P0091 Faecal Urgency in Crohn’s Disease: Correlation with Disease Location, Activity, Quality of Life and Mental Health Status – A Cross-Sectional Study
Authors: Borges Chaves C , Azevedo Silva I , Feijó D , Temido M J , Souto P , Ferreira A M , Lopes S , Mendes S , Ferreira M , Narra Figueiredo P , Portela F 
Published: January 2025

Background

Faecal urgency (FU) is relatively neglected yet common among patients with inflammatory bowel disease (IBD) and has been correlated with disease activity1,2. Its presence in ulcerative colitis is easily understood; however, in Crohn's disease (CD), where lesions are in more proximal regions such as the ileum or right colon while the left colon remain unaffected, the presence of FU is less straightforward.

This study aims to compare the prevalence and severity of FU in patients with CD with proximal involvement versus those with distal involvement, using the splenic flexure as a dividing point and to correlate these findings with disease activity, work productivity, quality of life (QoL), and symptoms of anxiety or depression.

Methods

We conducted a cross-sectional study at a tertiary centre, conveniently sampling all consenting patients with Crohn's disease (CD) who completed a questionnaire between July and September 2024. FU was assessed using a numeric rating scale from 0 to 10, with scores of 0 or 1 indicating FU absence3. Additionally, participants completed the following questionnaires: Work Productivity and Activity Impairment Questionnaire (WPAI-GH), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and the Hospital Anxiety and Depression Scale (HADS). Statistical analyses were performed using SPSS Statistics version 26®.

Results

We included 158 patients with a mean age of 42.1 ± 1.3 years, 88 (55.7%) were female and 109 (69.0%) reported FU. Overall, 97 (61.4%) had proximal disease, while 61 (38.6%) had distal disease, of whom 69 (71.1%) and 40 (65.6%) reported FU, respectively. Distal involvement was not associated with the presence of FU symptoms (OR = 0.77; 95% CI [0.39-1.54]; p = 0.46) nor with complaint severity, even if rectal involvement was described (n=24; 39.3%). The presence and severity of FU did not correlate with disease activity (faecal calprotectin, C-reactive protein, endoscopic, ultrasonographic, or clinical). A positive correlation was observed between the severity of FU and higher levels of anxiety symptoms (r = 0.18; p = 0.03) and depressive symptoms (r = 0.16; p = 0.04). Increasing severity of FU was not associated with absenteeism (r = 0.04; p = 0.71) but was associated with presenteeism (r = 0.27; p = 0.01), overall work productivity loss (r = 0.26; p = 0.01), activity impairment (r = 0.28; p &lt; 0.001), and poorer QoL (r = -0.39; p &lt; 0.001).

Conclusion

In our study, the presence of FU in CD is not related to involvement site and disease activity, but rather correlated with symptoms of anxiety and depression. Therefore, treatment approaches for FU may require different strategies than immunomodulators4.

References

1. Ha C, Naegeli AN, Lukanova R, Shan M, Wild R, Hennessy F, Jyothi Kommoju U, Potts Bleakman A, Hunter Gibble T. Rectal Urgency Among Patients With Ulcerative Colitis or Crohn's Disease: Analyses from a Global Survey. Crohns Colitis 360. 2023 Sep 25;5(4):otad052. doi: 10.1093/crocol/otad052. PMID: 37928613; PMCID: PMC10622170.

2. Dawwas GK, Jajeh H, Shan M, Naegeli AN, Hunter T, Lewis JD. Prevalence and Factors Associated With Fecal Urgency Among Patients With Ulcerative Colitis and Crohn's Disease in the Study of a Prospective Adult Research Cohort With Inflammatory Bowel Disease. Crohns Colitis 360. 2021 Jul 8;3(3):otab046. doi: 10.1093/crocol/otab046. PMID: 36776663; PMCID: PMC9902261.

3. Dubinsky MC, Clemow DB, Hunter Gibble T, Li X, Vermeire S, Hisamatsu T, Travis SPL. Clinical Effect of Mirikizumab Treatment on Bowel Urgency in Patients with Moderately to Severely Active Ulcerative Colitis and the Clinical Relevance of Bowel Urgency Improvement for Disease Remission. Crohns Colitis 360. 2022 Dec 13;5(1):otac044. doi: 10.1093/crocol/otac044. PMID: 36777368; PMCID: PMC9802448.

4. Caron B, Ghosh S, Danese S, Peyrin-Biroulet L. Identifying, Understanding, and Managing Fecal Urgency in Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol. 2023 Jun;21(6):1403-1413.e27. doi: 10.1016/j.cgh.2023.02.029. Epub 2023 Mar 9. PMID: 36906079.