Els van de Vijver

79 INTRODUCTION Inflammatory bowel disease (IBD) is a chronic disease of the gastrointestinal tract. The disease is characterized by relapsing periods of inflammation and remission and usually presents with abdominal pain, diarrhoea, rectal bleeding and weight loss.(1) The ultimate goal in IBD treatment is to reach clinical remission as quickly as possible. Fatigue and decreased physical fitness may continue to affect a patient’s daily life despite disease remission. Ten percent of patients with IBD are diagnosed before the age of 19 years.(2) Fatigue refers to a subjectively overwhelming sense of tiredness, lack of energy, and feeling of exhaustion that decreases one’s capacity for physical and mental activity.(3) It is a common, independent, and nonspecific symptom identified in numerous chronic health conditions in childhood.(4) In adults with chronic disease, fatigue can be a major source of disablement and is often reported as being among the most severe and distressing symptoms.(5) It affects physical, emotional, cognitive, and social functioning, impacting quality of life. Nevertheless, fatigue has typically been ignored in the assessment of symptom severity or outcome in many diseases in which it is observed.(5) The quantification of fatigue is challenging due to the lack of a consensus framework, vague terminology, and the multidimensional nature of symptoms. Subjective methods, such as self-reported or parent-reported surveys (6, 7), are commonly used but can be distorted by response and recall bias. More objective methods, such as polysomnography and performance tests (8-10), are expensive and time-consuming. Furthermore, the prevalence of fatigue varies among healthy paediatric age groups; it is common in infancy, early childhood, and late adolescence and less frequently observed during mid-childhood; it is more common in girls than in boys.(9) We aimed to systematically review the literature to identify factors that contribute to fatigue in children and adolescents with IBD. Systematic review: fatigue 79