Sara Horst, MD: Fatigue Among Patients With IBD

In this video, Dr Sara Horst discusses quality of life and effects of fatigue among patients with inflammatory bowel disease.

Sara Horst, MD, is an associate professor of medicine and affiliated with the IBD Clinic at Vanderbilt University in Nashville, Tennessee.

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Transcript:

Hi. I'm Sara Horst. I'm a gastroenterologist at Vanderbilt University Medical Center, and I specialize in the care of patients with inflammatory bowel disease. So today, I got to talk about a very common issue for patients with inflammatory bowel disease, and that's fatigue. And so, in my talk, I focused first on the prevalence of fatigue in patients with inflammatory bowel disease, and it is very common.

In one meta analysis, over almost 50% of patients with inflammatory bowel disease reported significant fatigue. Then we talked about what be the risk factors for patients with IBD to have significant fatigue, and that includes active disease. Females may be more likely to experience significant and chronic fatigue. Things like anxiety and depression can worsen the experience of chronic and severe fatigue, and then, also things like certain medications. So after we talked through the risk factors and who might experience fatigue, I really wanted to focus on the approach for treatment.

And I gave a little bit of bad news, which is there's no one groundbreaking prescription that you can give for patients with inflammatory bowel disease that is going to make fatigue go away. And so we really focused on an algorithmic approach to how how you can best approach this for your patients. And I gave sort of the top 10 checklist things that I do in practice when I'm trying to approach management. And the top is sort of the more I called them easy things to do, things that you might be able to treat a little bit more easily with medications or think about. And then we got into more difficult things, and that includes things where the patient's gonna have more responsibility, and it really includes lifestyle interventions.

So at the top, number one important thing for patients with inflammatory bowel disease is to try to treat active inflammation. We focused and show that things like anti tumor necrosis factor medications and even newer biologics and small molecules can give patients better symptoms and actually relieve fatigue in these patients. So number one, treat active inflammation. The second thing is to make sure that the patient's not on medicines that might be causing this fatigue. So for IBD, that might be azathioprine or methotrexate, but also look at the entire med list and make sure that you have that your patient's not on something like opiates or antianxiety medications or other things that can commonly cause fatigue.

Then we talked about how important it is to make sure and rule out nutritional deficiencies and treat those such as iron deficiency anemia or or B12 deficiency. As you go down the line, then we started to talk about things that can actually help fatigue a lot, but can involve more counseling to the patient and actually have more responsibility for the patient. So making sure that the patient It has good sleep hygiene, that they've talked to their primary care doctor to make sure that they don't have something like sleep apnea or other sleep disorders, that they don't have a they are not experiencing a psychosocial condition or a psychological comorbidity such as anxiety or depression because we know that's more likely to give a larger experience of chronic fatigue for patients. So trying to deal with any psycho psychological comorbidity is really important. Then we talked about diet.

The Dine study showed that patients who did the Mediterranean diet or the STD diet actually had improved quality of life measures, and one of those was fatigue. So even managing diet can help with this. Exercise can be important, and so really focusing on how to talk to your patients about lifestyle intervention. And so I think in summary, we we talked about how fatigue is complex. It's multifactorial and that you really need to think about an algorithm or a checklist that you can go down, with your patient to try to help them manage this chronic condition.

Thank you.

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