P0408Fatigue beyond remission: a multicenter study in IBD patients

Abstract Background Fatigue is a common, disabling, under-recognized symptom in inflammatory bowel disease (IBD), even during sustained clinical and mucosal remission. Disease–symptom discordance, with symptoms persisting despite healing, is increasingly acknowledged. This study aimed to identify predictors and patterns of fatigue in IBD remission. Methods We conducted a multicenter, cross-sectional study including 295 adult patients with IBD,46.4% with Crohn’s disease (CD) and 50.7% with ulcerative colitis(UC), from two Italian referral centers. All were in sustained deep remission, defined as a Harvey–Bradshaw Index (HBI) ≤4 for CD or Simple Clinical Colitis Activity Index (SCCAI) ≤2 for UC, with normal endoscopy and histology for≥12 months. Data collection included clinical characteristics, laboratory parameters (hemoglobin, ferritin, transferrin, iron), nutritional markers (vitamin B12, folate, vitamin D), and inflammatory biomarkers (C-reactive protein CRP, fecal calprotectin). Patient-reported outcomes (PROs) included the Functional Assessment of Chronic Illness Therapy–Fatigue scale (FACIT-F),Hospital Anxiety and Depression Scale(HADS), and IBD Disk,a visual tool assessing disability.FACIT-F subdomains explored physical and mental fatigue.Univariate analysis explored associations with fatigue severity. Multivariate regression identified independent predictors among psychological distress(HADS), quality of life (IBD Disk), and biological parameters. A simple composite fatigue risk score was developed using HADS and IBD Disk thresholds. Results Fatigue was reported by 30% of patients (n = 89). Iron deficiency was present in 35%, anemia in 24%, folate deficiency in 7.8%, and vitamin B12 deficiency in 10%, and vitamin D deficiency in 12% with higher rates among Crohn’s disease patients. CRP was elevated in 6% and fecal calprotectin in 9%.Psychological distress (HADS ≥8) was found in 30%, and 35% reported impaired quality of life (IBD Disk). Fatigue was more prevalent in patients with ileocolonic Crohn’s disease, complicated behavior, or prior surgery. Extraintestinal manifestations (25%) were significantly associated with higher fatigue scores (mean FAS 1.24 vs. 0.92, p=0.03). Mental fatigue was strongly associated with HADS, while physical fatigue correlated weakly with hemoglobin. Multivariate analysis identified HADS (p0.01) and IBD Disk (p0.05) as independent predictors. A composite model using HADS ≥8 and IBD Disk ≥2.5 was associated with fatigue(OR 3.9, 95% CI 1.5–9.8, p0.01). Conclusion Fatigue is common in IBD patients in deep remission and mostly independent of inflammation. Psychological distress and poor quality of life are key drivers. A composite score may help identify high-risk patients and guide personalized fatigue management. Conflict of interest: Dr. Palmisano, Chiara Maria: No conflict of interest Contaldo, Antonella: No conflict of interest Puzziferri, Vincenzo: No conflict of interest Principi, Maria Beatrice: No conflict of interest