Bowel Urgency in Inflammatory Bowel Disease: A Critical Review of Patient-Reported Outcomes and Clinical Significance
Abstract
Background: Bowel urgency, defined as the sudden and immediate need to defecate, is a highly distressing symptom of inflammatory bowel disease (IBD), particularly in patients with ulcerative colitis (UC). Despite its profound impact on daily functioning and quality of life, this symptom remains underrecognized and undertreated in routine clinical practice. This review aims to highlight the clinical significance of bowel urgency, its role as a crucial patient-reported outcome (PRO), and its response to novel therapeutic interventions.
Methods: This is a focused narrative review of existing literature, including clinical trials, consensus statements, and patient-centered studies, that addresses the prevalence, impact, and therapeutic management of bowel urgency in IBD.
Results: Bowel urgency is a prevalent symptom, with over 80% of IBD patients reporting it, and 35-40% continuing to experience it even in clinical remission [3, 9, 14]. Its impact extends beyond physical discomfort, leading to significant emotional distress, including fear, embarrassment, and social withdrawal [9]. The CONFIDE study, for example, revealed that up to 45% of UC patients weekly use pads or diapers to manage this symptom [9]. The absence of bowel urgency is strongly correlated with better clinical and endoscopic outcomes, positioning it as a key indicator of disease control and a valid therapeutic target [14]. Emerging therapies such as mirikizumab, upadacitinib, and risankizumab have demonstrated meaningful improvement in bowel urgency, reinforcing its value as a relevant endpoint in clinical trials [12, 13, 14, 15, 16].
Conclusion: Bowel urgency is a central and debilitating symptom for many IBD patients that is often not adequately assessed. A paradigm shift is needed in clinical practice to prioritize the use of validated PRO tools to better capture and address this symptom. Improving patient-clinician communication and integrating bowel urgency into treatment goals is essential for achieving more comprehensive disease management and improving patient outcomes
Keywords
Inflammatory Bowel Disease, Ulcerative Colitis; Bowel Urgency, Patient-Reported Outcomes, ; Mirikizumab; RisankizumabHow to Cite
References
Greenberger NJ, Blumberg RS, Burakoff R. eds. CURRENT Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy, 3e. McGraw-Hill Education; 2016. ISBN:978-0-07-183773-6
Barnes, A., Toson, B., Bryant, R. et al. Latent profiles of fatigue in inflammatory bowel disease. BMC Gastroenterol 24, 148 (2024). https://doi.org/10.1186/s12876-024-03239-2
Dubinsky M, Bleakman AP, Panaccione R, Hibi T, Schreiber S, Rubin D, Dignass A, Redondo I, Gibble TH, Kayhan C, Travis S. Bowel Urgency in Ulcerative Colitis: Current Perspectives and Future Directions. Am J Gastroenterol. 2023 Nov 1;118(11):1940-1953. doi: 10.14309/ajg.0000000000002404. Epub 2023 Jun 12. PMID: 37436151; PMCID: PMC10617668.
Horrigan JM, Louis E, Spinelli A, Travis S, Moum B, Salwen-Deremer J, Halfvarson J, Panaccione R, Dubinsky MC, Munkholm P, Siegel CA. The Real-World Global Use of Patient-Reported Outcomes for the Care of Patients With Inflammatory Bowel Disease. Crohns Colitis 360. 2023 Feb 22;5(2):otad006. doi: 10.1093/crocol/otad006. PMID: 36937140; PMCID: PMC10022710.
Kim AH, Roberts C, Feagan BG, Banerjee R, Bemelman W, Bodger K, Derieppe M, Dignass A, Driscoll R, Fitzpatrick R, Gaarentstroom-Lunt J, Higgins PD, Kotze PG, Meissner J, O’Connor M, Ran ZH, Siegel CA, Terry H, van Deen WK, van der Woude CJ, Weaver A, Yang SK, Sands BE, Vermeire S, Travis SP. Developing a Standard Set of Patient-Centred Outcomes for Inflammatory Bowel Disease-an International, Cross-disciplinary Consensus. J Crohns Colitis. 2018 Mar 28;12(4):408-418. doi: 10.1093/ecco-jcc/jjx161. PMID: 29216349.
Pittet VEH, Maillard MH, Simonson T, Fournier N, Rogler G, Michetti P; Swiss IBD Cohort Study Group(∗). Differences in Outcomes Reported by Patients With Inflammatory Bowel Diseases vs Their Health Care Professionals. Clin Gastroenterol Hepatol. 2019 Sep;17(10):2050-2059.e1. doi: 10.1016/j.cgh.2018.11.029. Epub 2018 Nov 22. PMID: 30471455.
Williet N, Sandborn WJ, Peyrin-Biroulet L. Patient-reported outcomes as primary end points in clinical trials of inflammatory bowel disease. Clin Gastroenterol Hepatol. 2014 Aug;12(8):1246-56.e6. doi: 10.1016/j.cgh.2014.02.016. Epub 2014 Feb 15. PMID: 24534550.
Teich N, Schulze H, Knop J, Obermeier M, Stallmach A. Novel Approaches Identifying Relevant Patient-Reported Outcomes in Patients With Inflammatory Bowel Diseases-LISTEN 1. Crohns Colitis 360. 2021 Jul 17;3(3):otab050. doi: 10.1093/crocol/otab050. PMID: 36776662; PMCID: PMC9802460.
Travis S, Potts Bleakman A, Dubinsky MC, Schreiber S, Panaccione R, Hibi T, Hunter Gibble T, Kayhan C, Atkinson C, Sapin C, Flynn EJ, Rubin DT. The Communicating Needs and Features of IBD Experiences (CONFIDE) Study: US and European Patient and Health Care Professional Perceptions of the Experience and Impact of Symptoms of Moderate-to-Severe Ulcerative Colitis. Inflamm Bowel Dis. 2024 Jun 3;30(6):939-949. doi: 10.1093/ibd/izad142. PMID: 37603837; PMCID: PMC11144997.
Roseira J, Magro F, Fernandes S, Simões C, Portela F, Vieira AI, Patita M, Leal C, Lago P, Caldeira P, Gago T, Currais P, Dias CC, Santiago M, Dias S, Tavares de Sousa H. Sexual Quality of Life in Inflammatory Bowel Disease: A Multicenter, National-Level Study. Inflamm Bowel Dis. 2020 Apr 11;26(5):746-755. doi: 10.1093/ibd/izz185. PMID: 31504518.
Tanaka, M., Kawakami, A., Sakagami, K. et al. Development and validation of a 13-item short version of the inflammatory bowel disease self-efficacy scale. BMC Gastroenterol 24, 190 (2024). https://doi.org/10.1186/s12876-024-03206-x
Marc Ferrante, Silvio Danese, Minhu Chen, Geert D’Haens, Subrata Ghosh, Tadakazu Hisamatsu, Vipul Jairath, Jaroslaw Kierkus, Laurent Peyrin-Biroulet, Britta Siegmund, Sonja Michelle Bragg, Wallace Crandall, Theresa Hunter Gibble, Zhantao Lin, Michelle Ugolini Lopes, Nathan Morris, Hilde Carlier, Bruce E. Sands, Primary Efficacy and Safety of Mirikizumab in Moderate to Severe Crohn’s Disease: Results of the Treat Through VIVID 1 Study, ECCO’24 Congress, 2024.
Bretto E, Ribaldone DG, Caviglia GP, Saracco GM, Bugianesi E, Frara S. Inflammatory Bowel Disease: Emerging Therapies and Future Treatment Strategies. Biomedicines. 2023 Aug 11;11(8):2249. doi: 10.3390/biomedicines11082249. PMID: 37626745; PMCID: PMC10452708.
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.
Theresa Hunter Gibble, Jake Macey, HarrietMakin, Rodica Rosu, Katie Mellor, Helen Kitchen, Hilde Carlier, Marla Dubinsky, Exit interviews exploring Crohn’s disease patients’ experience of changes in their bowel urgency during the mirikizumab Phase 3 clinical trial in adult patients with moderate to severe Crohn’s disease, 2024.
Loftus E, Panaccione R, Parkes G. Risankizumab induction therapy in patients with moderately to severely active ulcerative colitis: efficacy and safety in the randomized phase 3 INSPIRE study
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Individual articles are published Open Access under the Creative Commons Licence: CC-BY 4.0.
