Fatigue in Patients with Inflammatory Bowel Disease in Remission One Year After Diagnosis (the IBSEN III Study)

Category	Detail
Condition	Inflammatory Bowel Disease (Crohn’s disease and ulcerative colitis)
Key Mechanisms	Fatigue related to disease activity, immunological and metabolic factors, and psychological impact; fatigue prevalence remains high even in remission
Target Population	Adult patients (≥18 years) with Crohn’s disease or ulcerative colitis, one year post-diagnosis
Care Setting	Population-based cohort study with clinical follow-up including endoscopy, radiology, and biochemical testing

Symptomatic remission significantly reduces odds of substantial and chronic fatigue in both Crohn’s disease and ulcerative colitis.
Biochemical remission reduces odds of substantial fatigue in ulcerative colitis but stricter remission definitions (endoscopic/radiological, histological) do not further reduce fatigue likelihood.
Chronic fatigue in patients with endoscopic/radiological remission is independently associated with sleep disturbances and current infliximab treatment.

Use clinical disease activity indices (Harvey–Bradshaw Index for CD, SCCAI for UC) to define symptomatic remission.
Assess biochemical remission via fecal calprotectin ≤ 250 µg/g.
Confirm endoscopic/radiological remission with ileocolonoscopy and intestinal MRI/CT as appropriate.
Evaluate histological remission through mucosal biopsies from endoscopy.

Consider symptomatic remission status when evaluating fatigue in IBD patients.
Monitor and address sleep disturbances in patients with chronic fatigue despite endoscopic/radiological remission.
Review current infliximab treatment in patients experiencing chronic fatigue.

Regular clinical assessment using disease activity indices and fecal calprotectin.
Endoscopic and radiological evaluations as clinically indicated to confirm remission status.
Fatigue assessment using validated questionnaires (e.g., Fatigue Questionnaire) with attention to duration (≥6 months for chronic fatigue).

Persistent fatigue despite remission may be linked to sleep disturbances and ongoing infliximab therapy.
Stricter remission definitions do not necessarily correlate with reduced fatigue, indicating multifactorial fatigue etiology.

IBD patients in endoscopic/radiological remission one year post-diagnosis

Current infliximab treatment is independently associated with increased odds of chronic fatigue; sleep disturbances also strongly associated.

Incorporate multidimensional remission assessment (symptomatic, biochemical, endoscopic/radiological, histological) for comprehensive disease evaluation.
Assess fatigue systematically using validated tools and consider chronicity (≥6 months) in clinical evaluation.
Address sleep disturbances proactively in patients with chronic fatigue despite remission.
Evaluate the impact of biologic therapies such as infliximab on fatigue symptoms and consider this in treatment planning.

Clinical Scorecard: Evaluating Fatigue Levels in Inflammatory Bowel Disease Patients in Remission One Year Post-Diagnosis: Insights from the IBSEN III Study