Bathroom urgency could well predict UC severity

Frequent bathroom urgency in patients with ulcerative colitis (UC) could well predict UC severity. Hence, it should be considered a UC-specific patient-reported outcome, said experts at AIBD 2021.

A form of inflammatory bowel disease, UC causes irritation, inflammation, and ulcers in the lining of the colon. Currently, there is no cure for UC and patients would usually have symptoms on and off for life.  

In a cross-sectional study, researchers evaluated 632 patients with UC who were enrolled in the IBD Partners research network. [AIBD 2021, abstract P075]

Urgency levels (no urgency, hurry, immediately, and incontinence) associated with quality of life, as demonstrated by the patient-reported outcome measurement information system (PROMIS) scores, were the main outcomes assessed.

Urgency was defined as the need for immediate stool frequency. Corticosteroid use, colectomy risk, and future hospitalizations within 12 months were also assessed.

Multivariate models adjusted for demographics, stool frequency, rectal bleeding, and additional clinical factors, such as prior hospitalizations and time from diagnosis, use of biologics, immunomodulators, or aminosalicylates.

Adjusted multivariate models showed patients who were in a hurry (odds ratio 2.05, 95 percent confidence interval [CI], 1.24–3.40) or had to immediately go to the bathroom or toilet (OR, 2.76, 95 percent CI, 1.10–6.74), or experienced incontinence (OR, 7.7, 95 percent CI, 1.66–38.30), were at increased risk of social impairment associated with their level of urgency vs those without any urgency, said study author Dr Jared Sninsky from the University of North Carolina at Chapel Hill, North Carolina, US.

The risk of colectomy within 12 months also went higher as patients went from being in a hurry to go to the bathroom (OR, 1.41, 95 percent CI, 1.15–1.72) to immediately requiring a bathroom (OR, 1.80, 95 percent CI, 1.39–2.35), and to being incontinent (OR, 3.29, 95 percent CI, 2.13–5.09), reported Sninsky.

Urgency significantly increased the risk of anxiety, depression, fatigue, use of corticosteroids, and hospitalizations in patients with UC.

“These findings support the consideration of urgency as a UC-specific patient-reported outcome and its use as an outcome in clinical trials to capture the quality of life and risk of clinical decompensation,” said Sninsky.

Commenting on the study, Dr Dana Lukin from Weill Cornell Medicine in New York City, New York, US, who was unaffiliated with the study, said urgency is fast gaining attention as a UC-patient reported outcome owing to its impact on patients’ quality of life and other disease-related outcomes. “Newer clinical trial designs have also begun to consider the inclusion of urgency as a trial endpoint,” she added. “The study validates the use of urgency as a real-world predictor of UC severity and its inclusion in clinical trial design.”

However, she considered as study limitations the use of patient-reported outcomes and the relatively short patient follow-up period of 12 months.