Abstract Background Persistent fatigue is one of the most disabling symptoms reported by patients with inflammatory bowel disease (IBD), even during clinical remission. The relationship between subclinical endoscopic inflammation and fatigue remains poorly defined, particularly in resource-limited settings where endoscopic reassessment is not systematically performed. Aim To assess the impact of endoscopic activity on fatigue severity and quality of life among IBD patients in clinical remission. Methods A prospective observational study was conducted at Mohammed VI University Hospital in Marrakech between February and September 2025. Patients with Crohn’s disease or ulcerative colitis in clinical remission (CDAI 150 or partial Mayo 2) who underwent colonoscopy for disease monitoring were included. Endoscopic activity was evaluated using SES-CD (Crohn’s) and Mayo endoscopic subscore (UC). Fatigue was assessed using the Fatigue Severity Scale (FSS), and quality of life using the Inflammatory Bowel Disease Questionnaire (IBD-Q). Correlations were analyzed using Spearman coefficients, and multivariate regression identified independent predictors of fatigue. Results Eighty-six patients were included (Crohn’s disease = 49, ulcerative colitis = 37). Despite clinical remission, 36 % showed residual endoscopic activity (SES-CD ≥ 3 or Mayo endo ≥ 1). Patients with endoscopic activity had significantly higher fatigue scores (FSS = 4.9 ± 1.1 vs 3.8 ± 0.9; p 0.001) and lower quality of life (IBD-Q = 152 ± 27 vs 178 ± 25; p 0.001). Fatigue correlated strongly with endoscopic scores (r = 0.56; p 0.001) and inversely with IBD-Q (r = –0.61; p 0.001). In multivariate analysis, endoscopic activity (β = 0.43; p = 0.002) and female sex (β = 0.27; p = 0.028) were independent predictors of fatigue. Conclusion Subclinical endoscopic inflammation significantly contributes to fatigue and reduced quality of life in IBD patients in clinical remission.Endoscopic healing should be considered a key therapeutic goal not only for mucosal outcomes but also for patient-reported well-being. Conflict of interest: Dr. Aouroud, Hala: No conflict of interest Aouroud, Meryem: No conflict of interest Nacir, Oussama: No conflict of interest lairani, fatima ezzahra: No conflict of interest ait errami, adil: No conflict of interest Oubaha, Sofia: No conflict of interest Samlani, Zouhour: No conflict of interest Krati, Khadija: No conflict of interest
Aouroud et al. (2026) studied this question.