Chronic fatigue is associated with increased disease-related worries and concerns in inflammatory bowel disease

AIM:To investigate the impact of chronic fatigue on disease-related worries in inflammatory bowel disease (IBD) and the potential multicolinearity between subjective questionnaires.METHODS:Patients in remission or with mild-tomoderate disease activity completed the fatigue questionnaire (FQ),the rating form of IBD patient concerns (RFIPC),the Short-Form 36 (SF-36),and IBD questionnaire (N-IBDQ).In addition,clinical and epidemiological data were obtained.RESULTS:In total,140 patients were included;of which 92 were diagnosed with ulcerative colitis and 48 with Crohn's disease.The mean age of patients with chronic fatigue was 44.2 years (SD=15.8) and for non-fatigued patients was 44.7 years (SD=16.0).Chronic fatigued patients had clinically significantly increased levels of disease-related worries,as measured by Cohen's d effect size.Worries about having an ostomy bag,loss of bowel control,and energy levels were most prominent in both chronic fatigued and non-chronic fatigued IBD patients.Variance inflation factor (VIF) and tolerance indicated that there were no problematic multicolinearity among the FQ,RFIPC,SF-36 and N-IBDQ responses (VIF < 5 and tolerance > 2).CONCLUSION:Chronic fatigue is associated with increased levels of disease-related worries and concerns in IBD.Increased levels of worries were also associated with impaired health-related quality of life.

Favorable lifestyle before diagnosis associated with lower risk of screen-detected advanced colorectal neoplasia

AIM: To investigate the association between adherence to health recommendations and detection of advanced colorectal neoplasia(ACN) in colorectal cancer(CRC) screening.METHODS: A total of 14832 women and men were invited to CRC screening, 6959 in the fecal immunochemical test arm and 7873 in the flexible sigmoidoscopy arm. These were also sent a self-reported lifestyle questionnaire to be completed prior to their first CRC screening. A lifestyle score was created to reflect current adherence to healthy behaviors in regard to smoking, body mass index, physical activity, alcohol consumption and food consumption, and ranged from zero(poorest) to six(best). Odds ratios(ORs) and 95%CIs were calculated using multivariable logistic regression to evaluate the association between the single lifestyle variables and the lifestyle score and the probability of detecting ACN.RESULTS: In all 6315 women and men completed the lifestyle questionnaire, 3323(53%) in the FIT arm and 2992(47%) in the FS arm. This was 89% of those who participated in screening. ACN was diagnosed in 311(5%) participants of which 25(8%) were diagnosed with CRC. For individuals with a lifestyle score of two, three, four, and five-six, the ORs(95%CI) for the probability of ACN detection were 0.82(0.45-1.16), 0.43(0.28-0.73), 0.41(0.23-0.64), and 0.41(0.22-0.73), respectively compared to individuals with a lifestyle score of zero-one. Of the single lifestyle factors, adherence to non-smoking and moderate alcohol intake were associated with a decreased probability of ACN detection compared to being a smoker or having a high alcohol intake 0.53(0.42-0.68) and 0.63(0.43-0.93) respectively.CONCLUSION: Adopted healthy behaviors were inversely associated with the probability of ACN detection. Lifestyle assessment might be useful for risk stratification in CRC screening.

Psychological effects of colorectal cancer screening: Participants vs individuals not invited

AIM To investigate the possible long-term psychological harm of participating in colorectal cancer(CRC)screening in Norway.METHODS In a prospective, randomized trial, 14294 participants(aged 50-74 years) were invited to either flexible sigmoidoscopy(FS) screening, or a faecal immunochemical test(FIT)(1:1). In total, 4422 screening participants(32%) completed the questionnaire, which consisted of the Hospital Anxiety and Depression Scale and the SF-12, a generic health-related quality of life(HRQOL) measurement, when invited to screening and one year after the invitation. A control group of 7650 individuals was invited to complete the questionnaire only, at baseline and one year after, and 1911(25%) completed the questionnaires.RESULTS Receiving a positive or negative screening result and participating in the two different screening modalities did not cause clinically relevant mean changes in anxiety, depression or HRQOL after one year. FS screening, but not FIT, was associated with an increased probability of being an anxiety case(score ≥ 8) at the one-year follow-up(5.6% of FS participants transitioned from being not anxious to anxious, while 3.0% experienced the reverse). This increase was moderately significantly different from the changes in the control group(in which the corresponding numbers were 4.8% and 4.5%, respectively), P = 0.06. CONCLUSION Most individuals do not experience psychological effects of CRC screening participation after one year, while FS participation is associated with increased anxiety for a smaller group.

Fatigue is not associated with vitamin D deficiency in inflammatory bowel disease patients

AIM To investigate if vitamin D deficiency is associated with fatigue in patients with inflammatory bowel disease(IBD).METHODS IBD patients were recruited from nine hospitals in the southeastern and western regions of Norway to participate in a multicenter cross-sectional study lasting from March 2013 to April 2014. Data were collected by interviews, from medical records and laboratory tests. The Fatigue Questionnaire(FQ) was used to measure fatigue. Linear and logistic regression models were applied to explore the possible association between vitamin D deficiency and total fatigue scores and chronic fatigue, respectively. The analyses were adjusted for age, gender, disease activity, depressive symptoms and sleep disturbance.RESULTS In total, 405 patients were included in the analyses, of which 227(56%) had Crohn's disease(CD) and 178(44%) had ulcerative colitis(UC). Vitamin D deficiency(< 50 nmol/L) was present in half(203/405) of the patients. Chronic fatigue was reported by 116(29%) of all included patients with substantial fatigue reported by 194(48%). Vitamin D levels were neither associated with total fatigue nor with chronic fatigue. Higher total fatigue scores and chronic fatigue were both associated with increased disease activity scores in patients with UC and CD, but not with increased CRP or fecal calprotectin. In UC patients, female gender was associated with fatigue in the univariate analysis, but no such difference was found when adjusted for elevated disease activity scores. Sleep disturbance and more depressive symptoms were associated with total fatigue scores in both UC and CD patients, but with chronic fatigue only in CD patients.CONCLUSION In this study, no significant association between fatigue and vitamin D deficiency in IBD patients was revealed.