Sara Horst, MD, Reviews Fatigue and IBD

Even though it is common in overall population, affecting nearly 31% of adult Americans, the concept of fatigue is still poorly understood with many different underlying etiologies, Sara Horst, MD, said at the Advances in Inflammatory Bowel Disease annual meeting in Orlando, Florida, on December 14.

Dr Horst is an associate professor of medicine at the Vanderbilt University Medical Center in Nashville, Tennessee.

Dr Horst defined fatigue as “a persistent, overwhelming sense of tiredness, weakness or exhaustion, resulting in a decreased capacity for physical and/or mental work and is typically unrelieved by adequate sleep or rest.”

Fatigue can correlate with inflammation, but it can persist with inflammatory remission. It can be caused by a multitude of reasons—anemia, nutrition, psychological comorbidities, and/or lifestyle.

Citing sleep disturbance as the main risk factor for fatigue, Dr Horst said that patients with active disease battle with it more than those with inactive disease. However, patients with inactive disease may also experience the burden of fatigue. From a cohort of 2427 patients with IBD, 74% reported fatigue at baseline. Only 31% reported active disease.

The single most important step in a patient workup for fatigue, Dr Horst said, is to acknowledge the problem. She laid out a 10-step plan for evaluating and treating fatigue:

1. Evaluate for inflammation and treat active IBD.
2. Rule out medications that can cause fatigue as a side effect, such as methotrexate, antihistamines, antidepressants, antipsychotics, muscle relaxants, sedatives, and antinausea medications.
3. Look into possible medications that can help patients improve sleep, such as melatonin, magnesium (200-400 mg daily) and high-dose thiamine.
4. Eliminate nutritional deficiencies, anemia, and vitamin B12 deficiencies, which could be causing fatigue.
5. Patients with IBD often suffer from psychological comorbidities such as depression and anxiety. Evaluating and treating these underlying conditions may help fatigue.
6. Check for sleep disorders. About 10% of adults suffer from insomnia; 14% of men and 6% of women suffer from obstructive sleep apnea, and roughly 10% of adults suffer from restless legs syndrome.
7. Advise patients to improve sleep hygiene, by reducing naps at odd times, keeping consistent sleep and wake-up schedules, avoiding caffeine and alcohol, and not using electronics before bedtime.
8. Improve diet by switching to Mediterranean diet or a specific carbohydrate diet and increasing healthy food and cutting down on “junk”.
9. Including exercise in the daily routine, which helps boost immune response and reduce proinflammatory cytokines.
10. Overall lifestyle interventions could help —a health coach, healthy food recipes, positive feedback, smoking cessation, and consultation with dieticians or mental health providers.

“Sleep, stress, movement, and relationships are all the building blocks toward helping patients with fatigue and IBD,” Dr Horst concluded.

Reference:
Horst S. Common complications in IBD: Fatigue in patients with IBD. Presented at: Advances in Inflammatory Bowel Disease Annual Meeting; December 14, 2023. Orlando, Florida.