Eskazan T, Saribas S, Kocazeybek B. Fatigue: The missing target in Crohn’s disease management. World J Gastroenterol 2026; 32(26): 118961 [DOI: 10.3748/wjg.v32.i26.118961]
Corresponding Author of This Article
Bekir Kocazeybek, Professor, Department of Medical Microbiology, Istanbul University Cerrahpasa, Cerrahpasa Faculty of Medicine, Kocamustafapaşa St No. 53, Istanbul 34098, Türkiye. bzeybek@istanbul.edu.tr
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
editorial
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World J Gastroenterol. Jul 14, 2026; 32(26): 118961 Published online Jul 14, 2026. doi: 10.3748/wjg.v32.i26.118961
Fatigue: The missing target in Crohn’s disease management
Bekir Kocazeybek, Suat Saribas, Tugce Eskazan
Tugce Eskazan, Division of Gastroenterology, Department of Internal Medicine, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul 34098, Türkiye
Suat Saribas, Bekir Kocazeybek, Department of Medical Microbiology, Istanbul University Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul 34098, Türkiye
Co-first authors: Tugce Eskazan and Suat Saribas.
Author contributions: Eskazan T and Saribas S wrote the manuscript, they contributed equally to this article, they are the co-first authors of this manuscript; Eskazan T and Kocazeybek B designed the article, and all authors have read and approved the final letter to the editor.
AI contribution statement: Generative artificial intelligence tools, specifically ChatGPT, were used. After the manuscript had been written by the authors, AI tools were used solely for language polishing, grammar correction, improving readability, and shortening the abstract to meet the required word count.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Bekir Kocazeybek, Professor, Department of Medical Microbiology, Istanbul University Cerrahpasa, Cerrahpasa Faculty of Medicine, Kocamustafapaşa St No. 53, Istanbul 34098, Türkiye. bzeybek@istanbul.edu.tr
Received: January 15, 2026 Revised: March 5, 2026 Accepted: April 7, 2026 Published online: July 14, 2026 Processing time: 162 Days and 1.1 Hours
Abstract
Treat-to-target strategies have improved mucosal healing in inflammatory bowel disease; however, nearly half of patients in clinical remission still experience disabling fatigue. Morais et al published a study in the World Journal of Gastroenterology demonstrated that biologic treatment success does not necessarily improve patient-reported outcomes and fatigue cannot be explained solely by disease activity or conventional inflammatory biomarkers. A major strength of the study lies in its focus on fatigue as a primary clinical outcome. Although depression, anxiety, stress, and insomnia had limited predictive value individually, their combined assessment increased fatigue risk up to 45-fold. The composite psychological score demonstrated good discriminative performance, supporting its practical use in routine care. Fatigue was also associated with leukocyte alterations, such as relative neutrophilia and lymphopenia/eosinopenia, consistent with stress-related immune activation. No significant associations were found with anemia, nutritional deficiencies, thyroid function, or C-reactive protein, underscoring the multidimensional and largely inflammation-independent nature of fatigue in Crohn’s disease and highlighting the need for a more patient-centered management approach.
Core Tip: The study by Morais et al suggested that Crohn’s disease management should move beyond controlling inflammation to addressing overall well-being and holistic healing. Fatigue emerges as a persistent, often overlooked symptom that may continue despite mucosal healing and apparent disease control. It should not be considered a nonspecific or secondary complaint but a clinically meaningful outcome with biological and psychological determinants. The use of appropriate hematologic and psychometric assessment tools enables accurate identification of fatigue and its contributors. Integrating these evaluations into routine practice may support a patient-centered approach and ultimately improve the long-term quality of life of patients with Crohn’s disease.
