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Review article: The aetiology of fatigue in inflammatory bowel disease and potential therapeutic management strategies


Jordan J. McGing

Shellie Jean Radford

Assistant Professor in Metabolic Biochemistry

Clinical Associate Professor


Background: Fatigue is the inability to achieve or maintain an expected work output resulting from central or peripheral mechanisms. The prevalence of inflammatory bowel disease (IBD) fatigue can reach 86% in active disease, persisting in 50%-52% of patients with mild to inactive disease. Fatigue is the commonest reason for work absence in IBD, and patients often report fatigue burden to be greater than that of primary disease symptoms. Relatively few evidence-based treatment options exist, and the aetiology is poorly understood. Aim: To review the available data and suggest a possible aetiology of IBD fatigue and to consider the efficacy of existing management strategies and highlight potential future interventions. Methods: We reviewed fatigue-related literature in IBD using PubMed database. Results: Disease related factors such as inflammation and pharmacological treatments negatively impact skeletal muscle and brain physiology, likely contributing to fatigue symptoms. Secondary factors such as malnutrition, anaemia, sleep disturbance and psychological comorbidity are potential determinants. Immune profile, faecal microbiota composition and physical fitness differ significantly between fatigued and non-fatigued patients, suggesting these may be aetiological factors. Solution-focused therapy, high-dosage thiamine supplementation and biological therapy may reduce fatigue perception in IBD. The effect of physical activity interventions is inconclusive. Conclusions: A multimodal approach is likely required to treat IBD fatigue. Established reversible factors like anaemia, micronutrient deficiencies and active disease should initially be resolved. Psychosocial intervention shows potential efficacy in reducing fatigue perception in quiescent disease. Restoring physical deconditioning by exercise training intervention may further improve fatigue burden.


McGing, J. J., Radford, S. J., Francis, S. T., Serres, S., Greenhaff, P. L., & Moran, G. W. (2021). Review article: The aetiology of fatigue in inflammatory bowel disease and potential therapeutic management strategies. Alimentary Pharmacology and Therapeutics, 54(4), 368-387.

Journal Article Type Article
Acceptance Date May 20, 2021
Online Publication Date Jul 6, 2021
Publication Date Aug 1, 2021
Deposit Date Sep 1, 2021
Publicly Available Date Jul 7, 2022
Journal Alimentary Pharmacology and Therapeutics
Print ISSN 0269-2813
Electronic ISSN 1365-2036
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 54
Issue 4
Pages 368-387
Keywords Pharmacology (medical)
Public URL
Publisher URL
Additional Information This is the peer reviewed version of the following article: McGing, JJ, Radford, SJ, Francis, ST, Serres, S, Greenhaff, PL, Moran, GW. Review article: The aetiology of fatigue in inflammatory bowel disease and potential therapeutic management strategies. Aliment Pharmacol Ther. 2021; 54: 368– 387. , which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.