Bowel Urgency in Ulcerative Colitis is Independently Associated with Histologic Inflammation and Stool Form Despite Endoscopic Remission

Zih-Hao Wei; Tai-Di Chen; Jen-Wei Chou; Shih-Hua Lin; Tien-Yu Huang; Chen-Wang Chang; Cheng-Tang Chiu; Chien-Ming Chen; Tony Kuo; Ming-Yao Su; Yu-Bin Pan; Puo-Hsien Le

doi:10.2147/JIR.S549513

Bowel Urgency in Ulcerative Colitis is Independently Associated with Histologic Inflammation and Stool Form Despite Endoscopic Remission

J Inflamm Res. 2025 Oct 8:18:13897-13906. doi: 10.2147/JIR.S549513. eCollection 2025.

Authors

Zih-Hao Wei¹, Tai-Di Chen^{2

3}, Jen-Wei Chou^{4

5

6}, Shih-Hua Lin^{3

4

7}, Tien-Yu Huang^{4

8}, Chen-Wang Chang^{4

9

10

11}, Cheng-Tang Chiu^{3

4

12

13

14}, Chien-Ming Chen^{3

15}, Tony Kuo^{3

4

13}, Ming-Yao Su^{3

4

7

14}, Yu-Bin Pan¹⁶, Puo-Hsien Le^{3

4

12

13

14

17}

Affiliations

¹ Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan.
² Department of Pathology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
³ Chang Gung Inflammatory Bowel Disease Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
⁴ Taiwan Association for the Study of Intestinal Diseases (TASID), Taoyuan City, Taiwan.
⁵ Center for Digestive Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
⁶ School of Chinese Medicine, China Medical University, Taichung, Taiwan.
⁷ Division of Gastroenterology and Hepatology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, Tucheng, New Taipei City, Taiwan.
⁸ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
⁹ Division of Gastroenterology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
¹⁰ MacKay Junior College of Medicine, Nursing and Management, Taipei, Taiwan.
¹¹ College of Medicine, MacKay Medical College, New Taipei City, Taiwan.
¹² Chang Gung Microbiota Therapy Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
¹³ Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
¹⁴ College of Medicine, Chang Gung University, Taoyuan, Taiwan.
¹⁵ Department of Medical Imaging and Interventions, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
¹⁶ Biostatistical Section, Clinical Trial Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.
¹⁷ Chang Gung Liver Research Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan.

Abstract

Background: Bowel urgency (BU) is a distressing symptom in patients with ulcerative colitis (UC), yet its associations with disease activity and patient-reported outcomes remain unclear. This study aimed to provide the first comprehensive evaluation of these relationships.

Materials and methods: Between September 2024 and March 2025, we enrolled 100 patients with UC. Patients were stratified into two groups based on the Urgency Numeric Rating Scale (NRS): bowel urgency-active (BU-A; NRS > 1) and bowel urgency-remission (BU-R; NRS ≤ 1). Clinical parameters including the partial Mayo score, Mayo endoscopic subscore (MES), Nancy Index (NI), Bristol Stool Form Scale (BSFS), and IBD Disk score were evaluated. Logistic regression analyses were performed to identify independent predictors of active BU.

Results: 50 patients were in BU-A, and 50 in BU-R. Endoscopic remission (MES=0) occurred in 14% of BU-A and 34% of BU-R; Histological remission (NI = 0) in 10% and 36%, respectively. Stool consistency was predominantly normal (Bristol types 3-5) in both groups (60% of BU-A, 72% of BU-R); however, type 6-7 stools were significantly more frequent in the BU-A group (36% vs 6%, P < 0.001). The BU-A group also had significantly higher partial Mayo scores, MES, NI, and total IBD Disk scores (25.3 ± 20.0 vs 12.0 ± 14.9, P < 0.001). In multivariate analysis, higher NI (OR: 1.874; 95% CI: 1.277-2.750; P < 0.001) and BSFS score (OR: 1.499; 95% CI: 1.052-2.137; P = 0.025) were independently associated with active BU.

Conclusion: Histological inflammation and loose stool form were identified as independent predictors of BU. BU may persist despite endoscopic or histological remission and normal stool form, warranting targeted evaluation beyond traditional marker of disease activity.

Keywords: bowel urgency; patient-reported outcomes; ulcerative colitis.

Plain language summary

Summarize the established knowledge on this subject Bowel urgency (BU) is a frequent, distressing symptom of ulcerative colitis (UC) that markedly impairs quality of life.The precise links between BU, objective disease activity, and patient-reported outcomes remain unclear. What are the significant and/or new findings of this study? Active histological inflammation and loose stool form are independent predictors of BU.BU can persist despite simultaneous endoscopic and histological remission and normal stool consistency, revealing a symptom burden not captured by conventional indices.Recognising BU as an independent treatment target supports more personalised, patient-centred management strategies and may translate into measurable gains in quality of life.