Berit Mære Skjellerudsveen

Stavanger University Hospital

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Roald Omdal

Stavanger University Hospital

Tore Grimstad

Stavanger University Hospital

Inger Marie Skoie

Stavanger University Hospital

Jan Terje Kvaløy

Stavanger University Hospital

Lars Aabakken

University of Oslo

Anne Kristine Hetta

Stavanger University Hospital

Ingvild Dalen

University of Stavanger

Lars Karlsen

Stavanger University Hospital

Arne Carlsen

Stavanger University Hospital

Cooperative Institutions

Stavanger University Hospital

University of Bergen

University of Stavanger

Haukeland University Hospital

St Olav's University Hospital

University of Oslo

Norwegian Medical Association

Østfold Hospital Trust

Akershus University Hospital

University Medical Center Utrecht

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Fatigue in celiac disease: A review of the literature

JGH Open (2019)

Berit Mære Skjellerudsveen Roald Omdal Tore Grimstad

Fatigue is increasingly recognized as a significant problem in patients with chronic inflammatory and autoimmune diseases. In celiac disease, a chronic immune‐mediated disease triggered by dietary gluten, conflicting opinions exist regarding both the size of the problem and the effect of a gluten‐free diet (GFD) on fatigue. We reviewed the existing literature regarding fatigue in celiac disease. We conducted a systematic search in the Embase, Ovid Medline, and Cochrane databases using subject terms from controlled vocabularies. Articles were reviewed based on language, type of article, title, and abstract or full text. Eighteen articles were finally selected for review. Fatigue was significantly greater in patients with celiac disease compared to healthy control subjects. Fatigue prevalence ranged from 8 to 100%. Fatigue severity was assessed in six studies. The fatigue visual analogue scale was the most frequently used fatigue instrument with scores from 57 to 79 prior to starting a GFD and from 39 to 59 in patients on a GFD. Seven studies investigated the effect of a GFD on fatigue, including five studies that reported less fatigue while on the diet and two studies that showed no significant difference. This review concludes that fatigue is a substantial complaint in patients with celiac disease. A GFD seems to reduce fatigue, but existing data are limited.

Gluten free

Chronic Fatigue

10.1002/jgh3.12134

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Fatigue: a frequent and biologically based phenomenon in newly diagnosed celiac disease

Scientific Reports (2022)

Berit Mære Skjellerudsveen Roald Omdal Anne Kristine Hetta Jan Terje Kvaløy Lars Aabakken

Abstract Fatigue is increasingly recognized as a major complaint in patients with chronic inflammatory and autoimmune diseases. Although fatigue is assumed to represent a significant problem in celiac disease, existing knowledge is scarce, and opinions are conflicting. This study aimed to investigate the prevalence and severity of fatigue in patients with newly diagnosed celiac disease and compare it with healthy control subjects. Ninety patients with newly diagnosed celiac disease were compared with 90 age- and sex-matched healthy subjects. The primary endpoints were fatigue severity as measured by: the fatigue Visual Analog Scale (fVAS), the Fatigue Severity Scale (FSS), and the inverted Vitality subscale of the MOS36 (SF-36vs). Higher scores indicate more severe fatigue. Clinically relevant fatigue was determined using predefined cut-off values. Secondary endpoints were the associations between fatigue, and sex, age, depression, pain, and selected biochemical variables. The median (IQR) fVAS-scores were 43.0 (18.0–64.5) in patients, and 9.0 (2.0–16.0) in the control group ( p < 0.001); and the FSS scores 3.8 (2.0–4.8) in patients, and 1.4 (1.0–1.9) in control subjects ( p < 0.001). Inverted SF-36vs scores had a mean (SD) value of 58.8 (23.6) in patients, and 29.7 (14.3) in healthy subjects ( p < 0.001). The presence of clinically relevant fatigue ranged from 41 to 50% in patients. Increased fatigue severity was associated with female sex, younger age, and elevated pain and depression scores, but not with levels of selected biochemical variables, including hemoglobin. Fatigue is a severe and frequent phenomenon in patients with untreated celiac disease.

Depression

Chronic Fatigue

10.1038/s41598-022-11802-8

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The influence of disease activity on fatigue in patients with ulcerative colitis – a longitudinal study

Scandinavian Journal of Gastroenterology (2021)

Tore Grimstad Berit Mære Skjellerudsveen Jan Terje Kvaløy Inger Marie Skoie Arne Carlsen

The relationship between the disease activity of ulcerative colitis and fatigue is unclear. We investigated how reaching deep remission versus remaining in active disease influenced the severity of fatigue.We included 149 consecutive patients in a longitudinal study. Patients were re-examined after 3 months of conventional treatment and dichotomized into A: Active disease or B: Deep remission. The Partial Mayo Score (PMS) was recorded in all patients. Fatigue was rated using the fatigue visual analog scale (fVAS), Fatigue Severity Scale (FSS), and Short Form-36 Vitality Subscale (SF-36vs). A control group of 22 age and sex-matched healthy subjects were included as controls for patients reaching deep remission.After 3 months there were no significant differences in fVAS, FSS and SF-36vs scores in patients with active disease compared to patients reaching deep remission, when adjusting for baseline fatigue scores. Patients in remission based on MES-UC scores had no significant reduction in fatigue scores, whereas patients in remission based on PMS had all three fatigue scores reduced. However, patients reaching deep remission still had higher fVAS and lower SF-36vs scores compared to healthy control subjects.After 3 months of conventional treatment there were no differences in fatigue severity in patients reaching deep remission compared with patients still having active disease. Fatigue was more pronounced in patients in deep remission than in healthy subjects, and was associated with subjective and not objective measures of disease activity. This indicates that other potent factors than inflammation influence fatigue in UC.

10.1080/00365521.2021.2007281

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Less, but not gone—gluten-free diet effects on fatigue in celiac disease: a prospective controlled study

Frontiers in Medicine (2023)

Berit Mære Skjellerudsveen Roald Omdal Anne Kristine Hetta Jan Terje Kvaløy Lars Aabakken

Fatigue is a frequent complaint in patients with celiac disease. A gluten-free diet is the only established treatment for celiac disease, but how this diet influences fatigue is uncertain. We aimed to investigate fatigue prevalence, severity, and associated factors in patients with celiac disease, at diagnosis and at 1 year after commencing a gluten-free diet.78 patients with serologically and histologically verified celiac disease, 78 age- and sex-matched healthy subjects. Primary endpoints were Fatigue Visual Analog Scale (fVAS), Fatigue Severity Scale (FSS), and inverted Vitality subscale of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36vs). Clinically relevant fatigue was defined as: FSS score ≥ 4, fVAS score ≥ 50 mm, or inverted SF-36vs score ≥ 65. Higher scores represented more fatigue.Fatigue was reduced after a 12-month gluten-free diet. Median scores changed from 3.8 (interquartile range [IQR]: 2.2 to 4.8) to 1.9 (IQR: 1.4 to 3.5) for FSS, from 44.5 (IQR: 18.8 to 66.0) to 15.5 (IQR: 7.8 to 43.3) for fVAS, and from 65 (IQR: 40 to 75) to 35 (IQR: 25 to 55) for inverted SF-36vs (p < 0.001 for all). Fatigue prevalence also declined after treatment. However, scores were significantly higher in patients compared to control subjects. Higher fatigue scores were associated with depression and pain, but not with signs of disease activity or nutritional deficiency.At diagnosis, patients with celiac disease frequently had severe fatigue. Fatigue declined after a gluten-free diet, but it remained higher than that observed in healthy subjects.ClinicalTrials.gov, Identifier NCT01551563.

Gluten free

10.3389/fmed.2023.1242512

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The Effect of Biological Treatment on Fatigue in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis

Drugs (2023)

Berit Mære Skjellerudsveen Inger Marie Skoie Ingvild Dalen Tore Grimstad Roald Omdal

Fatigue is a frequent complaint in patients with inflammatory bowel disease. Biological drugs have demonstrated beneficial effects on some extraintestinal manifestations, but the effect on fatigue is not clear. This study investigated the effects of biological and small molecule drugs approved for inflammatory bowel disease on fatigue. We performed a systematic review and meta-analysis of randomized, placebo-controlled trials reporting Federal Drug Agency (FDA)-approved biological and small molecule drugs for use in ulcerative colitis and Crohn's disease in which measures of fatigue were recorded before and after treatment. Only induction studies were included. Maintenance studies were excluded. We searched Embase (Ovid), Medline (Ovid), PsycINFO (Ovid), Cinahl (EBSCOhost), Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov in May 2022. Risk of bias was analyzed using the Cochrane risk-of-bias tool. Standardized mean difference was used to measure the treatment effect. A total of seven randomized controlled trials composed of 3835 patients were included in the meta-analysis. All of the studies included patients with moderately to severely active ulcerative colitis or Crohn's disease. The studies used three different generic fatigue instruments: the Functional Assessment of Chronic Illness Therapy-Fatigue and the Short Form 36 Health Survey Vitality Subscale versions 1 and 2. Overall treatment with biological or small molecule agents showed a beneficial effect compared with placebo, with a standardized mean difference of 0.25 (95% confidence interval 0.15–0.34, p < 0.001). The effect was independent of type of drug or subtype of inflammatory bowel disease. The risk of bias was considered to be low for all domains except for missing outcome data. Even though the included studies were of high methodological quality, the review is limited by the small number of studies included and that the available studies were not designed to evaluate fatigue specifically. Biological and small molecule drugs used in inflammatory bowel disease have a consistent, though small, beneficial effect on fatigue.

Pharmacotherapy

10.1007/s40265-023-01888-3

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Citations (9)