Published online Feb 7, 2019. doi: 10.3748/wjg.v25.i5.632
Peer-review started: October 2, 2018
First decision: November 7, 2018
Revised: December 16, 2018
Accepted: December 19, 2018
Article in press: December 19, 2018
Published online: February 7, 2019
To identify factors other than active disease and anemia that contribute to fatigue in pediatric inflammatory bowel disease (IBD).
We performed an electronic search in Medline and EMBASE from their inception to May 2017 using the search term “fatigue” or the related keywords “physical impairment” and “inflammatory bowel disease” with the filter “child” (age 0-18 years). Cross-sectional and case-control studies were included. We restricted our search to studies published in English. We used the PRISMA checklist and flow diagram. Duplicate articles were manually deleted in End Note. To identify further relevant studies, we checked the reference lists of the selected articles.
We identified 149 papers, of which 19 were retrieved for full text review. Eleven studies were subsequently excluded because fatigue was not evaluated as an outcome measure. Eight papers focused on the desired topic and were discussed in the final analysis. A lack of uniformity of outcome measures made the pooling of data impossible. In all but one study, questionnaires were used to evaluate fatigue. In the remaining study, an accelerometer was used to measure daily activities, sleeping time and their relationships with fatigue in a more quantifiable manner. Adolescents with IBD are significantly more fatigued than healthy controls. In addition to active disease, increased anxiety or depression and disturbed family relationships were frequently reported predictors of fatigue. Quantitative measurement of physical activity in patients with Crohn’s disease showed a reduction in the number of steps per day, and patients with ulcerative colitis had a shorter duration of physical activity during the day.
Fatigue in pediatric IBD is related to a combination of biological, functional and behavioral factors, which should all be taken into account when managing fatigue.
Core tip: Children and adolescents with inflammatory bowel disease (IBD) often report fatigue as their most severe and distressing symptom. Fatigue is often attributed to active disease and anemia. We systematically reviewed the literature to identify additional factors that contribute to fatigue in pediatric IBD. After a strict selection process, eight studies were suitable for detailed data extraction. Increased anxiety or depression and disturbed family relations were frequently reported predictors of fatigue. This systematic review demonstrates the importance of evaluating biological, functional, and psychobehavioral factors to facilitate the optimal management of fatigue.