Background: Fecal urgency (FU) is common in patients with active inflammatory bowel disease (IBD) and is associated with reduced well-being and poor quality of life (QOL). Despite greater therapeutic options, clinical symptoms may persist, and data is lacking regarding FU in patients with quiescent IBD. This study aimed to estimate the prevalence of FU, assess predictors of FU, and describe the impact of FU on QOL in patients with endoscopic quiescent IBD.

Methods: This cross-sectional study used prospectively collected data from SPARC (Study of a Prospective Adult Research Cohort) IBD, a multicenter longitudinal study of well-phenotyped adult IBD patients initiated by the Crohn’s & Colitis Foundation in 2016. Quiescent IBD was defined as Mayo endoscopy score 0-1 for ulcerative colitis (UC) and SES-CD score <3 for Crohn’s disease (CD). Patient reported outcomes within 30 days of endoscopy were analyzed. Patients with ostomy or IPAA were excluded. Odds ratio (OR) with 95% confidence interval was reported for univariate logistic regression of predictors for moderate/severe FU.

Results: Among 943 patients with quiescent IBD (579 CD; 364 UC) FU was more commonly reported in CD (37.5% mild, 27.8% moderate/severe) compared to UC (33.5% mild, 19.8% moderate/severe) (p<0.001) (Table 1). In the entire cohort, any urgency was associated with subjective abdominal pain, stool frequency, and bloody stool (all p<0.001). In UC, moderate-severe FU was associated with female sex (OR 1.6: 0.9, 2.8), IBD-related surgery (OR 4.0: 1.5, 10.4), recent smoking (OR 2.4: 1.2, 4.4), prior hospitalization for severe UC (OR 1.6: 0.9, 2.7). In CD, moderate-severe FU was associated with female sex (OR 1.3: 0.9, 1.9), IBD-related surgery (OR 1.2: 0.8, 1.7), recent smoking (OR 2.2: 1.4, 3.6), penetrating phenotype (OR 1.5: 0.9, 2.6). Patients with moderate/severe FU were more likely to be hospitalized (2.4% no FU, 1.5% mild FU, 3.4% moderate/severe FU, p=0.607) or seek emergency department (ED) visits (1.1% no FU, 0.3% mild FU, 3.0% moderate/severe FU, p=0.016) within 6 months from their quiescent endoscopy.

General well-being was poorer for those with more severe FU (p<0.001), and patients were more likely to utilize the ED (p=0.016). There were significant differences across all PROMIS domains, and those with moderate/severe FU reported pain (38.8%) and fatigue (60.0%) interfered with enjoyment of life at least some of the time compared to those without FU (3.9%; 10.0%) or mild FU (15.1%; 32.2%) (Figure 1).

Conclusion: In this study of SPARC IBD patients with endoscopic quiescent IBD, the overall prevalence of FU was 65.2% for CD and 53.3% for UC. FU was common in quiescent IBD and associated with poorer general well-being and QOL. Further research is needed to elucidate the pathophysiology of FU in quiescent IBD and personalize management.

<b>Table 1</b>. Demographics and inflammatory bowel disease (IBD) characteristics of SPARC IBD patients with quiescent Crohn’s disease (CD) and ulcerative colitis (UC) with symptoms of none, mild and moderate/severe fecal urgency. BMI, body mass index. 1. Pearson’s Chi-squared test 2. Kruskal-Wallis rank sum test.

Table 1. Demographics and inflammatory bowel disease (IBD) characteristics of SPARC IBD patients with quiescent Crohn’s disease (CD) and ulcerative colitis (UC) with symptoms of none, mild and moderate/severe fecal urgency. BMI, body mass index. 1. Pearson’s Chi-squared test 2. Kruskal-Wallis rank sum test.

<b>Figure 1. </b>Severity of Fecal Urgency on Quality of Life for Patients with Endoscopic Quiescent IBD using PROMIS (Patient-Reported Outcomes Measurement Information System) Scores for Fatigue, Pain Interference<sup>†</sup> and Social Interference<sup>†</sup>*.<br /> <br /> <sup>†</sup>Responses indicate the degree and frequency of interference with each of the activities listed.<br /> <b>*</b>Polarity of Social Interference subscale reversed for consistency and interpretability of the figure.

Figure 1. Severity of Fecal Urgency on Quality of Life for Patients with Endoscopic Quiescent IBD using PROMIS (Patient-Reported Outcomes Measurement Information System) Scores for Fatigue, Pain Interference^† and Social Interference^†*.

^†Responses indicate the degree and frequency of interference with each of the activities listed.
*Polarity of Social Interference subscale reversed for consistency and interpretability of the figure.

Tara Fehlmann

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