FECAL URGENCY ASSOCIATED WITH POOR QUALITY OF LIFE IN QUIESCENT IBD: A CROSS-SECTIONAL STUDY OF SPARC IBD COHORT
Authors: Dunleavy Katie , Dilmaghani Saam , Fehlmann Tara , Raffals Laura , Chedid Victor 
Published: January 2024

Abstract

BACKGROUND
Fecal urgency (FU) is common in patients with active inflammatory bowel disease (IBD) and has been associated with reduced well-being and poor quality of life (QOL). Despite greater therapeutic options, clinical symptoms may persist in some patients. Data is lacking regarding FU in patients with objectively documented quiescent disease.

OBJECTIVE
Among endoscopic quiescent disease: (1) estimate prevalence of urgency, (2) assess predictors of FU, (3) describe its impact on validated QOL measures.

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 &lt;2 for ulcerative colitis (UC) and SES-CD score &lt;3 for Crohn’s disease (CD). Patient reported outcomes (PROs) within 30 days of endoscopy were analyzed. Patients with ostomy or IPAA were excluded. Self-reported urgency was categorized as none, mild, or moderate/severe. Univariate statistics used Pearson’s Chi-square and Kruskal-Wallis tests.

RESULTS
A total of 943 patients with quiescent IBD (579 CD; 364 UC) were included in the study (Table 1). Fecal urgency was more commonly reported in quiescent CD (37.5% mild, 27.8% moderate/severe) as compared to quiescent UC (33.5% mild, 19.8% moderate/severe) (p&lt;0.001). In the entire quiescent cohort, those with mild or moderate/severe FU were more likely to be female sex (58.4%; 63.2%), higher BMI (28.2; 29.5) and have an IBD-related surgery (p=0.030). Mild and moderate/severe urgency was associated with subjective abdominal pain, stool frequency, and bloody stool (all p&lt;0.001). There was a trend towards ileocolonic involvement and penetrating disease in quiescent CD with moderate/severe urgency.
General well-being was poorer for those with more severe urgency (p&lt;0.001), and they were more likely to utilize the emergency department (p=0.016). Figure 1 depicts the PROMIS responses. There were significant differences across all domains, and notably those with moderate/severe urgency reported pain (38.8%) and fatigue (60.0%) interfered with enjoyment of life at least some of the time compared to those without urgency (3.9%; 10.0%) or with mild urgency (15.1%; 32,2%).

CONCLUSION
In this study of patients in SPARC IBD with endoscopic quiescent IBD the overall prevalence of fecal urgency was 65.2% for CD and 53.3% for UC. Fecal urgency was common in quiescent IBD and associated with poorer general well-being and quality of life. Further research is needed to elucidate the pathophysiology for presence of fecal urgency in quiescent IBD and develop personalized management approaches.

Table 1 Demographics and IBD characteristics of SPARC IBD patients with quiescent Crohn’s disease (CD) and ulcerative colitis (UC) with symptoms of mild versus moderate/severe fecal urgency.

Table 2 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.