The Clinical Course of Bowel Urgency Severity Among Patients with Inflammatory Bowel Disease-A Real-World Study

James D Lewis; Theresa Hunter Gibble; Mingyang Shan; Xian Zhou; April N Naegeli; Ghadeer K Dawwas

doi:10.1007/s40801-024-00434-1

The Clinical Course of Bowel Urgency Severity Among Patients with Inflammatory Bowel Disease-A Real-World Study

Drugs Real World Outcomes. 2024 Sep;11(3):403-412. doi: 10.1007/s40801-024-00434-1. Epub 2024 Jun 15.

Authors

James D Lewis¹, Theresa Hunter Gibble², Mingyang Shan², Xian Zhou³, April N Naegeli², Ghadeer K Dawwas⁴

Affiliations

¹ Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 7th Floor, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA. lewisjd@pennmedicine.upenn.edu.
² Eli Lilly and Company, Indianapolis, USA.
³ Syneos Health, Morrisville, NC, USA.
⁴ Vanderbilt University Medical Center, Nashville, TN, USA.

Abstract

Background: Bowel urgency is a highly burdensome symptom among patients with inflammatory bowel disease (IBD).

Objectives: To assess changes in severity of bowel urgency and identify predictors of worsening or improvement among patients with Crohn's disease (CD) and ulcerative colitis (UC) at 6 months from their enrollment visit.

Methods: Data from patients in the Study of a Prospective Adult Research Cohort with IBD were analyzed. Enrolled patients with CD or UC with 6-month visits were included. Changes and predictors of bowel urgency severity over 6 months in patients with CD or UC were examined using two separate analyses: (a) "worsening" versus "no change" excluding those with moderate-to-severe bowel urgency at enrollment, and (b) "improvement" versus "no change" excluding those with no bowel urgency at enrollment. The enrollment characteristics were compared within these groups.

Results: At baseline, in both CD and UC, use of biologics and/or immunomodulators at enrollment was similar across cohorts. Among patients with CD, 206 of 582 (35.4%) reported worsening, and 195 of 457 (42.7%) reported improvement in bowel urgency. Younger age (P = 0.013) and moderate-to-severe bowel urgency (P < 0.001) were associated with improvement. Moderate bowel urgency (P = 0.026) and bowel incontinence while awake (P = 0.022) were associated with worsening. Among patients with UC, 84 of 294 (28.6%) reported worsening, and 111 of 219 (50.7%) reported improvement in bowel urgency. Higher symptomatic disease severity (P = 0.011) and more severe bowel urgency (P < 0.001) were associated with improvement.

Conclusions: Bowel urgency is an unpredictable and unstable symptom among patients with IBD. Over 50% of patients with CD or UC experienced either worsening or improvement at 6 months postenrollment.

Plain language summary

WHAT IS KNOWN ABOUT BOWEL URGENCY IN INFLAMMATORY BOWEL DISEASE (IBD)?: Around six to eight in every ten patients with inflammatory bowel disease suffer from bowel urgency, a sudden need to have bowel movement. Many patients with IBD perceive bowel urgency as a bothersome symptom impacting their everyday activities. WHY DID WE DO THIS STUDY?: Despite the importance of bowel urgency, the changes in bowel urgency severity among the IBD-affected US population are yet to be fully known. We aimed to assess changes in severity of bowel urgency in patients with Crohn’s disease (CD) or ulcerative colitis (UC) at 6 months. WHAT HAVE WE FOUND FROM THIS STUDY?: Bowel urgency is a common and unpredictable symptom among patients with CD and UC. Over 50% of patients reported that the severity of bowel urgency has either worsened or improved at the 6 months postenrollment. While about 40–50% of IBD patients reported improvement, about 30% reported worsening, suggesting a lack of effective therapies to treat bowel urgency. FUTURE IMPLICATION: There is a need for advanced therapies to resolve bowel urgency in patients with CD and UC.