaza14, J. R. Pineda15, M. Navarro-Llavat16, S. García-López17, P. Robledo-Andrés18, I. Marín-Jiménez19, E. Iglesias-Flores20, O. Merino21, F. Bermejo22, M. R. Arribas-López23, J.M. Banales3, B. Castro4, L. Castro-Laria5, R. Honrubia6, P. Almela8, J. P. Gisbert1
1Hospital Universitario de La Princesa, IIS-IP and CIBERehd, Gastroenterology Unit, Madrid, Spain, 2Hospital Clínico Universitario de Santiago, Gastroenterology Unit, Santiago de Compostela, Spain, 3Hospital de Donostia, Instituto Biodonostia, UPV/EHU and CIBEREHD, Gastroenterology Unit, Guipuzcoa, Spain, 4Hospital Universitario Marqués de Valdecilla, Gastroenterology Unit, Santander, Spain, 5Hospital Universitario Virgen de La Macarena, Gastroenterology Unit, Sevilla, Spain, 6Hospital Universitario La Paz, Gastroenterology Unit, Madrid, Spain, 7Hospital Universitario 12 de Octubre, Gastroenterology Unit, Madrid, Spain, 8Hospital General Universitario de Castellón, Gastroenterology Unit, Castellón, Spain, 9Hospital Sant Joan de Deu, Gastroenterology Unit, Manresa, Spain, 10Hospital Galdakao, Gastroenterology Unit, Vizcaya, Spain, 11Hospital Universitari Vall d’Hebron, Gastroenterology Unit, Barcelona, Spain, 12Hospital Clínico Universitario de Valladolid, Gastroenterology Unit, Valladolid, Spain, 13Hospital de Sagunto, Gastroenterology Unit, Valencia, Spain, 14Hospital Universitario Infanta Leonor, Gastroenterology Unit, Madrid, Spain, 15Hospital Álvaro Cunqueiro, Gastroenterology Unit, Vigo, Spain, 16Hospital de Sant Joan Despí Moisès Broggi, Gastroenterology Unit, Barcelona, Spain, 17Hospital Universitario Miguel Servet, Gastroenterology Unit, Zaragoza, Spain, 18Hospital Universitario San Pedro Alcántara, Gastroenterology Unit, Cáceres, Spain, 19Hospital Gregorio Marañón and IiSGM, Gastroenterology Unit, Madrid, Spain, 20Hospital Universitario Reina Sofía, Gastroenterology Unit, Córdoba, Spain, 21Hospital Universitario de Cruces, Gastroenterology Unit, Bilbao, Spain, 22Hospital Universitario de Fuenlabrada, Gastroenterology Unit, Madrid, Spain, 23Hospital Universitario Infanta Sofía, Gastroenterology Unit, Madrid, Spain
Fatigue is an important problem for inflammatory bowel disease (IBD) patients, and there are several controversial aspects. Aims: to determine the prevalence of fatigue in patients with IBD, to identify the factors associated with fatigue; to assess the effect of fatigue on quality of life; and to evaluate the effect of fatigue on sleep quality.
Prospective multicentre study conducted at 23 Spanish centres. Consecutive Crohn’s disease (CD) and ulcerative colitis patients followed at IBD Units were included. Patients diagnosed with cognitive disorders or psychiatric illness (except anxiety and depression), and chronic diseases in which fatigue is a primary symptom, were excluded. Fatigue was evaluated with the Fatigue Severity Scale (FSS), and the Fatigue Impact Scale (FIS). The quality of life and the sleep quality were assessed using the Inflammatory Bowel Disease Questionnaire-Short Form (IBDQ-9) and the Pittsburgh Sleep Quality Index (PSQI), respectively. The association between the different variables and the presence of fatigue was evaluated by logistic regression analysis.
In total, 402 patients were included (51% women, with mean age 44 years, and 64% CD). Further, 25% of patients had extraintestinal manifestations; 35% had disease activity; 28% had anaemia; and 11% had been treated recently with systemic steroids. The maintenance treatment was 55% 5-ASA, 49% immunomodulators (IMMs), 39% anti-TNF, 19.2% combo therapy (IMMs and anti-TNFs), and 1% none. The prevalence of fatigue was 43% (95% CI = 38%–48%). Patients treated with anti-TNFs or combined therapy had a lower frequency of fatigue (18.2% and 9.2%, respectively). Patients with fatigue had a significantly decreased IBDQ-9 score (p < 0.001) compared with those without fatigue. In the multivariate analysis, anxiety (OR = 1.97, 95% CI = 1.23–3.17), depression (OR = 2.3, 95% CI = 1.38–3.86), and poor sleep quality (OR = 1.7, 95% CI = 1.07–2.75) were the only variables associated with a higher risk of fatigue; however, activity of IBD was not associated with the risk of fatigue.
The prevalence of fatigue in IBD patients is high and is not associated with the disease activity. Fatigue has a negative effect on quality of life. The presence of fatigue is associated with anxiety, depression, and poor sleep quality in patients with IBD, even when the disease is in remission.