A significant percentage of patients with an inflammatory bowel disease (IBD) encounter fatigue which can profoundly diminish patients' quality of life, particularly during periods of disease remission when gastrointestinal symptoms have receded. Various contributing risk factors have been identified including active inflammation, anemia, psychological, lifestyle and drug-related factors. While addressing these risk factors has been suggested as the initial approach to managing fatigue, a considerable number of patients still experience persisting symptoms, the primary causes of which remain incompletely understood. Recent insights suggest that dysfunction of the gut-brain axis may play a pathogenic role. This review provides an overview of established risk factors for fatigue, alongside emerging perspectives on the role of the gut-brain axis, and potential treatment strategies. 

Unraveling the fatigue puzzle: insights into the pathogenesis and management of IBD-related fatigue including the role of the gut-brain axis


 
 
 Fatigue is a frequent symptom among patients with inflammatory bowel disease (IBD). While the recent STRIDE II international guidelines consider disability-free and normal quality of life as therapeutic targets, the degree of endoscopic healing required to limit fatigue is unknown. The aim of this study was to investigate the prevalence of fatigue and its determinants in a cohort of IBD patients with endoscopic healing.
 
 
 
 We conducted a single-center cross-sectional study between January 2019 and June 2023. All consecutive IBD patients with endoscopic healing Crohn's disease (CD, CDEIS <4) and ulcerative colitis (UC, Mayo ≤ 1) were assessed for disability (IBD-disk) the day of the colonoscopy. Fatigue and severe fatigue were defined by an IBD-Disk energy subscore >5 and >7, respectively.
 
 
 
 166 patients were included, of whom 64% (107/166) had CD. The majority of patients were treated with anti-TNF (91/166, 55%), half of them in combination therapy (44/166). The prevalence of fatigue and severe fatigue were 39% (65/166) and 23.5% (39/166) respectively, with no significant difference between CD and UC (p=0.59). The prevalence of fatigue in patient with partial endoscopic healing (Mayo 1 and CDEIS>0 and <4)) and with complete healing (Mayo 0, CDEIS 0) was 44.4% (24/54) and 36.6% (41/112) p =0.424.In multivariate analysis, factors associated with fatigue were female gender (OR=4.2, [1.1; 16.5], p= 0.040), presence of joint pain (OR=4.36, [1.0; 18.2], p= 0.04), sleep disturbance (OR =26.2, [5.5; 124.4], p <0.0001). Younger age (OR=0.95, [0.9; 0.99], p= 0.023) was associated with a significantly lower risk of fatigue. In multivariate analysis, severe fatigue was associated with female gender (OR=3.2, [1.1; 9.2], p= 0.026), the presence of joint pain (OR=2.9, [1.1; 8.1], p= 0.037) or sleep disorders (OR =11.3, [3.6; 35.9], p <0.0001).
 
 
 
 One third of IBD patients with endoscopic healing suffer from fatigue. Female gender, arthralgia and especially sleep disorders are risk factors for fatigue. These results argue in favor of a holistic management of IBD patients.


P360 Prevalence and risk factors for fatigue in patients with inflammatory bowel disease and endoscopic healing

/pdf/p130-intestinal-ultrasound-combined-to-fecal-calprotectin-is-t38s6qm9.pdf

P130 Intestinal ultrasound combined to fecal calprotectin is effective to predict endoscopic mucosal healing in ulcerative colitis: a cross-sectional study


 
 
 Endoscopic and histological healing are associated with improved long term outcomes in ulcerative colitis (UC). Considering all the limitations of endoscopy, we aimed to compare the performance of complete colonoscopy, rectosigmoidoscopy (RS) and rectoscopy to assess endoscopic and histological healing in UC.
 
 
 
 Between January 2021 and January 2023, all consecutive UC patients who underwent complete colonoscopy were prospectively included. Endoscopic activity was assessed by the Mayo Endoscopic Score (MES) on the 5 colonic segment. Endoscopic healing was defined by a MES=0 on all explored segments and histological healing was defined by a NANCY score ≤ 1 (2 biopsies/segments). The correlation between colonoscopy, RS and rectoscopy in terms of endoscopic and histological mucosal was assessed using Cohen's kappa coefficient.
 
 
 
 80 patients were included. Thirty-four patients had a MES=0 on all the 5 colonic segments. The correlation between the colonoscopy and RS was almost perfect with an index к of 0.949 for Mayo 0, and к of 0.945 for Mayo 0-1. The correlation between histological healing in RS and colonoscopy was almost perfect (к=0.877, p<0.001). Additionally, the correlation between rectoscopy and colonoscopy for the evaluation of endoscopic[mf1] and histological healing was almost perfect (к=0.826 (p < 0.001) and к=0.8 (p < 0.001), respectively).
 
 
 
 RS is sufficient to assess both endoscopic healing and histological healing in UC. With a false negative rate < 10%, rectoscopy is effective to assess endoscopic and histologic healing in UC.


P318 Performance of rectosigmoidoscopy and rectoscopy to assess endoscopic and histological healing in ulcerative colitis

Rectal and Rectosigmoid Endoscopy to Assess Endoscopic and Histological Remission in Ulcerative Colitis: A Prospective Study.


 
 
 Ulcerative colitis (UC) is a major cause of disability, affecting physical, emotional and social well-being. The recent STRIDE II international guidelines consider disability-free and normal quality of life as therapeutic targets. Today, the degree of mucosal healing required to reduce disability, incontinence and bowel urgencies is poorly known.
 
 
 
 We conducted a single-center cross-sectional study between January 2021 and June 2023. All consecutive patients with UC and endoscopic healing (Mayo ≤ 1) underwent IBD-disk disability assessment the day of the colonoscopy. Histological healing was defined as Nancy score 0 or 1 (2 biopsies per segment from rectum to right colon). Moderate to severe disability was defined as an overall score ≥ 40. Incontinence was defined by a Wexner score >5 and bowel urgency by an NRS urgency score > 1).
 
 
 
 A total of 57 patients were included, with 34 (59.6%) women. Median age and disease duration were 47.4 (interquartile range [IQR] [43.5; 51.2]) and 13.0 years (IQR, 13.1-18.4), respectively. 37/57 (65%) patients had complete endoscopic healing Mayo 0 and 43/54 (80%) histological healing. The median overall IBD-Disk score was 29 [25.5; 37.5] and 27 (47%) had moderate to severe disability. There were no differences in terms of age, gender, body mass index, smoking status, disease extension and treatment for the 3 groups Mayo 1, Mayo 0 and histological healing. The rate of moderate to severe disability was not different among patients with Mayo 0 (7/20, 35%) vs. Mayo 1 (20/37, 54%) patients (p=0.26), or in patients with (22/43, 51%) or without histological healing (4/11,36%) (p =0.51). Of the 35 patients assessed, bowel urgency were reported in 11 (31.4%), with no difference between the two definitions of endoscopic healing (p=0.72) or histological healing (p=0.37). Among the 35 patients with a Wexner score evaluation, incontinence was observed in 19% (4/21) and 14% (2/14) of Mayo 0 and Mayo 1 patients respectively (p=0.99), and 24% (6/25) vs. 0% (0/7) of patients with or without histological healing (p=0.3).
 
 
 
 Half of patients with UC who achieved endoscopic healing reported a moderate to severe disability. Mayo 0 (vs. 1) endoscopic healing and histological healing do not appear to provide any short-term benefit in terms of disability, fecal incontinence or bowel urgency.


P231 Impact of the depth of mucosal healing on the burden of ulcerative colitis : a cross-sectional study

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