Fatigue in pediatric patients with inflammatory bowel disease: a multicenter study by the SEGHNP

Abstract

Background: Fatigue is a common and disabling symptom in pediatric inflammatory bowel disease (IBD), often persisting even during clinical remission and reflecting a multifactorial origin. Despite its significant impact on patients' lives, it remains under-recognized. The IMPACT-III and IMPACT-III-P questionnaires facilitate fatigue assessment within a biopsychosocial framework of health-related quality of life (HRQOL). Methods: In this multicenter study supported by the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP), 382 patients aged 10-17 years and their caregivers from 37 hospitals completed the IMPACT-III and IMPACT-III-P questionnaires between February 2021 and June 2023. Fatigue-related items were analyzed, and predictive models were de- veloped using univariate and multivariate logistic regression. Results: A total of 370 patient questionnaires were included in the analysis. The median age at diagnosis was 11.3 years (inter- quartile range [IQR] 8.7-13.3), and at assessment, 14.4 years (IQR 12.4–16.1). Males represented 56% of the cohort, and 61.1% had Crohn’s disease. Treatments included immunosuppressants (44.6%), 5-ASA (33.7%), biologics (30.8%), corticosteroids (6%), and other therapies (27.8%). Fatigue was reported by 81.1% of patients, including 77.5% of those in clinical remission. Severe fatigue was significantly associated with female sex, older age, active disease, and dietary treatment. Conversely, absence of fatigue was independently associated with male sex, earlier pubertal stage, and not receiving biologics. Notable discrepancies were observed between patient and caregiver perceptions of energy levels. Fatigue correlated with significant- ly lower HRQOL scores across all IMPACT-III domains. In Crohn’s disease, the strongest impacts were observed in the social and systemic domains, whereas in ulcerative colitis, emotional and physical domains were more affected. Patients without severe fatigue consistently scored higher in all domains. Conclusion: Fatigue is a highly prevalent and multifactorial symptom in pediatric IBD, with a marked negative impact on qual- ity of life, even in clinical remission. The IMPACT-III and IMPACT-III-P questionnaires are valuable tools for its assessment and highlight the need for routine, systematic evaluation of fatigue to guide holistic and individualized management strategies.