Faecal urgency in Crohn's disease: associations with disease location and activity, psychobiological burden and adverse outcomes.

Background: Faecal urgency (FU) is a frequent and disabling symptom in inflammatory bowel disease, although evidence in Crohn's disease (CD) remains limited. We aimed to evaluate the prevalence and severity of FU in CD and assess its association with disease location, inflammatory activity, psychobiological factors, quality of life (QoL), work productivity, and adverse clinical outcomes after 52 weeks.

Methods: We conducted a single-centre observational study including adult patients with CD recruited between July-September 2024. Participants completed the Faecal Urgency Numeric Rating Scale (FU NRS), WPAI-GH, SIBDQ, and HADS questionnaires. Disease activity was assessed clinically, biochemically, endoscopically, and ultrasonographically. Patients were followed for 52 weeks for emergency room (ER) admissions, hospitalization, corticosteroid requirement, treatment escalation, surgery, and death.

Results: A total of 158 patients were included, of whom 109 (69.0%) reported clinically relevant FU (FU NRS ≥2). In the primary analysis, neither distal disease nor rectal involvement were significantly associated with clinically relevant FU (p=0.46 and 0.83, respectively). FU severity was not significantly correlated with inflammatory measures. Conversely, FU severity correlated with anxiety, depressive symptoms, impaired work productivity, and poorer QoL (all p<0.001). In multivariate models, FU was associated with overall work productivity loss and reduced SIBDQ scores. In an exploratory analysis, greater FU severity was associated with higher odds of ER admissions after 52 weeks (p=0.007).

Conclusions: In this CD cohort, FU was significantly associated with psychobiological burden, impaired QoL, and healthcare utilization, supporting the multifactorial nature of this symptom.