Underevaluation of bowel urgency in clinical care: patient experiences and outcomes in ulcerative colitis: a retrospective cohort study

BACKGROUND: Bowel urgency increases the burden of disease in patients with ulcerative colitis (UC). It is unclear how urgency impacts UC-related outcomes independent of other hallmark symptoms such as rectal bleeding and increased stool frequency. We aimed to evaluate the assessment of urgency in real-world patients with UC and to characterize its association with UC-related outcomes. METHODS: This retrospective cohort study included patients with UC who were attending the IBD Clinic in Calgary, Canada, and had an index visit between December 2022-May 2023. We determined the correlation between urgency and other symptoms, endoscopy, and biomarkers. We assessed the association between urgency and developing a UC-related event in follow-up, defined by the requirement for advanced treatment change, hospitalization, or surgery for UC, evaluated using Cox proportional hazards and modeling urgency as a time-varying covariable. RESULTS: A total of 262 patients were included. Across all encounters, urgency was evaluated in 58.2% of visits, almost exclusively as being present or absent. Urgency was weakly-to-modestly correlated with rectal bleeding (r = 0.46), endoscopic appearance (0.31), and fecal calprotectin (0.33). One in 5 patients had persistent urgency, despite the normalization of rectal bleeding and stool frequency. Urgency was associated with an increased hazard of a UC-related event, after adjusting for rectal bleeding and stool frequency (adjusted hazard ratio, 2.64; 95% CI, 1.29-5.40; P = .008). CONCLUSION: Urgency is inconsistently assessed in routine clinical care, although when present it provides additive information to other measures of disease activity in UC and is associated with an increased risk of disease-related events.