P0362 Bowel urgency in inflammatory bowel disease: The URGENT index
Authors: Caron B , Bouhnik Y , Stefanescu C , Treton X , Buisson A , Bourreille A , Fumery M , Nachury M , Roblin X , Nancey S , Vicaut E , Peyrin-Biroulet L 
Published: January 2025

Abstract

Background
Bowel urgency is commonly defined as the sudden need to rush to the bathroom to empty one’s bowel. In a systematic review including 321 studies evaluating bowel urgency, definition of bowel urgency was heterogeneous (1). In most of these studies, non-validated questionnaires, based on subjective responses of the patients, were used. The objective of this study were to develop the URGENT index, an IBD-specific bowel urgency index, and to evaluate correlation between the URGENT index and the Urgency Numeric Rating Scale (UNRS).

Methods
URGENT-1 was a cross-sectional, multicenter study with prospective inclusions of IBD patients and with an optional follow-up for a subset of patients. A stratification on the type of IBD was performed. The components of the URGENT index were based on variables describing in systematic review and expert opinion. All the symptoms potentially associated with bowel urgency were collected, and assessed with a 10-point visual analog scale.

Results
The content validity of the symptoms potentially associated with bowel urgency was tested by five experts. Face validity of the selected items was checked for clarity, comprehension, and ease of response with 20 patients. Then data corresponding to the selected items were collected.
The overall Cronbach’s alpha coefficient was 0.972. We systematically removed items based on their individual impact on the overall Cronbach’s Alpha. Three main factors explained most of the variance (87.9%): immediate urgency and action, ability to delay to go to toilets, and emotional and behavioral responses to urgency. There was no difference in gender and IBD type in the distribution in the factorial structure. To construct the index, we extracted the loadings from the PCA results and identified significant loadings with a threshold of 0.6. Next, we calculated the row means for these significant items to create subscale scores for each component. These scores were then weighted by the variance explained by each component. The weights were normalized, and the final index, named URGENT index, was calculated as a weighted sum of the subscale scores.
A sample of 40 patients, who were considered as stable, were studied to evaluate the test-retest reliability after a 3- week-period. Consistency of the URGENT index with the UNRS was tested using Spearman correlation test (0.77). Overall, the ICC values indicated good to excellent reliability across different models. Each index proposal will be tested prospectively.

Conclusion
This study developed an IBD-specific bowel urgency index. This will allow to have a homogeneous and standardized definition of bowel urgency, measure the effectiveness of treatments, and systematically assess this symptom in clinical practice for IBD patients.

References
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.