Faecal incontinence in inflammatory bowel disease: The Nancy experience

Kurt, S.; Caron, Bénédicte; Gouynou, Célia; Netter, Patrick; Vaizey, C. J.; Wexner, Steven D.; Danese, Silvio; Baumann, Cédric; Peyrin–Biroulet, Laurent

doi:10.1016/j.dld.2022.01.125

Cited by 5 publications

(6 citation statements)

References 24 publications

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“…Previous clinical estimates of FI in the IBD literature have varied mainly due to methodological difficulties including heterogeneity of previous definitions of FI used. [33][34][35] Whilst not specifically validated in IBD populations, the use of Rome IV criteria definitions for FI is a particular strength of our study. Firstly, the Rome IV questionnaire allows direct comparison to global prevalence data in the general population using these definitions for the first time.…”

Section: Discussionmentioning

confidence: 99%

“…Regardless of whether FI was defined by the ICIQ‐IBD questionnaire, or by the more stringent Rome IV criteria (requiring FI at least 2–3 days a month), those with FI had significantly poorer QoL during remission and during relapse, and significantly higher levels of psychological distress. Previous clinical estimates of FI in the IBD literature have varied mainly due to methodological difficulties including heterogeneity of previous definitions of FI used 33–35 . Whilst not specifically validated in IBD populations, the use of Rome IV criteria definitions for FI is a particular strength of our study.…”

Section: Discussionmentioning

confidence: 99%

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The prevalence and burden of Rome IV faecal incontinence in ulcerative colitis: A cross‐sectional study

Vasant

Nigam

Bate

et al. 2023

Aliment Pharmacol Ther

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Summary Background Despite advances in ulcerative colitis (UC) therapies, a relatively undefined proportion of patients experience faecal incontinence (FI) in the absence of active inflammation. For this group, there remains a significant unmet need with a limited evidence base. Aims We aimed to estimate the prevalence and impact of FI in UC. Methods In a prospective cross‐sectional study, patients with UC completed a series of validated questionnaires, including Rome IV FI criteria, an inflammatory bowel disease (IBD)‐specific FI questionnaire (ICIQ‐IBD), Hospital Anxiety and Depression Scale and IBD‐Control. UC remission was defined as faecal calprotectin (FCP) ≤250 μg/g, or IBD‐control 8 score ≥13 and IBD‐Control‐VAS ≥ 85. Results Of 255 patients with UC, overall, 20.4% fulfilled Rome IV criteria for FI. Rome IV FI prevalence did not differ between active and quiescent UC regardless of whether disease activity was defined by IBD‐Control scores ± FCP (p = 0.25), or objectively with FCP thresholds of 250 μg/g (p = 0.86) and 100 μg/g (p = 0.95). Most patients (75.2%) reported FI when in ‘remission’ and during ‘relapse’ (90.6%) according to ICIQ‐IBD. Those who reported FI according to both ICIQ‐IBD and Rome IV definitions had higher anxiety, depression and worse quality‐of‐life (QoL) scores (p < 0.05). In those with Rome IV FI, there was a strong correlation between FI symptom severity and impaired QoL (r = 0.809, p < 0.001). Conclusions The prevalence of FI in UC is high, even in remission, and associated with significant psychological distress, symptom burden and impaired QoL. These findings highlight the urgent need for further research and development of evidence‐based treatments for FI in UC.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The prevalence and burden of Rome IV faecal incontinence in ulcerative colitis: A cross‐sectional study

Vasant

Nigam

Bate

et al. 2023

Aliment Pharmacol Ther

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“…A method for assessing deferral time is asking patients, "Over the last week, how much urgency have you had before bowel movements?" with response scale options being none ("I can wait 15 minutes or more to have a bowel movement"), mild ("I need the bathroom within 5-15 minutes"), moderate ("I need the bathroom within 2-5 minutes"), moderately severe ("I need the bathroom in less than 2 minutes"), and too severe ("sometimes I am unable to make it to the bathroom in time") (91). A further aspect of BU is fecal urge incontinence, which is distinct from passive incontinence and involves the…”

Section: Multidimensional Aspects Of Bumentioning

confidence: 99%

“…Deferral time is the period during which it is possible to defer defecation after the desire to evacuate ( 8 ). In a real-world cohort of patients with IBD, clinically relevant deferral time was defined as an inability to hold stool for 15 minutes ( 91 ). However, deferral time has been reported to be as low as 5 minutes or less in 28%–54% of patients with UC ( 8 , 45 ), and some patients report deferral times of less than 30 seconds ( 66 ).…”

Section: Assessments Of Bumentioning

confidence: 99%

Bowel Urgency in Ulcerative Colitis: Current Perspectives and Future Directions

et al. 2023

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Bowel urgency, the sudden or immediate need for a bowel movement, is one of the most common and disruptive symptoms experienced by patients with ulcerative colitis. Distinct from the separate symptom of increased stool frequency, bowel urgency has a substantial negative impact on quality of life and psychosocial functioning. Among patients with ulcerative colitis, bowel urgency is one of the top reasons for treatment dissatisfaction and one of the symptoms patients most want improved. Patients may not discuss bowel urgency often due to embarrassment, and healthcare providers may not address the symptom adequately due to lack of awareness of validated tools and/or knowledge of the importance of assessing bowel urgency. The mechanism of bowel urgency in ulcerative colitis 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 bowel urgency 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 bowel urgency in ulcerative colitis and its impact on quality of life and psychosocial functioning. Patient-reported outcome measures developed to assess the severity of bowel urgency in ulcerative colitis are discussed alongside overviews of treatment options and clinical guidelines. Implications for the future management of ulcerative colitis from the perspective of bowel urgency are also explored.

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“…In IBD patients, the altered bowel functions and non-bowel related symptoms ( 83 , 84 ) heavily impact on patients’ work, social and home life activities, leading to various degrees of disability.…”

Section: Participatementioning

confidence: 99%

Personalize, participate, predict, and prevent: 4Ps in inflammatory bowel disease

et al. 2023

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Inflammatory bowel disease (IBD), which includes Crohn’s disease (CD) and ulcerative colitis (UC), is a complex, immune-mediated, disorder which leads to several gastrointestinal and systemic manifestations determining a poor quality of life, disability, and other negative health outcomes. Our knowledge of this condition has greatly improved over the last few decades, and a comprehensive management should take into account both biological (i.e., disease-related, patient-related) and non-biological (i.e., socioeconomic, cultural, environmental, behavioral) factors which contribute to the disease phenotype. From this point of view, the so called 4P medicine framework, including personalization, prediction, prevention, and participation could be useful for tailoring ad hoc interventions in IBD patients. In this review, we discuss the cutting-edge issues regarding personalization in special settings (i.e., pregnancy, oncology, infectious diseases), patient participation (i.e., how to communicate, disability, tackling stigma and resilience, quality of care), disease prediction (i.e., faecal markers, response to treatments), and prevention (i.e., dysplasia through endoscopy, infections through vaccinations, and post-surgical recurrence). Finally, we provide an outlook discussing the unmet needs for implementing this conceptual framework in clinical practice.

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Faecal incontinence in inflammatory bowel disease: The Nancy experience

Cited by 5 publications

References 24 publications

The prevalence and burden of Rome IV faecal incontinence in ulcerative colitis: A cross‐sectional study

The prevalence and burden of Rome IV faecal incontinence in ulcerative colitis: A cross‐sectional study

Bowel Urgency in Ulcerative Colitis: Current Perspectives and Future Directions

Personalize, participate, predict, and prevent: 4Ps in inflammatory bowel disease

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