Els van de Vijver

100 ABSTRACT OBJECTIVES AND STUDY: Inflammatory bowel diseases (IBD) are known to affect the patient’s energy level. Although children and adolescents report fatigue as their most distressing symptom, even at times of disease remission, it has hardly been studied. We aimed to obtain a better understanding of the nature of fatigue in paediatric patients with IBD. We compared biological and functional parameters in fatigued and non-fatigued paediatric patients with IBD to assess possible (non-)correlations. METHODS : We conducted a cross-sectional observational study of 106 children and adolescents with quiescent to moderately active IBD (defined as having Paediatric Ulcerative Colitis Activity Index (PUCAI) scores below 65 or Paediatric Crohn’s Disease Activity Index (PCDAI) scores below 37.5). Participants were recruited from five tertiary care and six secondary care centers in Belgium and the Netherlands. Patients were considered fatigued when the PedsQL TM fatigue was < -2.0 Z for age, while non-fatigued patients had scores above this cut-off point. We measured haemoglobin concentration, iron indicators, faecal calprotectin, six-minute walking distance (6MWD) and disease specific quality-of-life (IMPACT-III). RESULTS : The study cohort’s mean PedsQL TM fatigue Z-score was -1.0. Twenty-three of 106 (22%) patients were fatigued. Fatigued and non-fatigued IBD patients were not significantly different in IBD disease phenotype. Fatigued IBD patients had a significant lower IMPACT-III score than non-fatigued patients (respectively 120 vs. 146, p<0.0001), and a larger proportion was not in clinical remission (26% vs. 63%, p=0.003). Mean haemoglobin Z-scores (-1.7 vs -1.5, p=0.589), ferritin concentration (14 vs 23 µg/L, p=0.206) and faecal calprotectin concentrations (414 vs 355 µg/g, p=0.928) were not significantly different between fatigued and non-fatigued IBD patients. CONCLUSION: Our data indicate that neither haemoglobin levels nor faecal calprotectin levels are strongly correlated with the self-rating of fatigue. Further investigations are needed to identify practical treatment targets. Chapter 6 100