Gao X, Xiao P, Di JQ, Jiao Y, Liu Q. Beyond inflammation control: Rethinking fatigue as a multidimensional target in Crohn’s disease management. World J Gastroenterol 2026; 32(36): 118624 [DOI: 10.3748/wjg.118624]
Corresponding Author of This Article
Yan Jiao, Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun 130021, Jilin Province, China. lagelangri1@126.com
Research Domain of This Article
Gastroenterology & Hepatology
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editorial
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Gao X, Xiao P, Di JQ, Jiao Y, Liu Q. Beyond inflammation control: Rethinking fatigue as a multidimensional target in Crohn’s disease management. World J Gastroenterol 2026; 32(36): 118624 [DOI: 10.3748/wjg.118624]
World J Gastroenterol. Sep 28, 2026; 32(36): 118624 Published online Sep 28, 2026. doi: 10.3748/wjg.118624
Beyond inflammation control: Rethinking fatigue as a multidimensional target in Crohn’s disease management
Xue Gao, Ping Xiao, Jian-Qi Di, Yan Jiao, Qing Liu
Xue Gao, Ping Xiao, Department of The First Operation Room, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
Jian-Qi Di, Department of Gastric and Colorectal Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
Yan Jiao, Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Qing Liu, Department of Endocrinology and Metabolism, China-Japan Union Hospital of Jilin University, Changchun 130000, Jilin Province, China
Co-first authors: Xue Gao and Ping Xiao.
Co-corresponding authors: Yan Jiao and Qing Liu.
Author contributions: Gao X and Xiao P contributed to the conceptual development of the editorial and the initial drafting of the manuscript, and they are co-first authors. Di JQ participated in the critical appraisal of the literature and provided domain-specific clinical insights. Jiao Y and Liu Q conceived and supervised the overall framework of the article, critically revised the manuscript for important intellectual content, and guided the refinement of the clinical and conceptual focus, and they are co-corresponding authors. All authors contributed to manuscript revision, approved the final version, and agree to be accountable for all aspects of the work.
AI contribution statement: AI was used only as a supplementary language polishing tool during manuscript preparation. It did not participate in research design, data collection, data analysis, or the creation of core scientific content. This use is fully compliant with academic ethics and journal guidelines.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Yan Jiao, Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun 130021, Jilin Province, China. lagelangri1@126.com
Received: January 7, 2026 Revised: January 24, 2026 Accepted: February 28, 2026 Published online: September 28, 2026 Processing time: 226 Days and 22.2 Hours
Abstract
Fatigue is among the most disabling and least understood symptoms in patients with Crohn’s disease (CD), frequently persisting despite adequate pharmacological control of intestinal inflammation. In this editorial, we comment on the recent study by Morais et al published in the World Journal of Gastroenterology, which provides new evidence on psychological and hematological determinants of fatigue in CD. Traditionally viewed as a secondary manifestation of active disease or anemia, fatigue is increasingly recognized as a complex, multidimensional problem. Recent observational evidence highlights that fatigue in treated CD patients is strongly associated with psychological burden - including depression, anxiety, stress, and insomnia - as well as markers of immune imbalance, rather than classic nutritional deficiencies alone. These findings challenge the inflammation-centric paradigm that often dominates clinical decision-making in inflammatory bowel disease. Importantly, the coexistence of psychological distress and subtle hematological alterations suggests a bidirectional interaction between the brain, immune system, and gut that may perpetuate fatigue independently of overt disease activity. From a gastroenterology perspective, this has practical implications: Optimizing fatigue management in CD requires moving beyond escalation of anti-inflammatory therapy toward integrated assessment strategies that incorporate mental health, lifestyle factors, and immune profiles. Recognizing fatigue as a distinct therapeutic target may improve quality of life and patient-reported outcomes, underscoring the need for multidisciplinary approaches in the long-term management of CD.
Core Tip: Fatigue in Crohn’s disease persists in a substantial proportion of patients despite adequate control of intestinal inflammation and is increasingly recognized as a multidimensional clinical problem. Accumulating evidence suggests that psychological distress, sleep disturbance, and neuroimmune dysregulation play a central role in the pathogenesis and maintenance of fatigue, often outweighing traditional contributors such as anemia or biochemical disease activity. These editorial challenges the inflammation-centric paradigm and highlights fatigue as a distinct therapeutic target. Integrating mental health assessment, lifestyle factors, and emerging gut-brain axis mechanisms into routine care may substantially improve patient-reported outcomes and long-term quality of life in Crohn’s disease.
