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Determinants of fatigue in Crohn’s disease patients

Vogelaar, Laurana; van’t Spijker, Adriaanb; van Tilburg, Antonie J.P.d; Kuipers, Ernst J.a,c; Timman, Reinierb; van der Woude, Christien J.a

European Journal of Gastroenterology & Hepatology: February 2013 - Volume 25 - Issue 2 - p 246–251
doi: 10.1097/MEG.0b013e32835aba83
Original Articles: Inflammatory Bowel Diseases

Objective Crohn’s disease (CD) is often associated with severe fatigue. Little is known about patients who may be at the highest risk for fatigue. Therefore, we assessed the disease phenotype and factors related to fatigue in the presence of CD in two different populations.

Methods Patients presenting at the clinic of a referral hospital and a general hospital were included in the study. They completed questionnaires including the Checklist Individual Strength, the Hospital Anxiety and Depression Scale, a questionnaire on disease activity, and one on medication use. The Montreal classification and sociodemographics were obtained from medical records. Hemoglobin and C-reactive protein levels were measured at baseline.

Results In total, 425 patients were included (276 women, mean age: 42 years). Compared with patients from the general hospital, patients at the referral hospital had worse disease activity, worse disease behavior, more bowel resections, and a higher percentage of side-effects to medication and use of anti-tumor necrosis factor (TNF). The prevalence of fatigue was significantly higher in the referral patients compared with the general patients (65.7 vs. 52.5%, respectively; P=0.01). Similar results were found in patients in remission (53.3 vs. 40.5%; P=0.061). Factors related to fatigue were the use of anti-TNF at baseline, side-effects to 5-aminosalicylic acid, disease activity, female sex, and shorter disease duration. Furthermore, we found improvement in fatigue and a trend toward lower disease activity after 1 year of anti-TNF use.

Conclusion A high percentage of CD patients suffer from fatigue. As a more aggressive phenotype seems to be associated with more severe fatigue and patients in remission still suffer from fatigue, a multidimensional approach for fatigue is warranted in these patients.

Departments of aGastroenterology and Hepatology

bPsychology and Psychotherapy

cInternal Medicine, Erasmus MC

dDepartment of Gastroenterology and Hepatology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands

Correspondence to Lauran Vogelaar, MD, Department of Gastroenterology and Hepatology, Erasmus MC, ‘s Gravendijkwal 230, Room HS-306, 3000 CA Rotterdam, The Netherlands Tel: +31 6 26664056; fax: +31 10 703 5172; e-mail:

Received July 9, 2012

Accepted September 25, 2012

© 2013 Lippincott Williams & Wilkins, Inc.