More Bathroom Visits Tied To Social Impairments in Ulcerative Colitis

Patients with ulcerative colitis (UC) who experienced higher levels of stool frequency (urgency) had greater risks of social impairment and colectomy, a researcher reported.

In an analysis with over 600 UC patients, adjusted multivariate models showed patients who were in a hurry (odds ratio 2.05, 95% CI 1.24-3.40) or had to immediately go to the toilet (OR 2.76, 95% CI 1.10-6.74), or experienced incontinence (OR 7.7, 95% CI 1.66-38.30), were at increased risks of social impairment associated with their level of urgency compared to those without any urgency, according to Jared Sninsky, MD, of the University of North Carolina at Chapel Hill.

The risk of a required colectomy within 12 months also grew higher as patients went from being in a hurry to go to the bathroom (OR 1.41, 95% CI 1.15-1.72) to immediately requiring a bathroom (OR 1.80, 95% CI 1.39-2.35), to being incontinent (OR 3.29, 95% CI 2.13-5.09), Sninsky and colleagues demonstrated in a poster presentation at the Advances in Inflammatory Bowel Disease virtual meeting.

Urgency significantly increased the risk of anxiety, depression, fatigue, requiring the use of corticosteroids, and hospitalizations for patients with UC, they reported.

“Our findings support the consideration of urgency as a UC-specific PRO [patient reported outcome] and its use as an outcome in clinical trials to capture quality of life [QoL] and risk of clinical decompensation,” they stated.

“Urgency is a UC-patient reported outcome gaining attention for its impact on quality of life and other disease-related outcomes, and newer clinical trial designs have begun to consider the inclusion of urgency as a trial endpoint,” explained Dana J. Lukin, MD, of Weill Cornell Medicine in New York City, who was not involved in the study. “This study validates the use of urgency as a real-world predictor of UC severity and its inclusion in clinical trial design.”

For the cross-sectional study, Sninsky and colleagues evaluated 632 patients with UC enrolled in the IBD Partners research network.

The main outcomes assessed the levels of urgency (no urgency, hurry, immediately, and incontinence) associated with QoL, as demonstrated by the PRO measurement information system (PROMIS) scores. Urgency was defined as the need for immediate stool frequency. Additional outcomes assessed were corticosteroid use, colectomy risk, and future hospitalizations within 12 months.

Multivariate models adjusted for demographics, stool frequency, rectal bleeding, and additional clinical factors, such as prior hospitalizations and time from diagnosis, as well as use of biologics, immunomodulators, or aminosalicylates (5-ASA).

Study limitations including the use of PROs, which is subject to reporting bias, and the relatively short 12-month patient follow-up.