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Review
. 2023 Nov 1;118(11):1940-1953.
doi: 10.14309/ajg.0000000000002404. Epub 2023 Jun 12.

Bowel Urgency in Ulcerative Colitis: Current Perspectives and Future Directions

Marla Dubinsky  1 , Alison Potts Bleakman  2 , Remo Panaccione  3 , Toshifumi Hibi  4 , Stefan Schreiber  5 , David Rubin  6 , Axel Dignass  7 , Isabel Redondo  2 , Theresa Hunter Gibble  2 , Cem Kayhan  2 , Simon Travis  8
Affiliations
Review

Bowel Urgency in Ulcerative Colitis: Current Perspectives and Future Directions

Marla Dubinsky et al. Am J Gastroenterol. .

Abstract

Bowel urgency (BU), the sudden or immediate need for a bowel movement, is one of the most common and disruptive symptoms experienced by patients with ulcerative colitis (UC). Distinct from the separate symptom of increased stool frequency, BU has a substantial negative impact on quality of life and psychosocial functioning. Among patients with UC, BU is one of the top reasons for treatment dissatisfaction and one of the symptoms patients most want improved. Patients may not discuss BU often due to embarrassment, and healthcare providers may not address the symptom adequately due to the lack of awareness of validated tools and/or knowledge of the importance of assessing BU. The mechanism of BU in UC is multifactorial and includes inflammatory changes in the rectum that may be linked to hypersensitivity and reduced compliance of the rectum. Responsive and reliable patient-reported outcome measures of BU are needed to provide evidence of treatment benefits in clinical trials and facilitate communication in clinical practice. This review discusses the pathophysiology and clinical importance of BU in UC and its impact on the quality of life and psychosocial functioning. Patient-reported outcome measures developed to assess the severity of BU in UC are discussed alongside overviews of treatment options and clinical guidelines. Implications for the future management of UC from the perspective of BU are also explored.

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Conflict of interest statement

Guarantor of the article: Marla Dubinsky, MD.

Specific author contributions: All authors contributed to searching the literature and drafting the manuscript, and approved the final draft submitted.

Financial support: This narrative review was supported by Eli Lilly and Company. Authors who are employees of the sponsor played a role in interpreting the published studies included in this review and writing the manuscript. Medical writing support was provided by Andrew Sakko, PhD, CMPP, and Nicole Lipitz, and editorial support was provided by Antonia Baldo and Raena Fernandes, of Syneos Health, and funded by Eli Lilly and Company in accordance with Good Publication Practice (GPP 2022) guidelines (www.ismpp.org/gpp-2022).

Potential competing interests: A.P.B., T.H.G., C.K., and I.R. are employees of, and own stock in, Eli Lilly and Company. A.D. reports fees for participation in clinical trials, review activities such as data monitoring boards, statistical analysis, and end point committees from AbbVie, Bristol Myers Squibb, Falk Foundation, Gilead Sciences, Janssen, and Pfizer; consultancy fees from AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celltrion, Eli Lilly and Company, Falk Foundation, Ferring Pharmaceuticals, Fresenius Kabi, Galapagos, Hexal, Janssen, MSD, Pfizer, Pharmacosmos, Roche, Sandoz, Takeda, and Tillotts Pharma; payment from lectures including service on speakers bureaus from AbbVie, Celltrion, Falk Foundation, Ferring Pharmaceuticals, Galapagos, Gilead Sciences, Janssen, MSD, Pfizer, Pharmacosmos, Takeda, and Tillotts Pharma; and payment for article preparation from Eli Lilly and Company, Falk Foundation, Pfizer, and Takeda. M.D. reports consultancy fees from AbbVie, Arena Pharmaceuticals, Bristol Myers Squibb, Celgene, Eli Lilly and Company, Gilead Sciences, Janssen, Pfizer, Takeda, and UCB. T.H. is an editor of Intestinal Research and reports grants, personal fees, and/or other funds from AbbVie, Aspen Pharmacare, Celltrion, EA Pharma, Eli Lilly and Company, Ferring Pharmaceuticals, Gilead Sciences, Janssen, JIMRO, Kissei Pharmaceutical, Kyorin Pharmaceutical, Mitsubishi Tanabe Pharma, Miyarisan Pharmaceutical, Mochida Pharmaceutical, Nichi-Iko Pharmaceutical, Nippon Kayaku, Otsuka, Pfizer, Takeda, and Zeria Pharmaceutical. R.P. reports consulting and/or lecture fees from AbbVie, Abbott, Alimentiv (formerly Robarts), Amgen, Arena Pharmaceuticals, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Celltrion, Cosmo Pharmaceuticals, Eisai, Elan Corporation, Eli Lilly and Company, Ferring Pharmaceuticals, Galapagos, Genentech, Gilead Sciences, GlaxoSmithKline, Janssen, Merck, Mylan, Oppilan Pharma, Pandion Therapeutics, Pfizer, Progenity, Protagonist Therapeutics, Roche, Sandoz, Satisfai Health, Shire, Sublimity Therapeutics, Takeda, Theravance Biopharma, and UCB. D.R. reports grant support from Takeda and has served as a consultant for AbbVie, AltruBio, Arena Pharmaceuticals, Bristol Myers Squibb, Eli Lilly and Company, Genentech, Gilead Sciences, Iterative Scopes, Janssen, Pfizer, Prometheus Biosciences, Roche, Takeda, and Techlab. S.S. reports no conflicts of interest. S.T. reports grants and/or research support from AbbVie, Buhlmann Diagnostics, Celgene, Eli Lilly and Company, the International Organization for the Study of Inflammatory Bowel Disease, Janssen, the Norman Collisson Foundation, Takeda, UCB, and Vifor Pharma; consulting fees from Abacus Pharmaceuticals, AbbVie, Actial, ai4gi, Alcimed, Allergan, Amgen, Arena Pharmaceuticals, Asahi Kasei Pharma, Astellas Pharma, AstraZeneca, Atlantic Pharmaceuticals, Barco, Biocare Pharma, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Buhlmann Diagnostics, Calcico, Celgene, Cellerix, Celsius Healthcare, Cerimon Pharmaceuticals, ChemoCentryx, Cisbio, Coronado Biosciences, Cosmo Pharmaceuticals, Ducentis BioTherapeutics, Dynavax, Elan Corporation, Eli Lilly and Company, Enterome, Falk Foundation, Ferring Pharmaceuticals, FPRT Bio, Giuliani, Genentech, Genzyme, GlaxoSmithKline, Glenmark Pharmaceuticals, Grünenthal, GW Pharmaceuticals, Immunocore, Immunometabolism, Indigo Biosciences, Janssen, Lexicon Pharmaceuticals, Medarex, Merck, MSD, Neovacs, Netbiotix, Novartis, Novo Nordisk, NPS Pharma, Ocera Therapeutics, Otsuka, Palau Pharma, Pentax Medical, Pfizer, Philips, Procter & Gamble, Pronota, Proximagen, Ptima Pharma, Receptos, Resolute, Robarts Pharmaceutical, Roche, Sandoz, Santarus, Sensyne Health, Shire, Sigmoid Pharma, SynDermix, Synthon, Takeda, Theravance Biopharma, TiGenix, Tillotts Pharma, TopiVert, TxCell, UCB, Vertex, VHsquared, Vifor Pharma, Warner Chilcott, and Zeria Pharmaceutical; and speaker fees from AbbVie, Amgen, Biogen, Falk Foundation, Ferring Pharmaceuticals, GlaxoSmithKline, Janssen, Shire, Takeda, and Zeria Pharmaceutical.

Figures

Figure 1.
Figure 1.
Multifactorial mechanisms of bowel urgency in ulcerative colitis.
Figure 2.
Figure 2.
Impact of bowel urgency on patient quality-of-life and psychosocial functioning. Sources: Waljee et al (61); Dubinsky et al (6); Hibi et al (9); Dibley and Norton (14); Larsson et al (13); Schreiber et al (62); Petryszyn and Paradowski (8); Miller et al (63); Dubinsky et al (64); Dibley et al (12); Sninsky et al (3); Tew et al (11); Travis et al (65); and Kemp et al (66).
Figure 3.
Figure 3.
Urgency Numerical Rating Scale (NRS), a patient-reported outcome measure to assess bowel urgency in adults with ulcerative colitis. Source: Dubinsky et al (6). Reproduced without changes per the Creative Commons license (https://creativecommons.org/licenses/by/4.0/legalcode). For permission to reproduce or use the Urgency NRS, please contact copyright@lilly.com.
See this image and copyright information in PMC

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