Iron deficiency, depression, and fatigue in inflammatory bowel diseases

Abstract

Background Iron deficiency and anemia are common findings in IBD. Treatment of anemia improves quality of life. Neurological symptoms like depression or anxiety are also common in IBD; however, their relationship with ID has not been studied in detail.

Methods Prospective, single center, non-interventional trial in an IBD cohort (n = 98), which is generally at risk for ID. Quality of sleep (using the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Insomnia Severity Index) and the presence of fatigue (Piper fatigue scale), depression (Self-rating Depression Scale [SDS]) or anxiety (Self-rating Anxiety Scale [SAS]) were related to ID (ferritin, transferrin saturation), anemia (hemoglobin), and inflammatory disease activity (CRP).

Results ID was present in 35 %, anemia in 16 %, and inflammation in 30 %. The overall quality of sleep in this cohort was similar to that reported for the general population. ID, anemia, or inflammation had no influence on the PSQI (median 4.0 [CI 3.0–5.0]), the ESS 5.5 (5.0–7.0), and the ISI 4.00 (2.5–5.5). Fatigue (PFS; present in 30 %), anxiety (SAS; present in 24 %), and depression (SDS; present in 33 %) were more common than in the general population. Iron deficient and anemic patients were more likely to be depressed (p = 0.02 and p < 0.01) and showed a trend towards presence of fatigue (p = 0.06 and 0.07). Systemic inflammation as measured by CRP had no effect on any of these conditions.

Conclusion In this IBD cohort, ID and anemia affect depression and possibly fatigue independent of the presence of inflammation.

Zusammenfassung

Hintergrund Eisenmangel und Anämie sind häufige extraintestinale Komplikationen der chronisch entzündlichen Darmerkrankungen (CED). Eine Behandlung der Anämie verbessert die Lebensqualität. Neurologische Symptome wie Depression oder Angst sind ebenfalls häufig bei CED; deren Zusammenhang mit Eisenmangel wurde aber noch nicht untersucht.

Methoden Prospektive, monozentrische, nichtinterventionelle Studie an Patienten mit CED (n = 98). Schlafqualität (mittels PSQI-Pittsburgh Sleep Quality Index, ESS-Epworth Sleepiness Scale, und ISI-Insomnia Severity Index) und das Vorliegen von Erschöpfung (PFS-Piper fatigue scale), Depression (SDS-Self-rating Depression Scale) oder Angst (SAS-Self-rating Anxiety Scale) und deren Zusammenhang mit Eisenmangel (Ferritin, Transferrinsättigung), Anämie (Hämoglobin) oder Entzündung (CRP) wurden untersucht.

Ergebnisse Eisenmangel war bei 35 % der CED-Patienten vorhanden, Anämie in 16 % und Entzündung in 30 % der Fälle. Die Schlafqualität war gesunden Probanden ähnlich. Ergebnisse der PQSI (median 4,0 [KI 3,0–5,0]), ESS 5,5 (5,0–7,0) und ISI 4,00 (2,5–5,5) wurden nicht durch Eisenmangel, Anämie, oder Entzündung beeinflusst. Erschöpfung (PFS; 30 % Prävalenz), Angst (SAS; 24 % Prävalenz) und Depression (SDS, 33 % Prävalenz) waren häufiger bei CED als in der Allgemeinbevölkerung. IBD-Patienten mit Eisenmangel oder Anämie waren häufiger depressiv (p = 0,02 and p < 0,01) und tendierten häufiger zu Erschöpfung (p = 0,06 and 0,07). Entzündungsaktivität – gemessen an CRP – hatte keinen Einfluss auf die Untersuchungsergebnisse.

Schlussfolgerung In dieser IBD-Kohorte beeinflussen Eisenmangel und Anämie die Depression und möglicherweise die Erschöpfung, unabhängig von vorhandener Entzündung.

Key words

IBD - iron deficiency - anxiety - depression - quality of life - quality of sleep

Schlüsselwörter

CED - Eisenmangel - Angst - Depression - Lebensqualität - Schlafqualität

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