Validation of the Urgency Numeric Rating Scale and correlation with endoscopic, histological, and manometric activity in ulcerative colitis

INTRODUCTION AND OBJECTIVES: The Urgency Numeric Rating Scale (U-NRS) assesses the severity of bowel urgency, a common symptom that is often underestimated in ulcerative colitis. This study aimed to translate the U-NRS into Portuguese and to provide validation in clinical practice, as well as to assess the prevalence of bowel urgency in a cohort of ulcerative colitis patients and, in those in clinical remission, to evaluate its relationship with endoscopic and histological activity and manometric changes. METHODS: After translation of the U-NRS into Portuguese, patients with ulcerative colitis seen at the outpatient clinic were asked to complete the scale at T0, after 2 weeks (T1) and after 3 months (T2). Patient-reported outcome-2 ulcerative colitis (PRO-2-UC), EQ-5D, EQ-Visual Analogue Scale (EQ-VAS), inflammatory bowel disease disk (IBD-Disk), and the Global Perceived Effect Scale were also completed. Acceptability, reliability, construct validity, responsiveness, and interpretability were assessed. A subgroup of patients in clinical remission with bowel urgency underwent sigmoidoscopy with rectal biopsies and anorectal manometry and were compared with a control group (in clinical remission without bowel urgency). RESULTS: In total, 126 patients were included, of whom 49.21% ( n = 62) had bowel urgency. Test-retest reliability was excellent (intraclass correlation coefficient: 0.768). The U-NRS correlated significantly with the PRO-2-UC, IBD-Disk, EQ-VAS, and EQ-5D ( P < 0.001), demonstrating construct validity. The U-NRS values correlated with the first constant sensation volume on anorectal manometry ( rs = -0.374, P = 0.038). CONCLUSION: The U-NRS scale is an easy and quick tool for assessing bowel urgency and can be incorporated into clinical practice.