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Fatigue in pediatric inflammatory bowel diseases: A systematic review and a single center experience
Shira T Turner1, Gili Focht2, Esther Orlanski-Meyer2
1Department of Psychology, Ben Gurion University of the Negev, Beersheba, Israel.
Insights
Fatigue is common in pediatric inflammatory bowel diseases (PIBD), affecting most children with active disease and even some in remission. Current measurement tools are limited, highlighting a need for PIBD-specific assessments.
Area of Science:
- Gastroenterology
- Pediatrics
- Inflammatory Bowel Disease Research
Background:
- Fatigue is a significant and often debilitating symptom in pediatric inflammatory bowel diseases (PIBD).
- Existing literature on fatigue in PIBD is limited, with a lack of specific measurement tools.
- Understanding the prevalence and impact of fatigue is crucial for improving patient care and quality of life.
Approach:
- A systematic literature review was conducted to assess existing research on fatigue in PIBD.
- A prospectively maintained inception cohort of PIBD patients was analyzed using the IMPACT-III questionnaire.
- Fatigue scores from 80 PIBD patients were compared to 44 healthy controls at 4 and 12 months post-diagnosis.
Key Points:
- The systematic review identified only 14 studies, with just two providing fatigue rates and none offering a PIBD-specific fatigue index.
- In the inception cohort, 78% of children reported at least mild fatigue (score ≤75), 33% moderate fatigue (score ≤50), and 11% severe fatigue (score ≤25).
- Children with active PIBD (92%) reported fatigue more frequently than those in clinical remission (63%), though fatigue was present in both groups.
Conclusions:
- There is a scarcity of literature and no dedicated measurement tools for fatigue in PIBD.
- Fatigue is highly prevalent in children with PIBD, impacting a significant majority, including those in remission.
- Further research is needed to develop and validate PIBD-specific instruments for fatigue assessment.
Objectives:
We aimed to review the literature on fatigue in pediatric inflammatory bowel diseases (PIBD), to explore how it is measured, and approximate its rate in an inception pediatric cohort.
Methods:
Studies on fatigue were systematically reviewed and selected by two authors. Next, we retrieved the two fatigue-related questions of the IMPACT-III questionnaire at 4 and 12 months after diagnosis from a prospectively maintained cohort of PIBD patients, each scoring 0-100 (lower scores imply more fatigue), and 44 healthy controls.
Results:
The systematic review identified 14 studies reporting fatigue in children, of which nine had fatigue as the primary outcome and only two provided rates of fatigue. No standalone index was identified for measuring fatigue specifically for PIBD. Of 80 children included in the inception cohort, 62 (78%) scored an average of ≤75 on the two IMPACT-III questions (approximating at least mild fatigue), 26 (33%) scored ≤50 (at least moderate fatigue) and nine (11%) scored ≤25 (severe fatigue). In comparison, only four (9%) healthy children scored at least moderate fatigue (p = 0.007). Fatigue rates at 12 months were only slightly and nonsignificantly lower. Fatigue of any severity was reported in 92% children with active disease versus 63% of those in clinical remission (p = 0.01).
Conclusion:
Literature reporting on fatigue in PIBD is scarce, and no PIBD-specific tool is available to measure fatigue. In our cohort, fatigue-related questions were frequently scored low in children with IBD, mainly among children with active disease but also during clinical remission.
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