Abstract Background Bowel urgency (BU) is a common and burdensome symptom for patients with Crohn’s disease (CD), yet its determinants remain insufficiently characterised. This study aimed to investigate clinical, therapeutic, and psychosocial factors associated with BU in adults with CD. Methods This prospective cross-sectional study included consecutive adult patients with CD. Demographic data, clinical characteristics, surgical history, exposure to biologic treatment including early (2years) vs late (2years) from diagnosis, and disease activity indices CRP, simple endoscopic severity score (SES-CD) were recorded. BU severity was assessed with the Urgency Numeric Scale (UNS) and stool deferral time. Participants completed two Greek-validated questionnaires: the Generalised Anxiety Disorder-7 (GAD-7) and the Hamilton Depression Rating Scale (HAM-D). Associations between categorical variables were evaluated using the chi-square test, and binary logistic regression was performed to assess correlations with urgency. Results Among 408 eligible patients, 324 were included in the analysis (49.5% male; mean age 48 years), yielding an 80% response rate. Overall, 83% were on advanced therapies, and 21.3% with early biologic initiation. Prior surgery was reported in 24.1% (78/324) of patients. Ileal and colonic involvement were present in 91.1% (295/324) and 46.8%(151/324), respectively. Rectal involvement was present in 23.5% (76/325) and perianal disease in 14.2% (46/324). 65.7% were in biologic and 60.8% in endoscopic remission. BU was reported by 116/325 patients (35.8%), among which, 41.8% had a UNS score ≥6. Deferral time 5min was observed in 35%(113/324) of the patients. Clinically relevant anxiety and depression were observed in 28.0% and 8.9% of patients, respectively, according to GAD-7 and HAM-D. Univariate analysis showed that urgency was significantly associated with prior surgery, biologic treatment failure, delayed initiation of biologic therapy, absence of endoscopic healing, and the presence of anxiety or depression. In multivariable analysis, anxiety demonstrated the strongest association with urgency (OR = 6.80, p 0.001). Biologic treatment failure was also associated with urgency (OR = 2.44, p = 0.016), while early biologic initiation was protective, reducing the odds by 60% (OR = 0.40, p = 0.033). Conclusion BU affects more than one-third of patients with CD, irrespective of location and disease activity. Anxiety was independently associated with BU. Biologic treatment failure was associated with BU, whereas early biologic initiation was protective. These findings highlight the importance of integrating psychological assessment and timely therapeutic intervention in the management of CD. Conflict of interest: Mr. Axiaris, Georgios: No conflict of interest Georgiadou, Glykeria: No conflict of interest Vachliotis, Ilias: No conflict of interest Mpountouridis, Anastasios: No conflict of interest Mollagiousoufoglou, Berkai: No conflict of interest Lazou, Dimitra: No conflict of interest Stafylidou, Maria: No conflict of interest Lazaraki, Georgia: No conflict of interest Soufleris, Konstantinos: No conflict of interest
Axiaris et al. (Thu,) studied this question.