P0229Bowel urgency across inflammatory bowel disease phenotypes: A large real-world analysis reveals high symptom burden in ileal Crohn’s disease

Abstract Background Bowel urgency (BU) is a highly burdensome yet underrecognized symptom of inflammatory bowel disease (IBD), ranked by patients as one of the most disruptive to daily life (CONFIDE study 1). To date, BU has been systematically evaluated primarily in ulcerative colitis (UC) and mostly in clinical trials. Evidence on BU in Crohn’s disease (CD), particularly across different disease locations and phenotypes, remains scarce. We therefore systematically investigated the relationship between BU and clinical phenotypes in a large, real-world IBD cohort. Methods We conducted a prospective study of all IBD patients treated at the IBD Centre of the University Hospital Schleswig-Holstein, Campus Kiel, between April 2024 and October 2025 who provided the UKSH Broad Consent, which is a one-sided data and biomaterial donation for research use 2. BU, within the preceding 24 hours, was assessed using an 11-point numeric rating scale 3 as part of the UKSH routine care. Clinical phenotype data, including demographics, Montreal classification, and disease activity indices (CD: PRO2, UC: Partial Mayo score), were extracted via structured electronic medical record exports. Multivariable logistic regression models were used to evaluate associations between BU and disease phenotypes, adjusting for age, sex, and disease activity. Results A total of 8444 visits from 1173 individuals with confirmed diagnosis of IBD (CD, UC, or indeterminate colitis (IC)) were available for analysis. While sex showed no significant influence on reported BU, this symptom was clearly associated with age (p = 2.61 x 10-5), PRO2 (p 2 x 10-16), and partial Mayo score (p 2 x 10-16). In UC, disease extent was not associated with differences in BU severity. CD patients with ileal disease reported BU levels higher to UC patients (p 2 x 10-16), and significantly higher BU than CD patients with colonic involvement (p = 0.00342). Penetrating/perianal disease was not linked with markedly higher reported BU in comparison to CD patients with non-stricturing/non-penetrating disease behaviour (Montreal classification: B1). These findings indicate that BU is not limited to colonic inflammation and may represent a broader marker of disease burden across IBD. Conclusion Bowel urgency is common across IBD phenotypes and is not restricted to colonic disease. Ileal CD is associated with unexpectedly high urgency scores, underscoring the need to systematically assess BU in all IBD patients. CD patients might report perceived BU differently in comparison to patients with UC as described previously 4. Dedicated therapeutic trial focusing on urgency as a lead symptom are therefore urgently warranted. References: 1. Travis S, Potts Bleakman A, Dubinsky MC, et al. The Communicating Needs and Features of IBD Experiences (CONFIDE) study: US and European patient and health care professional perceptions of the experience and impact of symptoms of moderate-to-severe ulcerative colitis. Inflamm Bowel Dis. 2024;30(6):939-949. doi:10.1093/ibd/izad142. 2. Richter G, Krawczak M, Lieb W, Wolff L, Schreiber S, Buyx A. Broad consent for health care–embedded biobanking: understanding and reasons to donate in a large patient sample. Genet Med. 2018;20(1):76-82. doi:10.1038/gim.2017.82. 3. Dubinsky MC, Delbecque L, Hunter T, et al. Validation of the bowel urgency numeric rating scale in patients with Crohn’s disease: results from a mixed methods study. Qual Life Res. 2023;32(12):3403-3415. doi:10.1007/s11136-023-03494-y. 4. Lewis JD, et al. Bowel urgency severity among patients with Crohn’s disease or ulcerative colitis on advanced therapies: real-world data using Study of a Prospective Adult Research Cohort with Inflammatory Bowel Disease. Gastro Hep Adv. 2024;4(10):100796. Conflict of interest: Prof. Dr. Tran, Florian: Grant: Sanofi/Regeneron Personal Fees: Speaker’s fees: Abbvie, Bristol-Myers-Squibb, Celltrion Healthcare, Dr Falk Pharma, Eli Lilly, Ferring Pharmaceuticals, J & J, Sanofi, Takeda Consulting honoraria: AbbVie, J & J, Takeda Non-financial Support: Sanofi for statistical analysis Bourgery, Matthieu: No conflicts Eicker, Nic Noa: No conflicts Hinrichsen, Finn: Received travel support from Pfizer. Holds shares in 10x Genomics Received research material from CatalYm Guggeis, Martina: No conflicts. Welz, Lina: Received support from Celltrion for independent reporting from scientific congresses. Schreiweis, Björn: none Aden, Konrad: Personal Fees: Lecture fee: Takeda, Janssen, Lilly, Abbvie Consulting fee: Takeda, Jannsen, Lilly, Guidepoint Rosenstiel, Philip: stock ownership Gerion Schreiber, Stefan Wolfgang: Personal Fees: AbbVie, Alfasigma, Amgen, Arena, Biogen, Boehringer Ingelheim, Bristol Meyers Squibb, Celgene, Celltrion, Falk, Ferring, Fresenius Kabi, Galapagos, Gilead, IMAB, Janssen, Lilly, MSD, Mylan, Novartis, Pfizer, Protagonist, Provention Bio, Roche, Sandoz/Hexal, Shire, Takeda, Theravance