Fatigue in inflammatory bowel disease: Prevalence, risk factors, assessment, outcomes, and management

Fatigue is a prevalent and often debilitating symptom in individuals with inflammatory bowel disease (IBD), affecting a substantial proportion of patients, even during periods of disease remission. The prevalence of fatigue in IBD remains high, affecting around half of the IBD patients and being more common in patients with active disease than those in remission. Several risk factors contribute to fatigue in IBD, including active disease and pro-inflammatory state, nutritional deficiencies and anemia, sleep disturbances, psychological comorbidities, microbiota changes and the gut-brain axis, muscle dysfunction, sarcopenia, and physical inactivity. Assessing fatigue in IBD is challenging due to its subjective nature and the lack of a uniformly quantifiable method. Fatigue significantly impacts the quality of life, affecting physical functioning, psychological and emotional well-being, and social and relational consequences. The management of fatigue in IBD requires a comprehensive, multidisciplinary approach. This includes addressing disease activity through conventional drug treatment, biologicals and small molecules, and surgical treatment. Psychological interventions such as cognitive behavioral therapy, problem-solving therapy, solution-focused therapy, mindfulness-based cognitive therapy, and brief behavioral therapy have shown promise in improving fatigue. Nutritional interventions, including treating deficiencies and supplementation, and lifestyle interventions, such as physical exercise, aromatherapy, and sleep interventions, are also important components of fatigue management. Pharmacological interventions like modafinil and bupropion may be considered in refractory cases. This review aims to summarize the current evidence on fatigue in IBD, including its prevalence, risk factors, assessment methods, outcomes, and management strategies.