Fatigue is highly prevalent in inflammatory bowel disease (IBD) and is associated with poor quality of life, often persisting despite improvement in mucosal disease. This clinical primer aims to provide an overview of IBD-related fatigue and its management, particularly for clinicians who lack access to a broad multidisciplinary team. We discuss the clinical presentation and epidemiology of IBD-related fatigue and potential underlying mechanisms, such as nutritional deficiencies and dysfunction of the gut-brain axis. We outline key screening tools, which can be easily used to identify severe fatigue, such as the IBD Fatigue Assessment Scale. We then outline a treatment algorithm for IBD-related fatigue, encompassing (1) identification of severe fatigue and appropriate screening tools; (2) addressing overt inflammatory, nutritional and other biomedical causes; (3) patient-led management of activity levels, including avoidance of ‘all-or-nothing’ behaviour and strategies to improve sleep hygiene and increase drivers of sleep; (4) medical management of sleep difficulties that have persisted despite non-pharmacological strategies and (5) using alerting medications such as modafinil and low-dose aripiprazole in refractory cases. We outline practical considerations in prescribing modafinil, including its dosing, common side effects and groups in whom caution is needed. We then discuss reassessment following treatment response or non-response. Finally, we outline key unmet needs for IBD-related fatigue research, such as better understanding of the clinical phenotype of fatigue, its underlying mechanisms and suggestions for novel interventional studies.
Danso et al. (Tue,) studied this question.