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

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