P1246 Fatigue trajectory and the impact of disease course through the first year after diagnosis in patients with Inflammatory Bowel Disease (the IBSEN III study)
Authors: Holten K I A , Bernklev T , Opheim R , Olsen B , Bengtson M B , Ricanek P , Hovde Ø , Asak Ø , Boyar R , Johansen I , Torp R , Aabrekk T B , Strande V , Frigstad S O , Detlie T E , Kristensen V A , Hagen M , Henriksen M , Huppertz-Hauss G , Høivik M L , Jelsness-Jørgensen L P 
Published: January 2025

Abstract

Background
Fatigue is common in both Crohn's disease (CD) and ulcerative colitis (UC), but the pathogenesis is still unclear. The primary aim of this study was to assess the odds for substantial fatigue (SF) and chronic fatigue (CF) one year after diagnosis based on the presence of SF at baseline. The secondary aim was to identify clinical factors that may be associated with SF one year after diagnosis.

Methods
Patients ≥18 years with a definite diagnosis of CD or UC at 1-year follow-up were recruited from the Inflammatory Bowel Disease South-Eastern Norway (IBSEN III) study, a population-based, observational inception cohort. Patients who completed the Fatigue Questionnaire (FQ) at the time of diagnosis and at the 1-year follow-up were included. CF was defined as a dichotomized FQ score ≥4 (SF) with duration ≥ 6 months. Univariate binary logistic regression analysis was used to estimate the odds for SF/CF one year after diagnosis depending on the presence of SF at baseline. Associations between SF at the 1-year follow-up and possible predictive clinical factors were included in a multivariate logistic regression model. All analysis were performed stratified by type of diagnosis.

Results
In total, 596/1370 (43.5%) patients were included (CD: 196 (32.9%), UC: 400 (67.1%)). The presence of SF at the time of diagnosis compared to no initial fatigue, significantly increased the odds for SF (CD: OR=8.23, 95% CI [4.13; 16.39], UC: OR=6.67, 95% CI [4.24; 10.49]) and CF (CD: OR=6.38, 95% CI [2.71; 15.03], UC: OR=4.59, 95% CI [2.68; 7.83]) at the 1-year follow-up.
Among patients with CD, development of non-passable stricture and/or surgically treated stricture within first year of disease (OR=4.37, 95%CI [1.58;12.11]), subjective flares since diagnosis (OR=2.22, 95%CI [1.11; 4.43]), female gender (OR=2.96, 95%CI [1.47; 5.95]) and presence of comorbidities (OR=4.36, 95%CI [2.06; 9.22]) were all independently associated with SF at the 1-year follow-up. For patients with UC, current biological treatment (OR=5.14, 95%CI [1.56; 16.96]), Mayo endoscopic score (0-3) at the 1-year follow-up (OR=1.54, 95%CI [1.01; 2.35]), subjective flares since diagnosis (OR=2.66, 95%CI [1.24; 5.72]) and female gender (OR=2.20, 95%CI [1.06; 4.57]) were independently associated with SF at the 1-year follow-up.

Conclusion
Fatigue may be expected to persevere during the first year of disease if present at the time of diagnosis. For patients with CD as well as UC, clinical factors reflecting severe disease, as severe stricturing disease in CD, biological therapy and higher Mayo endoscopic score in UC, were significantly associated with SF one year after diagnosis. Furthermore, comorbidities (only CD), female gender and subjective flares since diagnosis increased the odds for SF.