Research progress in influencing factors of fatigue symptoms in patients with inflammatory bowel disease_West China Medical Journal

Authors：

QIAN Lin ¹ , LIU Yajun ¹ ,  WU Jing ²

1. Department of Gastroenterology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, P. R. China;
2. Department of Traditional Chinese Medicine, the Affiliated Drum Tower Hospital of Nanjing University Medical College / Institutes of Chinese Medicine, Nanjing University / Drum Tower Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing 210008, P. R. China;

Corresponding author：

WU Jing, Email: wujing@njucm.edu.cn

Keywords：

Inflammatory bowel disease; fatigue; inflammation; psychological disorder; metabolomics

DOI：

10.7507/1002-0179.202303125

Video：

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Abstract Full text Figures/Tables Video References Cited by

Inflammatory bowel disease (IBD) is characterized by recurrent abdominal pain, diarrhea, and mucopurulent bloody stools as its main clinical manifestations. In recent years, its parenteral manifestations have received increasing attention. Fatigue, as one of the extraintestinal manifestations of IBD, affects the quality of life of patients, and results in considerable distress for patients. The influencing factors of fatigue symptoms in IBD patients include inflammation, psychological comorbidities, sleep disorders, anemia, micronutrient deficiency, changes in microbiota, and metabolomics. The pathogenesis is currently unclear and may be related to disorders in tryptophan metabolism. This article will review the influencing factors and pathogenesis of fatigue symptoms in IBD patients, aiming to provide a basis for the prevention and treatment of IBD fatigue.

Citation： QIAN Lin, LIU Yajun, WU Jing. Research progress in influencing factors of fatigue symptoms in patients with inflammatory bowel disease. West China Medical Journal, 2023, 38(11): 1760-1765. doi: 10.7507/1002-0179.202303125 Copy

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1. 中华医学会消化病学分会炎症性肠病学组. 炎症性肠病诊断与治疗的共识意见(2018 年·北京). 中国实用内科杂志, 2018, 38(9): 796-813.
2. 秦有, 庞凤舜, 蔡北源, 等. 慢性疲劳综合征定义及诊断标准的变迁. 中国中西医结合杂志, 2009, 29(10): 946-948.
3. Su Y, Cochrane BB, Yu SY, et al. Fatigue in community-dwelling older adults: a review of definitions, measures, and related factors. Geriatr Nurs, 2022, 43: 266-279.
4. D’Silva A, Fox DE, Nasser Y, et al. Prevalence and risk factors for fatigue in adults with inflammatory bowel disease: a systematic review with meta-analysis. Clin Gastroenterol Hepatol, 2022, 20(5): 995-1009. e7.
5. Borren NZ, van der Woude CJ, Ananthakrishnan AN. Fatigue in IBD: epidemiology, pathophysiology and management. Nat Rev Gastroenterol Hepatol, 2019, 16(4): 247-259.
6. McGing JJ, Radford SJ, Francis ST, et al. Review article: the aetiology of fatigue in inflammatory bowel disease and potential therapeutic management strategies. Aliment Pharmacol Ther, 2021, 54(4): 368-387.
7. Bisgaard TH, Allin KH, Keefer L, et al. Depression and anxiety in inflammatory bowel disease: epidemiology, mechanisms and treatment. Nat Rev Gastroenterol Hepatol, 2022, 19(11): 717-726.
8. Bager P, Hvas CL, Rud CL, et al. Randomised clinical trial: high-dose oral thiamine versus placebo for chronic fatigue in patients with quiescent inflammatory bowel disease. Aliment Pharmacol Ther, 2021, 53(1): 79-86.
9. Jones K, Kimble R, Baker K, et al. Effects of structured exercise programmes on physiological and psychological outcomes in adults with inflammatory bowel disease (IBD): a systematic review and meta-analysis. PLoS One, 2022, 17(12): e0278480.
10. Nguyen TLL, Huynh DTN, Jin Y, et al. Protective effects of ginsenoside-Rg2 and -Rh1 on liver function through inhibiting TAK1 and STAT3-mediated inflammatory activity and Nrf2/ARE-mediated antioxidant signaling pathway. Arch Pharm Res, 2021, 44(2): 241-252.
11. Tasson L, Zingone F, Barberio B, et al. Sarcopenia, severe anxiety and increased C-reactive protein are associated with severe fatigue in patients with inflammatory bowel diseases. Sci Rep, 2021, 11(1): 15251.
12. Thomann AK, Wüstenberg T, Wirbel J, et al. Depression and fatigue in active IBD from a microbiome perspective-a Bayesian approach to faecal metagenomics. BMC Med, 2022, 20(1): 366.
13. 张培培, 张佳佳, 崔鹏, 等. 静止期炎性肠病患者粪便微生物群和 TNF-α及 IL-6 与疲劳感的相关性. 新疆医科大学学报, 2021, 44(2): 220-223.
14. Vogelaar L, de Haar C, Aerts BR, et al. Fatigue in patients with inflammatory bowel disease is associated with distinct differences in immune parameters. Clin Exp Gastroenterol, 2017, 10: 83-90.
15. Villoria A, García V, Dosal A, et al. Fatigue in out-patients with inflammatory bowel disease: prevalence and predictive factors. PLoS One, 2017, 12(7): e0181435.
16. Borren NZ, Plichta D, Joshi AD, et al. Alterations in fecal microbiomes and serum metabolomes of fatigued patients with quiescent inflammatory bowel diseases. Clin Gastroenterol Hepatol, 2021, 19(3): 519-527. e5.
17. Bourgonje AR, Wichers SJ, Hu S, et al. Proteomic analyses do not reveal subclinical inflammation in fatigued patients with clinically quiescent inflammatory bowel disease. Sci Rep, 2022, 12(1): 14581.
18. Miaskowski C. Future directions in symptom cluster research. Semin Oncol Nurs, 2016, 32(4): 405-415.
19. Emerson C, Barhoun P, Olive L, et al. A systematic review of psychological treatments to manage fatigue in patients with inflammatory bowel disease. J Psychosom Res, 2021, 147: 110524.
20. Lee HH, Gweon TG, Kang SG, et al. Assessment of fatigue and associated factors in patients with inflammatory bowel disease: a questionnaire-based study. J Clin Med, 2023, 12(9): 3116.
21. 李仲贤, 符文彬, 张嘉谕, 等. 整合针灸疗法对慢性疲劳综合征患者抑郁及焦虑状态的影响. 广州中医药大学学报, 2022, 39(5): 1084-1089.
22. Gong SS, Fan YH, Lv B, et al. Fatigue in patients with inflammatory bowel disease in Eastern China. World J Gastroenterol, 2021, 27(11): 1076-1089.
23. Vogelaar L, van't Spijker A, van Tilburg AJ, et al. Determinants of fatigue in Crohn’s disease patients. Eur J Gastroenterol Hepatol, 2013, 25(2): 246-251.
24. 李庆, 刘祥彦, 钟焱. 化疗对乳腺癌患者疲劳、焦虑抑郁和生活质量的影响研究. 医学理论与实践, 2022, 35(8): 1276-1279, 1298.
25. Davis SP, Chen DG, Crane PB, et al. Influencing factors of inflammatory bowel disease-fatigue: a path analysis model. Nurs Res, 2021, 70(4): 256-265.
26. Chrobak AA, Nowakowski J, Zwolińska-Wcisło M, et al. Associations between chronotype, sleep disturbances and seasonality with fatigue and inflammatory bowel disease symptoms. Chronobiol Int, 2018, 35(8): 1142-1152.
27. Chavarría C, Casanova MJ, Chaparro M, et al. Prevalence and factors associated with fatigue in patients with inflammatory bowel disease: a multicentre study. J Crohns Colitis, 2019, 13(8): 996-1002.
28. Graff LA, Vincent N, Walker JR, et al. A population-based study of fatigue and sleep difficulties in inflammatory bowel disease. Inflamm Bowel Dis, 2011, 17(9): 1882-1889.
29. Ranjbaran Z, Keefer L, Farhadi A, et al. Impact of sleep disturbances in inflammatory bowel disease. J Gastroenterol Hepatol, 2007, 22(11): 1748-1753.
30. Amiot A, Chaibi S, Bouhnik Y, et al. Prevalence and determinants of fatigue in patients with ibd: a cross-sectional survey from the GETAID. J Crohns Colitis, 2023, 17(9): 1418-1425.
31. Barnes A, Spizzo P, Bampton P, et al. Examining the influence of inflammatory bowel disease medications on sleep quality. JGH Open, 2023, 7(3): 190-196.
32. Meier-Ewert HK, Ridker PM, Rifai N, et al. Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol, 2004, 43(4): 678-683.
33. Shearer WT, Reuben JM, Mullington JM, et al. Soluble TNF-alpha receptor 1 and IL-6 plasma levels in humans subjected to the sleep deprivation model of spaceflight. J Allergy Clin Immunol, 2001, 107(1): 165-170.
34. Hodges S, Guler S, Sacca V, et al. Associations among acute and chronic musculoskeletal pain, sleep duration, and C-reactive protein (CRP): a cross-sectional study of the UK biobank dataset. Sleep Med, 2023, 101: 393-400.
35. 李华玉, 时萧寒, 张新蕊, 等. 203 例胶质瘤患者睡眠障碍与炎症细胞因子的关联分析. 山东大学学报(医学版), 2022, 60(12): 26-30, 38.
36. 邓介华, 温艳, 林文. 脑卒中并发睡眠障碍患者血清细胞因子及神经递质表达的变化研究. 世界睡眠医学杂志, 2019, 6(3): 269-271.
37. Loveikyte R, Boer M, van der Meulen CN, et al. Anemia and iron deficiency in outpatients with inflammatory bowel disease: ubiquitous yet suboptimally managed. J Clin Med, 2022, 11(22): 6843.
38. Bergamaschi G, Castiglione F, D'Incà R, et al. Prevalence, pathogenesis and management of anemia in inflammatory bowel disease: an IG-IBD multicenter, prospective, and observational study. Inflamm Bowel Dis, 2023, 29(1): 76-84.
39. Jelsness-Jørgensen LP, Bernklev T, Henriksen M, et al. Chronic fatigue is more prevalent in patients with inflammatory bowel disease than in healthy controls. Inflamm Bowel Dis, 2011, 17(7): 1564-1572.
40. Xu F, Hu J, Yang Q, et al. Prevalence and factors associated with fatigue in patients with ulcerative colitis in China: a cross-sectional study. BMC Gastroenterol, 2022, 22(1): 281.
41. Mahadea D, Adamczewska E, Ratajczak AE, et al. Iron deficiency anemia in inflammatory bowel diseases-a narrative review. Nutrients, 2021, 13(11): 4008.
42. König P, Jimenez K, Saletu-Zyhlarz G, et al. Iron deficiency, depression, and fatigue in inflammatory bowel diseases. Z Gastroenterol, 2020, 58(12): 1191-1200.
43. Goldenberg BA, Graff LA, Clara I, et al. Is iron deficiency in the absence of anemia associated with fatigue in inflammatory bowel disease?. Am J Gastroenterol, 2013, 108(9): 1392-1397.
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