Giri S, Harindranath S, Kulkarni A, Sahoo JK, Joshi H, Nath P, Sahu MK. Fatigue in inflammatory bowel disease: Prevalence, risk factors, assessment, outcomes, and management. World J Gastrointest Pathophysiol 2025; 16(3): 107573 [DOI: 10.4291/wjgp.v16.i3.107573]
Corresponding Author of This Article
Preetam Nath, DM, MD, Professor, Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Patia, Bhubaneshwar 751024, Odisha, India. drpreetamnath@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Suprabhat Giri, Preetam Nath, Manoj Kumar Sahu, Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar 751024, Odisha, India
Sidharth Harindranath, Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai 400012, Maharashtra, India
Akshay Kulkarni, Department of Gastroenterology, Deenanath Mangeshkar Hospital, Pune 411004, Mahārāshtra, India
Jiten Kumar Sahoo, Division of Pediatric Gastroenterology, Department of Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneshwar 751024, Odisha, India
Harshad Joshi, Department of Gastroenterology, Gleneagles Hospital, Mumbai 400012, Maharashtra, India
Co-first authors: Suprabhat Giri and Sidharth Harindranath.
Author contributions: Giri S and Harindranath S contributed to the conception and design of the manuscript; All authors contributed to the literature review, analysis, data collection, and interpretation; Giri S, Harindranath S, Kulkarni A, and Sahu JK drafted the initial manuscript; Giri S and Harindranath S contributed to the critical revision of the initial manuscript; All the authors approved the final version of the manuscript.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Preetam Nath, DM, MD, Professor, Department of Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Patia, Bhubaneshwar 751024, Odisha, India. drpreetamnath@gmail.com
Received: March 26, 2025 Revised: April 30, 2025 Accepted: July 3, 2025 Published online: September 22, 2025 Processing time: 177 Days and 15.7 Hours
Abstract
Fatigue is a prevalent and often debilitating symptom in individuals with inflammatory bowel disease (IBD), affecting a substantial proportion of patients, even during periods of disease remission. The prevalence of fatigue in IBD remains high, affecting around half of the IBD patients and being more common in patients with active disease than those in remission. Several risk factors contribute to fatigue in IBD, including active disease and pro-inflammatory state, nutritional deficiencies and anemia, sleep disturbances, psychological comorbidities, microbiota changes and the gut-brain axis, muscle dysfunction, sarcopenia, and physical inactivity. Assessing fatigue in IBD is challenging due to its subjective nature and the lack of a uniformly quantifiable method. Fatigue significantly impacts the quality of life, affecting physical functioning, psychological and emotional well-being, and social and relational consequences. The management of fatigue in IBD requires a comprehensive, multidisciplinary approach. This includes addressing disease activity through conventional drug treatment, biologicals and small molecules, and surgical treatment. Psychological interventions such as cognitive behavioral therapy, problem-solving therapy, solution-focused therapy, mindfulness-based cognitive therapy, and brief behavioral therapy have shown promise in improving fatigue. Nutritional interventions, including treating deficiencies and supplementation, and lifestyle interventions, such as physical exercise, aromatherapy, and sleep interventions, are also important components of fatigue management. Pharmacological interventions like modafinil and bupropion may be considered in refractory cases. This review aims to summarize the current evidence on fatigue in IBD, including its prevalence, risk factors, assessment methods, outcomes, and management strategies.
Core Tip: Fatigue is a prevalent and debilitating symptom in patients with inflammatory bowel disease (IBD), affecting nearly half of all patients and three-fourths with active disease. Its origins are multifactorial, involving inflammation, nutritional deficiencies, sleep issues, psychological factors, gut microbiota, muscle dysfunction, and inactivity. Identifying and addressing these factors is key to management. The IBD fatigue and functional assessment in chronic illness therapy - fatigue scales are common assessment tools for adults, with PedsQL for pediatric patients. Management involves physical exercise, medical or surgical management of active disease, correcting nutritional deficiencies, and addressing psychological and sleep disorders. Persistent fatigue may require physical and psychological interventions through a multidisciplinary approach.
