Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2021; 27(11): 1076-1089
Published online Mar 21, 2021. doi: 10.3748/wjg.v27.i11.1076
Fatigue in patients with inflammatory bowel disease in Eastern China
Shan-Shan Gong, Yi-Hong Fan, Bin Lv, Mie-Qing Zhang, Yi Xu, Jing Zhao
Shan-Shan Gong, Mie-Qing Zhang, Department of Gastroenterology, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310000, Zhejiang Province, China
Shan-Shan Gong, Yi-Hong Fan, Bin Lv, Yi Xu, Jing Zhao, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, Zhejiang Province, China
Author contributions: Gong SS conducted clinical observation, analyzed the data, and wrote the paper; Fan YH participated in the statistical analysis; Lv B and Zhang MQ collected the data; Xu Y conducted literature search and provided valuable suggestions for this study; Zhao J designed the research and revised the paper; all authors have read and approved the finial manuscript.
Supported by The National Natural Science Foundation of China, No. 81473506 and No. 81470814; and Zhejiang TCM Science and Technology Project, No. 2021ZA057, No. 2019ZA056, and No. 2018ZB046.
Institutional review board statement: This study was reviewed and approved by the ethics committee of the First Affiliated Hospital of Zhejiang Chinese Medical University (Approval No. 2020-K-097-01).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jing Zhao, MD, Doctor, Professor, Department of Gastroenterology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Shangcheng District, Hangzhou 310006, Zhejiang Province, China. qiaoxiao_916@163.com
Received: December 28, 2020
Peer-review started: December 28, 2020
First decision: January 9, 2021
Revised: January 14, 2021
Accepted: February 25, 2021
Article in press: February 25, 2021
Published online: March 21, 2021
Abstract
BACKGROUND

Fatigue is a very common but relatively neglected problem in patients with inflammatory bowel disease (IBD). The prevalence rate of IBD in China is the highest in Asia, but there is little research on fatigue in patients with IBD. Neither the relationship between fatigue and quality of life (QoL) nor the relationship between fatigue and work productivity (WP) in Chinese IBD patients has been reported.

AIM

To investigate the prevalence of fatigue related to IBD in Eastern China, to identify the risk factors associated with fatigue, to assess the impact of fatigue on QoL, and to evaluate the relationship between fatigue and WP.

METHODS

A cross-sectional study was conducted in a Regional Tertiary IBD Diagnostic and Treatment Center in Eastern China. Clinical data of patients were collected, and disease activity was evaluated. Blood samples were analyzed to assess anemia, albumin, and inflammation. Fatigue was assessed using the multidimensional fatigue inventory. QoL and WP were measured using the short inflammatory bowel disease questionnaire and the work productivity and activity impairment general health questionnaire, respectively. The patients also completed assessments of depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder 7-item Scale).

RESULTS

A total of 311 IBD patients, comprising 168 Crohn's disease patients and 143 ulcerative colitis patients, were enrolled. The prevalence of fatigue in patients with IBD was 60.77%. In a univariate logistic regression analysis, factors such as disease activity, depression, anxiety, anemia, and IBD-related surgery were individually related to a significantly increased risk of fatigue in IBD patients. Multivariate logistic regression analysis indicated that depression [odds ratio (OR) = 8.078, 95% confidence interval (CI): 4.113-15.865], anxiety (OR = 2.373, 95%CI: 1.100-5.119), anemia (OR = 2.498, 95%CI: 1.290-4.834), and IBD-related surgery (OR = 2.035, 95%CI: 1.084-3.819) were related to fatigue in IBD patients. There was a negative correlation between fatigue and QoL (r = -0.831; P < 0.0001) but a positive correlation between fatigue and WP loss.

CONCLUSION

The prevalence of fatigue in IBD patients in Eastern China is remarkably high even in clinical remission. Factors such as depression, anxiety, anemia, and IBD-related surgery are major risk factors for fatigue in IBD patients. In addition, fatigue has a negative impact on QoL and is positively correlated with WP loss.

Keywords: Inflammatory bowel disease, Fatigue, Quality of life, Work productivity, Risk factors, Eastern China

Core Tip: Fatigue is a highly prevalent and burdensome symptom in patients with inflammatory bowel disease (IBD), with an important impact on quality of life and (indirect) health expenditures. The prevalence rate of IBD in China is the highest in Asia, but there is little research on fatigue in patients with IBD. In addition, the relationships of fatigue with quality of life and work productivity in Chinese IBD patients have not been reported.