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P794 Fatigue in inflammatory bowel disease

P. Schreiner*1, J-B. Rossel2, L. Biedermann1, M. Scharl1, J. Zeitz3, P. Frei4, T. Greuter1, S. Vavricka5, V. Pittet6, A. Siebenhüner7, P. Juillerat8, R. von Känel9, G. Rogler1, B. Misselwitz1,8

1University Hospital Zurich, Gastroenterology and Hepatology, Zurich, Switzerland, 2University of Lausanne, Institute of Social and Preventive Medicine, Lausanne, Switzerland, 3Center of Gastroenterology Klinik Hirslanden, Zurich, Switzerland, 4Gastroenterology Bethanien, Zurich, Switzerland, 5Center of Gastroenterology and Hepatology, Zurich, Zurich, Switzerland, 6University of Lausanne, Lausanne, Switzerland, 7University Hospital Zurich, Department of Medical Oncology and Hematology, Zurich, Switzerland, 8Inselspital Bern University Hospital, Department of Visceral Surgery and Medicine, Bern, Switzerland, 9University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Zurich, Switzerland

Background

Fatigue is a common symptom of patients with chronic inflammatory diseases in general - and specifically in inflammatory bowel disease (IBD) - which results in huge impairment on quality of life of individuals. In spite of its frequency only few studies systematically investigated symptom burden and risk factors for fatigue in IBD. We aim to identify the prevalence of fatigue in a large IBD cohort and address physical risk factors, as well as psychological markers associated with fatigue.

Methods

We evaluated 1208 IBD patients from the Swiss Inflammatory Bowel Disease Cohort Study (SIBDCS). Significant fatigue was defined as a visual analogue scale (VAS-F, range 0–10) ≥4 and severe fatigue as a VAS ≥8. Impact of fatigue on daily activities was assessed by the Fatigue Severity Scale with a score > 3 defining relevant impairment. IBD-related factors were assessed through patient and physician questionnaires.

Results

Overall, 672 IBD patients (55.6%) reported fatigue (VAS-F ≥4), whereas only 133 (11%) reported severe fatigue. Fatigue was associated with female gender (women 65.8% vs. men 43.9%, p < 0.001) and initial IBD diagnosis (Crohn’s disease 59.1% vs. ulcerative colitis 51.5%, p = 0.008). Furthermore, patients with fatigue were of younger age (47.7 years vs. 51.4 years, p < 0.001), had a younger age at diagnosis (26.9 vs. 30.4 years, p = 0.001), lower educational level, higher disease activity indices and higher rates of complications, extraintestinal manifestation and intestinal surgery. Furthermore, patients suffering from fatigue had significantly higher indices for anxiety and depression in the Hospital Anxiety and Depression Scale and lower values in quality of life (IBD questionnaire). An impact of fatigue on daily activities was found in 49.5% of patients.

Conclusion

Fatigue is highly frequent in this large IBD cohort and impacts on daily activities. Patients at risk should be asked during outpatient visits about symptoms of fatigue and therapeutic strategies will need to be developed in the future.