GASTROENTEROLOGY
Inflammatory bowel disease – focus on chronic fatigue
The nature of IBD being typically a young person's disease may lead to an underestimation of fatigue in a young cohort
November 4, 2016
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Inflammatory bowel disease (IBD) is a chronic condition that affects approximately 20,000 people in Ireland. It is the umbrella term for ulcerative colitis and Crohn’s disease.
IBD is a chronic, relapsing and unpredictable condition that typically affects an age group of 15 to 35-year-olds. It is a condition with periods of being very well to periods of repeated flare-ups. There is no cure and treatment varies from person to person. Treatments have improved considerably for patients diagnosed with IBD over the past 10 years but chronic conditions and the related symptoms can be difficult to come to terms with.
Chronic fatigue
Fatigue is a problem associated with chronic conditions1,2,3 and may be underestimated in young people with IBD. Farrell and Savage highlight that the symptoms are a complex phenomenon that have adverse effects on an individual’s life.4
There is a lack of clarity on the terminology used in relation to IBD and fatigue2 and multiple definitions of fatigue exist.2,5 Put simply, fatigue is also called exhaustion, tiredness or lethargy and a feeling of lack of energy and motivation that can be physical or mental or both. Many features of chronic conditions contribute to fatigue, including muscle weakness, pain, anxiety and disturbed sleep.6
Chronic fatigue is a common symptom of chronic conditions2 and has a major impact on quality of life and the ability to function.6 It is a problem for patients because of the duration and its impact on quality of life. Fatigue, which is a common concern for IBD patients, is managed inadequately in Ireland.1,6
The very nature of IBD being typically a younger person’s condition, may lead to an underestimation of fatigue in this cohort.
Objectives
While studying fatigue and IBD, three objectives were identified:
• To assess fatigue in patients diagnosed with IBD related to relapse or remission status
• To assess symptom reporting of fatigue by healthcare professionals
• To raise awareness and provide a patient information leaflet.
Fatigue severity scale
Fatigue is subjective and difficult to measure. Until recently, fatigue has not been measured routinely in many conditions. Various measures of fatigue are available7 but are not specific to IBD at the time of this study.
The ‘fatigue severity scale’ (see Figure 1) designed by Krupp8 in 1989 was chosen as the scale of choice. It is a reliable and validated score designed to assess disabling fatigue in all individuals and to look at the connection between fatigue intensity and functional disability.9 It is easy to administer and can be completed quickly.