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Unmet Needs in IBD: the Case of Fatigue

Clinical Reviews in Allergy & Immunology volume 55, pages 368–378 (2018)Cite this article

Abstract

Fatigue is a highly prevalent but relatively ignored problem in IBD patients. It is one of the most burdensome symptoms to the patient with an important impact on the quality of life. Therefore, fatigue is a highly relevant patient-reported outcome that should be included not only in disease activity measurement but also in the endpoints of clinical trials in IBD. However, most of the currently available scoring systems to quantify fatigue are not specifically designed for patients with IBD and none of them has undergone a complete validation process for IBD-related fatigue. Fatigue is more prevalent in patients with active disease and may improve or disappear when remission is reached. Far more complex is the persistence or onset of fatigue in quiescent IBD which presents in up to 40% of the patients. In this subgroup of patients, fatigue can be related to smoldering systemic inflammation, a poor sleep quality, anemia, nutritional deficiencies, or comorbidities. In most cases, however, no direct cause can be identified. The lack of knowledge on the mechanisms that drive fatigue in IBD hamper the development of specific drugs to treat the condition and only psychological support can be offered to the patient. Rodent models are indispensable to increase our understanding of the molecular pathways that lead to fatigue in chronic intestinal inflammation, and to develop novel therapies.

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Abbreviations

CD:

Crohn’s disease

CIS:

Checklist Individual Strength

EQ-5D:

EuroQol-5D

FACIT-F:

Functional Assessment of Chronic Illness Therapy-Fatigue

HADS:

Hospital Anxiety and Depression Scale

IBD:

Inflammatory bowel disease

IBD-F:

Inflammatory bowel disease fatigue

IBDQ:

Inflammatory Bowel Disease Questionnaire

MAF:

Multidimensional Assessment of Fatigue

MFI:

Multidimensional Fatigue Inventory

RCT:

Randomized clinical trial

TNF:

Tumor necrosis factor

QoL:

Quality of life

UC:

Ulcerative colitis

VAS:

Visual Analog Scale

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Affiliations

  1. Department of Gastroenterology, University of Ghent, De Pintelaan 185, 1K12-IE, 9000, Ghent, Belgium

    Pieter Hindryckx & Debby Laukens

  2. Department of Gastroenterology, Humanitas University, Milan, Italy

    Ferdinando D’Amico & Silvio Danese

  3. Department of Biomedical Sciences, Humanitas University, Milan, Italy

    Silvio Danese

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Correspondence to Pieter Hindryckx.

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Conflict of Interest

Pieter Hindryckx has received consulting fees from Abbvie, Takeda, and Janssen; and speaker’s fees from Ferring, Falk Pharma, Vifor Pharma, Tillotts Pharma, Chiesi, Takeda, and Abbvie.

Debby Laukens reports no conflicts of interest.

Ferdinando D’Amico reports no conflicts of interest.

Silvio Danese has served as a speaker, a consultant, and an advisory board member for Abbvie, Allergan, Biogen, Boehringer Ingelheim, Celgene, Celltrion, Ferring, Hospira, Johnson & Johnson, Merck, MSD, Takeda, Mundipharma, Pfizer, Sandoz, Tigenix, UCB Pharma, and Vifor.

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Hindryckx, P., Laukens, D., D’Amico, F. et al. Unmet Needs in IBD: the Case of Fatigue. Clinic Rev Allerg Immunol 55, 368–378 (2018). https://doi.org/10.1007/s12016-017-8641-4

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  • DOI: https://doi.org/10.1007/s12016-017-8641-4

Keywords

  • Fatigue
  • Inflammatory bowel disease
  • Crohn’s disease
  • Ulcerative colitis