FATIGUE IN IBD
Fatigue is an important underecognized clinical problem in patients with IBD and one of the most frequently reported concerns of patients. It affects nearly 50 % of patients in clinical remission and 80% of those with active disease, resulting in a decrease in quality of life and impaired work productivity and functioning.
Fatigue is a debilitating, multidimensional and multifactorial symptom associated with a wide range of chronic illnesses. Within the causes contributing to fatigue in people with IBD appears disease activity, anemia, medications, alterations of the gut-brain axis and micronutrients deficiency.
This leaflet provides information about what fatigue really means, its etiologies and possible solutions and the affectation that fatigue has in the quality of life of IBD patients.
FATIGUE VERSUS TIREDNES
Fatigue and tiredness are often thought of as meaning the same thing and are frequently used interchangeably. But being tired is different as being fatigued and the difference matters a lot.
Medically speaking, tiredness is an expected feeling that happens to everyone after certain activities or at the end of the day and that can be solved with a good night’s sleep.
On the other hand, fatigue is a burdensome symptom that implies lack of energy or exhaustion out of proportion to physical exertion. Fatigue limits the daily activities and it is never relieved by rest.
WHAT CAUSES FATIGUE?
There are different factors that, together or separately, are to consider that could be affecting our energy levels and developing fatigue:
- Disease activity -Inflammation
IBD causes inflammation in the digestive track. Inflammation puts body under stress because it has to fight this inflammation what requires to spend more energy to work and, therefore, makes you feel fatigued.
Anemia is an important cause of fatigue. It appears when blood is low in red blood cells or hemoglobin. Both carry the necessary oxygen to your tissues. If they are low, blood does not carry enough oxygen and people feel fatigued.
The cause of anemia among IBD patients is most commonly due to iron deficiency anemia followed by anemia of chronic disease. Iron deficiency anemia may be due to chronic gastrointestinal bleeding and decreased nutritional intake. Anemia of chronic disease can be due to malabsorption of vitamins and minerals , very common in people with IBD. Without iron, folate and vitamin B12 the body is not able to create more red blood cells what is linked to weakness and fatigue.
CAUSES OF ANEMIA
Less common causes
Iron deficiency anemia
Folic acid deficiency
Anemia of chronic disease
B12 vitamin deficiency
- Micronutrients deficiency
A side effect of IBD includes loss of appetite, nausea or diarrhea. These factors lead directly to an insufficient intake of calories or to a poor absorption of nutrients to fuel the body correctly what makes people fatigued. And something similar happens with dietary restrictions that can carry also nutritional deficiencies. A gluten-free diet, for example, can be deficient in calcium, iron or niacin.
Fatigue can be a direct medication-related adverse effect. Although less commonly, some medicines to treat IBD may cause fatigue like corticosteroids, some immunomodulators, asteroids or other drugs. Antidepressants or narcotics are also associated with lethargy and somnolence and therefore fatigue.
- Altered gut microbiome
IBD is associated with decreased gut microbiome diversity. That means a higher intestine wall permeability that allows crossing bacteria to the circulation what can make the immune system react, resulting in inflammation. The more permeability, the more energy the body needs to expend to fight it and, therefore, you feel fatigued.
IMPACT OF FATIGUE ON QUALITY OF LIFE
IBD patients suffer from a disabling disease which greatly affects their quality of life in many aspects:
The ups and downs of the disease make really difficult to plan any social activity. This prevents IBD patients from pursuing an intimate relationship or from making or keeping friends since plans can be ruined depending on the unpredictability of the disease.
Fatigue implies lack of energy or exhaustion what makes very difficult to take part in any physical activity, be it playing sports or going to the supermarket.
The disease activity marks the relationships with your closest. Some of them will be more understanding than others in relation with the disease. In time of fatigue when you require more special attention and needs, family and friends will become your best support and caregivers.
Work and Education
Fatigue plays a crucial role in employment and education, even while the disease is in remission. Fatigue influences negatively the productivity in both areas and leads to higher unemployment and work disability rates in the case of employment.
Students feel that fatigue has a negatively affectation in their ability to perform their full potential what affects directly their job aspirations.
Memory and concentration.
Fatigue affects memory and concentration. Difficulties in concentration, brain fog, clouding of thought, memory lapses…These are some of the feelings of patients of IBD experiencing fatigue. It is a totally incapacitating fact for doing the most basic actions requiring memory and concentration.
HOW TO DEAL WITH FATIGUE
Disease activity - Inflammation
IBD therapy and control of inflammation is associated with an improvement in fatigue. For this reason, patients with symptoms of fatigue may benefit from the physician therapy provided to this purpose.
A basic anemia workout is recommended periodically for patients with active disease and maybe more time spaced for those in remission.
Early and aggressive treatment of iron deficiency with injected or oral iron is recommended to improve IBD outcomes.
Concerning vitamin B12 and folate can be supplemented in case of stores are low.
Testing for and replacing the deficient nutrient and ensuring a nutritionally replete diet will improve symptoms of fatigue.
A routinely review medication lists is necessary in patients with IBD suffering from fatigue. It is also to be considered withdrawing medications that could be associated with fatigue in absence of other more likely explanation.
Altered gut microbiome
Patients with altered microbiome may benefit from the different physician therapies provided to this purpose. Trying to know the cause of the microbiome alteration is essential to carry out an adequate therapy. Hopefully with medication, diet or lifestyle changes patients can recover the gut.
Impaired Quality of Working Life in Inflammatory Bowel Disease Patients. Sara van Gennep, Nanne K. H. de Boer, Marieke E. Gielen, Svend T. Rietdijk, Krisztina B. Gecse, Cyriel Y. Ponsioen, Marjolijn Duijvestein, Geert R. D’Haens, Mark Löwenberg & Angela G. E. M. de Boer
IBD and health-related quality of life — Discovering the true impact. Sanna Lönnfors, Severine Vermeire, Luisa Avedano