Els van de Vijver

122 Future perspectives Despite the high impact of fatigue in paediatric IBD there has been very limited evidence on successful pharmacological or non-pharmacological interventions, neither in paediatric nor in adults studies.(25) Future research needs to make use of validated measures of fatigue, and interventions should have a measurable effect on these fatigue scores. One of the few ongoing RCTs focusing on IBD-associated fatigue in children is the POPEYE- study (EudraCT number: 2012-005644-26). In this study, we compare the effect of intravenous iron supplementation to oral supplementation on recovery of physical activity, anaemia, subclinical inflammation, quality of life and fatigue. The primary outcome is the proportion of patients per group that show a 15% increase in 6MWD four weeks after the initiation of iron treatment. Non-pharmacological treatments also warrant further investigation in the paediatric IBD population. Physical activity, mindfulness, cognitive and behavioural therapy are some of the treatments to be invastigated, particularly in children and adolescents with cancer. Despite the scarce data in children, Robinson et al. underline the beneficial effect of physical activity interventions and relaxation or mindfulness exercise in the management of fatigue in children and adolescents with cancer.(14) Future research can show whether these beneficial effects can also be obtained in children with IBD. In conclusion, this dissertation addressed the diagnostic strategy that best selects, out of a group of children with gastrointestinal complaints, those that are most likely to have IBD. Secondly, it provides an attempt to quantify and characterise fatigue in children with IBD. With regard to the former point, we are confident in the quality of the optimal diagnostic strategy (with CRP, haemoglobin and faecal calprotectin). In the field of IBD-associated fatigue, however, it has become apparent that there is a lack of good quality studies. Measuring the efficacy of both pharmacological and non-pharmacological interventions for fatigue should be a research priority to improve the quality-of-life of children with IBD. Chapter 7 122