Fatigue prevalent in paediatric IBD patients

Fatigue is more frequently reported in paediatric patients with inflammatory bowel disease (IBD) compared with controls and is associated with anaemia in a nationwide study.

In this study, the proportion of participants with a fatigue-related code in their electronic medical records (EMRs) was greater among IBD patients than non-IBD controls (18.9 percent vs 12.8 percent; odds ratio [OR], 1.58, 95 percent confidence interval [CI], 1.52–1.63). This pattern was similarly seen in the comparison between paediatric IBD patients and non-IBD controls (14.5 percent vs 9.4 percent; OR, 1.90, 95 percent CI, 1.67–2.16).

Fatigue was also more prevalent among young adults (19–40 years), adults (41–65 years), and elderly (>65 years) patients with IBD as opposed to non-IBD controls, with ORs ranging between 1.34 and 1.58.

Time to first recording of fatigue code was earlier in the paediatric IBD vs non-IBD cohort (p<0.0001). Girls were also diagnosed with fatigue earlier than boys (p<0.0001). [ESPGHAN 2025, abstract G-OP048]

Moreover, the incidence of anaemia was higher among paediatric IBD patients with fatigue as opposed to those without (OR, 1.6), as were the odds of depression (OR, 2.15), anxiety (OR, 2.81), sleep disorders (OR, 2.09), and the utilization of sick days (OR, 3.8). Of note, this was not the case for iron deficiency (OR, 1.05).

A burdensome IBD symptom

About 80 percent of IBD patients with active disease and even those in remission do report fatigue. These patients even consider it more debilitating than urgency, diarrhoea, flatulence and pain. Left untreated, fatigue can worsen over time. [J Crohns Colitis 2016;10:315-322; Clin Gastroenterol Hepatol 2013;11:1140-1146]

“Fatigue is one of the most burdensome symptoms in IBD, yet it remains understudied and underrecognized, especially in paediatric IBD … Over 60 percent of children in clinical remission still report some extent of fatigue,” said Dr Gili Focht from The Juliet Keiden Institute of Pediatric Gastroenterology and Nutrition, Shaare Zedek Medical Center, Jerusalem, Israel, at ESPGHAN 2025.

“Hence, the burden of fatigue in paediatric IBD is underestimated. This gap encouraged us to look into how fatigue is documented in patients’ EMRs,” Focht continued.

Focht and colleagues evaluated the prevalence and incidence of fatigue-related codes in paediatric IBD patients using data from the epi-IIRN cohort. The fatigue codes included were malaise and fatigue (ICD-9* 780.7) and chronic fatigue (ICD-9 780.71). Of the entire IBD population (n=32,908), 5,567 comprised the paediatric cohort (mean age 14.3 years). The non-IBD control population included 74,688 participants.

In the paediatric cohort, over two-thirds (69 percent) had Crohn’s disease (CD), and half were female.

“This is the first nationwide study to assess recorded fatigue codes in IBD. In summary, fatigue code rates were higher amongst paediatric IBD patients than their matched controls. In children, fatigue rates were higher in CD than in ulcerative colitis, but it is not associated with iron deficiency,” said Focht.

While the fatigue rates were lower than previously reported in literature, these likely reflect more severe cases of fatigue, according to Focht. “Fatigue is probably multifactorial … We are currently developing a patient-reported outcome to assess fatigue in the paediatric population.”