Opinion Review
Copyright ©The Author(s) 2019.
World J Gastroenterol. Jul 28, 2019; 25(28): 3669-3683
Published online Jul 28, 2019. doi: 10.3748/wjg.v25.i28.3669
Table 1 Summary of recently published reviews specifically on fatigue in liver disease
Article title
Fatigue in chronic liver disease: New insights and therapeutic approaches[3]
Fatigue complicating chronic liver disease[95]
Depression, fatigue and neurocognitive deficits in chronic hepatitis C[96]
Patient-Reported outcomes and fatigue in patients with chronic hepatitis C infection[21]
Future directions for investigation of fatigue in chronic hepatitis C viral infection[97]
Fatigue, depression and chronic hepatitis C infection[98]
Fatigue in cholestatic liver disease-a perplexing symptom[99]
Fatigue in liver disease: Pathophysiology and clinical management[11]
Understanding and treating fatigue in primary biliary cirrhosis (cholangitis) and primary sclerosing cholangitis[19]
Liver-brain interactions in inflammatory liver diseases: implications for fatigue and mood disorders[30]
Fatigue in primary biliary cirrhosis (cholangitis)[100]
Complications, symptoms, quality of life and pregnancy in cholestatic liver disease[101]
Fatigue in primary biliary cirrhosis (cholangitis)[102]
Table 2 Commonly used measures of fatigue
Type of assessmentDomain(s) assessedLengthUsed in liver disease?
Fatigue assessment scale[103]5-point Likert scaleSeverity10 itemsRarely
Fatigue severity scale[104]7-point Likert scaleSeverity, Impact9 itemsOften
Fatigue impact scale[105]5-point Likert scalePhysical, Cognitive, Psychosocial40 itemsSometimes
Fatigue scale[106]4-point Likert scalePhysical, Mental11 itemsRarely
Multidimensional Assessment of Fatigue[107]Visual analog scaleSeverity, Distress, Impact on Activities14 itemsRarely
Multidimensional fatigue inventory[108]5-point Likert scaleGeneral, Physical, Activity, Motivation, Mental20 itemsSometimes
Visual analog fatigue scale[109]Visual analog scaleEnergy, Fatigue18 itemsRarely
Functional assessment of chronic illness therapy fatigue scale[110]5-point Likert scaleSeverity, Impact13 itemsOften
Sf-36 vitality scale[111]5-point Likert scaleEnergy4 itemsOften
Chronic liver disease questionnaire fatigue scale[112]7-point Likert scaleEnergy5 itemsOften
PROMIS®-fatigue[113]5-point Likert scaleSeverityVariable1Rarely
Table 3 Fatigue symptoms for diagnosing pathological fatigue
The symptoms must have been present every (or nearly every) day over a 2-wk period during the past month
NecessarySignificant fatigue
Diminished energy
Increased need to rest disproportionate to level of activity
At least five of these symptoms must be presentExperience of limb heaviness of generalized weakness
Diminished concentration or attention
Decreased motivation or interest to engage in usual activities
Insomnia or hypersomnia
Experience sleep as unrefreshing or non-restorative
Perceived need to struggle to overcome inactivity
Marked emotional reactivity to feeling fatigued
Perceived problems with short term memory
Post-exertional malaise for several hours
Table 4 Established associations among physical findings, diagnoses and fatigue
Adrenal insufficiency
Auto-immune diseases
CancerEspecially in breast, pancreatic, pulmonary
Cardiac failure
Electrolyte imbalance
MedicationAnti-emetics, anti-histamines, anxiolytics, chemotherapy, opioids, radiation, sedatives
PulmonaryChronic obstructive pulmonary disease, cystic fibrosis
Renal failure
StressPhysiological, hypercortisolism
Symptoms ContributingDepressive symptoms, insomnia, pain
Syndromes of unknown etiologyLyme disease, chronic fatigue syndrome
Vitamin deficiencyEspecially B complex