Institutional members access full text with Ovid®

Share this article on:

Factors Associated with Physical and Cognitive Fatigue in Patients With Crohn's Disease: A Cross-sectional and Longitudinal Study

van Langenberg, Daniel R. PhD; Gibson, Peter R. MD

doi: 10.1097/01.MIB.0000437614.91258.70
Original Clinical Articles

Background: Fatigue commonly impairs quality of life in patients with Crohn's disease (CD). This study aimed to evaluate the prevalence and severity of fatigue in CD (compared with ulcerative colitis [UC] and healthy controls) and to identify potentially modifiable factors associated with global, physical, and cognitive dimensions of fatigue.

Methods: Clinic attendees with confirmed CD or UC and healthy volunteers were surveyed on fatigue (Fatigue Impact Scale, FIS), psychological comorbidity, sleep quality, medication, and other clinical information. A CD subgroup also completed a similar follow-up survey.

Results: In 379 responders (181 CD, 113 UC, and 85 controls), global, physical, and cognitive FIS scores were highest in CD followed by UC and controls (P < 0.01), with a prevalence of global fatigue (total FIS ≥ 40) in 57% of CD patients. On multivariate analysis, concurrently active disease, poor sleep quality, and mental illness were significantly associated with all the 3 fatigue dimensions: regular vitamin B group supplementation was inversely associated with physical fatigue in the CD cohort and those of older age or with previous resection(s) (P = 0.05) were independently associated with cognitive fatigue only. Longitudinally in CD, fatigue scores remained constant between original and follow-up surveys (mean change in total FIS score +0.9; 95% confidence interval, −4.6 to 6.3). Factors independently associated with improved physical fatigue between surveys included avoidance of corticosteroids and establishment of regular exercise and with improved cognitive fatigue included cessation of immunomodulator therapy.

Conclusions: Fatigue is highly prevalent and more severe in CD. Anticipated and novel associations with improvement of physical and/or cognitive fatigue were identified, offering clues to potential therapeutic approaches to ameliorating fatigue for clinical evaluation.

Article first published online 27 November 2013Supplemental Digital Content is Available in the Text.

Eastern Health Department of Gastroenterology & Hepatology, Eastern Health Clinical School, Monash University.

Reprints: Daniel R. van Langenberg, PhD, Eastern Health Department of Gastroenterology & Hepatology, Eastern Health Clinical School, Monash University, Level 2, 5 Arnold Street, Box Hill, Victoria 3128, Australia (e-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Presented in part at the Australian Gastroenterological Week conference, Brisbane, Australia, October 2011.

The authors have no conflicts of interest to disclose.

Received September 25, 2013

Accepted October 18, 2013

© Crohn's & Colitis Foundation of America, Inc.
You currently do not have access to this article

To access this article:

Note: If your society membership provides full-access, you may need to login on your society website