Fatigue and IBD Algorithm • 40-50% patients have fatigue despite clinical remission • Risk factors: BMI, Depression, sleep disturbance, Female, Thiopurine, MTX?, Anemia • Prevalence Crohn's > UC Anemia and IBD Pearls: • IDA and active IBD: IV Fe > PO FE • Fe Carboxymaltose & Fe Sucrose > alt. IV FE formulations • If persistent macrocytosis after d/c IMM → consider NRH & Heme eval. re: BMBx • Supplement folate if on MTX or SSZ • Check Soluble Transferrin Receptor (sTfR) to differentiate IDA vs. ACD • Monitor & correct B12 (B12, MMA) for ileal Crohn's/resection/restricted diet/deficiency symptoms even if wnl B12 Patient Experience • 2/3 endorse persistent fatigue despite disease control • 1/3 have fatigue w/ active IBD and/or stress • Pts report dehydration as a factor • ~50% report no improvement despite attempted therapies • ~20% w/ improved fatigue after correction of lab abn./other causes • ~30% note improvement w/ mental health/Lifestyle/diet modifications Algorithm by Dr. Waseem Ahmed @Waseem_AhmedMD #Fatigue #IBD #Algorithm #diagnosis #management
