Systematic Reviews
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2019; 25(5): 632-643
Published online Feb 7, 2019. doi: 10.3748/wjg.v25.i5.632
Fatigue in children and adolescents with inflammatory bowel disease
Els Van de Vijver, Ann Van Gils, Laura Beckers, Yannick Van Driessche, Nicolette Dorien Moes, Patrick Ferry van Rheenen
Els Van de Vijver, Ann Van Gils, Nicolette Dorien Moes, Department of Paediatric Gastroenterology, Hepatology and Nutrition, Antwerp University Hospital, Edegem B-2650, Belgium
Laura Beckers, Department of Anesthesiology, Antwerp University Hospital, Edegem B-2650, Belgium
Yannick Van Driessche, Family Medicine, Deurne B-2100, Belgium
Patrick Ferry van Rheenen, Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
Author contributions: Van de Vijver E designed research; Van de Vijver E, Van Gils A, Beckers L and Van Driessche Y performed research; Moes ND contributed new reagents or analytic tools; Van de Vijver E and Van Gils A analyzed data; Van de Vijver E and van Rheenen PF wrote the paper.
Conflict-of-interest statement: All authors have no conflict of interest.
PRISMA 2009 Checklist statement: The guidelines of the PRISMA 2009 statement were adopted.
Open-Access: This 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 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:
Corresponding author: Els Van de Vijver, MD, Attending Doctor, Department of Paediatric Gastroenterology, Hepatology and Nutrition, Antwerp University Hospital, Wilrijkstraat 10, Edegem B-2650, Belgium.
Telephone: +32-3-8215524 Fax: +32-3-8291194
Received: October 2, 2018
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
Research background

Children and adolescents with inflammatory bowel disease (IBD) regularly report fatigue as their most severe and distressing symptom. Fatigue is often attributed to active disease and anemia, but also in quiescent IBD, fatigue can trouble daily life.

Research motivation

The ultimate goal in IBD management is not only to reach disease remission, but also to counteract fatigue and decreased physical fitness

Research objectives

We aimed to systematically review the literature to identify factors that contribute to fatigue in children and adolescents with IBD.

Research methods

We performed an electronic search in Medline and EMBASE from their inception to May 2017 using the search term “fatigue” or the related keyword “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. To identify further relevant studies, we checked the reference lists of the selected articles.

Research results

We ultimately identified eight papers that matched the search criteria. 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.

Research conclusions

Fatigue is a common problem in children and teenagers with IBD, and it is significantly more prevalent among young patients with IBD than in the healthy control population. It is multidimensional and caused by both physical and psychosocial factors. The most predictive factor seems to be disease activity. Health care providers need to pay attention to this problem because it is associated with reduced quality of life, increased sleeping problems and increased anxiety.

Research perspectives

The multifactorial nature of fatigue necessitates multilevel testing. 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.