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J Transl Med. 2019 Feb 22;17(1):55. doi: 10.1186/s12967-019-1797-3.

Increased risk of chronic fatigue syndrome in patients with inflammatory bowel disease: a population-based retrospective cohort study.

Tsai SY1,2,3,4,5, Chen HJ6,7, Lio CF8, Kuo CF9, Kao AC8, Wang WS9, Yao WC10, Chen C8, Yang TY11,12,13.

Author information

1
Department of Laboratory Medicine, MacKay Memorial Hospital, Taipei, Taiwan. stsai22@jhu.edu.
2
Department of Medicine, Mackay Medical College, New Taipei City, Taiwan. stsai22@jhu.edu.
3
Graduate Institute of Long-Term Care, Mackay Medical College, New Taipei City, Taiwan. stsai22@jhu.edu.
4
Graduate Institute of Biomedical Sciences, Mackay Medical College, New Taipei City, Taiwan. stsai22@jhu.edu.
5
Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. stsai22@jhu.edu.
6
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
7
College of Medicine, China Medical University, Taichung, Taiwan.
8
Department of Laboratory Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
9
Institute of Infectious Disease, MacKay Memorial Hospital, Taipei, Taiwan.
10
Department of Anesthesiology and Pain Medicine, Min-Sheng General Hospital, Tao-Yuan, 330, Taiwan.
11
College of Medicine, China Medical University, Taichung, Taiwan. hardawayoung@gmail.com.
12
Molecular and Genomic Epidemiology Center, China Medical University Hospital, Taichung, Taiwan. hardawayoung@gmail.com.
13
Division of Nephrology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan. hardawayoung@gmail.com.

Abstract

BACKGROUND:

Similarities in the symptoms of chronic fatigue syndrome (CFS) and inflammatory bowel disease (IBD) have been observed as follows: severe disease activity in IBD correlates with severe fatigue, major psychiatric signs, the common use of medication, and bacterial translocation. One of several hypotheses for explaining the mechanisms underlying CFS suggests a similarity to the impaired intestinal mucosa of IBD. "This study investigated the risk of incident CFS among patients with IBD".

METHODS:

We conducted a population-based retrospective cohort study by using Taiwan's National Health Insurance Research Database to evaluate the subsequent risk of CFS in patients with IBD, according to demographic characteristics and comorbidities. The exposure cohort comprised 2163 patients with new diagnoses of IBD. Each patient was randomly selected and frequency matching according to gender and age with four participants from the general population who had no history of CFS at the index date (control cohort). Cox proportional hazards regression analysis was conducted to estimate the relationship between IBD and the subsequent risk of CFS.

RESULTS:

The exposure cohort had a significantly higher overall risk of subsequent CFS than that of the control group [adjusted hazard ratio (Christophi in Inflamm Bowel Dis 18(12):2342-2356, 2012) = 2.25, 95%, confidence interval (Aaron and Buchwald in Ann Intern Med 134(9 Pt 2):868-881, 2001; Farraye et al. in Am J Gastroenterol 112:241, 2017) 1.70-2.99]. Further analysis indicated a significantly higher risk of CFS in patients who were male (HR = 3.23, 95% CI 2.12-4.91), were older than 35 years, and had IBD but without comorbidity status, e.g. Cancers, diabetes, obesity, depression, anxiety, sleep disorder, renal disease (HR = 2.50, 95% CI 1.63-3.84) after adjustment.

CONCLUSION:

The findings from this population-based retrospective cohort study suggest that IBD, especially Crohn's disease, is associated with an increased risk of subsequent CFS.

KEYWORDS:

Bacterial translocation; Chronic fatigue syndrome (CFS); Immunoinflammatory pathways; Inflammatory bowel disease; Microbiota-gut-brain interactions; Myalgic encephalomyelitis (ME); Oxidative and nitrosative stress (O&NS) pathways

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