Fatigue in pediatric inflammatory bowel disease: Explained by transdiagnostic and disease-focused factors

OBJECTIVE: Fatigue is highly prevalent in children with inflammatory bowel disease (IBD), even during clinical remission. This suggests a role for transdiagnostic factors-lifestyle, psychological, and social influences not specific to the disease. This study aimed to assess the prevalence of severe fatigue in pediatric IBD and evaluate its associations with both IBD-focused and transdiagnostic factors.

METHODS: Children with IBD ages 8-18 from the PROactive cohort completed the Pediatric Quality of Life Inventory-Multidimensional Fatigue Scale. IBD-focused clinical data were extracted from electronic health records. Transdiagnostic factors were assessed using validated patient-reported outcome measures. Associations with fatigue were examined using linear regression.

RESULTS: Among 127 patients (mean age 14.9 ± 2.7 years; 43% male), most were in clinical remission. One hundred six patients self-reported fatigue, and 99 parents reported their child's fatigue. Severe fatigue was self-reported by 29%. Of IBD-focused factors, only disease activity (β = -0.40) and comorbidity (β = -0.18) showed significant associations with fatigue. Of transdiagnostic factors, lower physical, emotional, and social functioning; poorer sleep quality; less physical activity; more pain, anxiety, and depressive symptoms; lower life satisfaction and self-rated health; and increased school absence and pressure were significantly associated with more fatigue. Backward selection retained only transdiagnostic factors in the multivariate model, which explained 78% of fatigue variance.

CONCLUSION: Fatigue is common in children with IBD and is more strongly associated with transdiagnostic than disease-focused factors. These findings highlight the importance of integrative care strategies that address modifiable psychosocial and lifestyle domains to reduce fatigue and improve functioning in children with IBD.