Bowel Urgency in Patients with Ulcerative Colitis: Prevalence and Association with Clinical, Endoscopic Data and Disability

Abstract Background Bowel urgency (BU), identified as the sudden need for bowel movements, is increasingly being recognized as an impactful symptom in patients with ulcerative colitis (UC), distinct from stool frequency (SF) and rectal bleeding (RB). We aimed to assess the association of BU with patient-reported outcomes (PRO), including SF and RB, as well as clinical and endoscopic activity and disability in a real-world setting, using data from the IBD-Disk:Italian translation and validation study. Methods We conducted a cross-sectional multicentre study, consecutively including ≥ 18yo UC patients between February 2023 and October 2023. Demographic, clinical and endoscopic data were collected. Clinical remission was defined as partial Mayo score ≤ 1 and endoscopic activity as MES ≥ 1. All patients completed the following questionnaire for disability IBD-Disk and IBD Questionnaire-32 (IBDQ-32) for quality of life. BU was assessed using the question about regulating defecation in the past 7 days using a 10-point NRS ranging from 0 (absolutely disagree) to 10 (totally agree) from the IBD-DISK. RB was measured from question 22 of IBDQ and SF from question 1 of IBDQ-32, both using a 7-point NRS ranging from 0 (always) to 7 (never). Results 209 UC patients with a median age of 37(IQR 28-52) were enrolled, 111(53.1%) being female. Overall, 31 (14.8%) had proctitis, 91(45.5%) had left colitis and 87(41.6%) had extended/pancolitis. The median pMAYO score was 4(IQR=2-6), while the median MES was 2(IQR=1-2). 75% patients (35.9%) reporting BU were more likely to have moderate clinical (pMAYO=5; IQR=3-6) and endoscopic activity of disease (median MES=2; IQR=1-2) compared to those without urgency (p< .0001). Additionally, BU was associated with a higher median rate of hospitalizations in the previous 12 months (Δ=1; p<0.001).Patients with BU reported a higher degree of RB(33.3%) and SF(50,7%) than patients without BU (p< .0001).Noteworthy, individuals with BU had higher median IBD-DISK total score (29; IQR=9-52) and lower scores for IBDQ-32 (168;IQR=138-196) compared to patients without BU [median IBD-DISK=17(IQR=5-39); median IBDQ-32=181,IQR=158-202), p<0.001]. In the univariate analysis, BU was associated with a higher IBD-DISK total score (OR=1.04,CI=1.02-1.06; p<0.001) and SF (OR=0.59,CI=0.45-0.78; p=0.001), without being associated with RB (p=0.57) and IBD-Q32 total score (p=0.84). Conclusion BU can be a surrogate marker for UC clinical and endoscopic activity. Our findings suggest that it is an independent factor from RB and it is associated with disability. Hence, it can be considered as an additional key PRO in UC. However, a systematic standardized approach for BU definition and assessment is strongly awaited to incorporate it as treat-to-target measure