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P676 The impact to disease activity, iron and vitamin D deficiency on fatigue in IBD patients

A. Atanassova*1, A. Georgieva1, D. Gerova2, M. Todorova2

1Medical University Varna, Clinic of Hepatogastroenterology, St. Marina University Hospital, Varna, Bulgaria, 2Medical University Varna, Department of General Medicine and Clinical Laboratory, Varna, Bulgaria

Background

Individuals with inflammatory bowel disease (IBD) and are at risk for a variety deficiencies because of decreased nutrient intake or absorption and/or increased losses. Iron and vitamin D deficiency are common in IBD patients, particularly during periods of prolonged disease activity. They are associated with adverse clinical outcomes and a reduced quality of life.

Methods

The aim of the current study is to evaluate the correlation between serum 25(OH)D concentrations and serum iron concentrations, in patients with ulcerative colitis (UC) or Crohn’s disease (CD), and their effect on the quality of life, more specifically on fatigue. In 79 consecutive patients with confirmed IBD diagnosis, 51 with CD and 28 with UC, who attended the gastroenterology clinic during a 1-year period 25(OH)D, serum iron concentrations were measured. In all of the patients the prevalence of fatigue was assessed though the IBDQ and SF36 questionnaires for evaluation of the quality of life. For the quantitative determination of total 25-hydroxyvitamin D [25(OH) vitamin D] levels we used a commercial paramagnetic particle chemiluminescent immunoassay. Serum 25(OH)D ≤ 10 50 nmol/l was considered a VitD deficiency and 50 ≤25(OH)D < 75 nmol/l a VitD insufficiency.

Results

There is a poor correlation between fatigue and the 25(OH)D concentrations, r = 0.204 p < 0.05. In IBD patients with Vitamin D deficiency SF 36-Energy/Fatigue (SF 36 E/F) is 48.43, which is significantly lower than SF 36 E/F in patients with normal Vitamin D- 65.63 concentrations, р < 0.05. There is a poor correlation between the measured concentrations of serum iron and the prevalence of fatigue r = 0.218 p < 0.05, in low serum iron concentrations SF36 E/F – 46.69, and in normal serum iron concentrations – 53.12. There is a significant difference between fatigue levels in different IBD activity р < 0.001, as follows: in remission SF36 E/F is 59.12; in mild activity SF36 E/F is 55.71; in moderate activity SF36 E/F is 42.08; in severe activity SF36 E/F is 30.68. We established a moderate direct correlation between fatigue and IBD activity r = 0.402 p < 0.001. In IBDQ levels ˃170, SF 36 E/F is 67.82, whereas in IBDQ < 170 SF 36 E/F is 41.94 p < 0.001. There is a strong direct correlation between the total IBDQ score and SF 36 E/F r = 0.695 p < 0.001. It can be said that 46.90% of the measured quality of life via IBDQ depends on the level of fatigue.

Conclusion

The low levels of serum iron and Vitamin D have no effect on fatigue in IBD patients, unlike the activity of the disease, with which we have established a strong direct correlation.