Understanding premature fatigue development in Inflammatory Bowel Disease (IBD). Crohn’s & Colitis UK
Jordan McGing, PhD funded by the Joan Browne legacy, supervisors Dr Gordan Moran, Professor Paul Greenhaff, Professor Sue Francis, Dr Sebastian Serres. NIHR Nottingham BRC GI&Liver, MSK and MRI themes.
Perception of fatigue is common in Inflammatory Bowel Disease (IBD) and often increases during disease remission. IBD patients present with a chronically heightened day-to-day perception of fatigue and premature muscle fatiguability during physical performance. This significantly reduces quality of life and is linked to adverse clinical outcomes. The aetiology of fatigue development is poorly understood however and there are no evidence-based treatment options available.
Fatigue is classically attributed to perturbations in the central nervous system and or skeletal muscle. IBD patients exhibit structural and metabolic changes at both of these sites. This could be a direct result of their heightened inflammatory state adversely affect organs that are distant from the primary site of disease. Alternatively, deconditioning as a result of reduced habitual physical activity levels could also be a significant contributor to increase fatiguability.
Indeed, moderate to large effect sizes have been reported for cardiorespiratory fitness and skeletal muscle function in CD patients with fatigue complaints relative to those without and also healthy control cohorts. This suggests the aetiology of premature fatigue in IBD could very likely be attributable to deconditioning.
Traditional Magnetic Resonance (MR) based methods enable resting state comparison of pathophysiology, providing limited mechanistic insight. However, relatively recent developments in MR compatible exercise devices now enable comprehensive MR imaging (MRI) and MR Spectroscopy (MRS) physiological and metabolic phenotyping during exercise. This provides real-time, non-invasive insight into whole-body metabolic physiology of disease during and in recovery from multiple modes of exercise stimuli. Moreover, it provides novel insight of metabolic and physiological resilience to stress.
This IBD fatigue project combines the application of functional and MRI- and MRS-based phenotyping to patients of differing fatigue status and healthy control volunteers. This approach will help to characterise the aetiology of this debilitating symptom and inform on potential treatment interventions.