Managing Ulcerative Colitis Improves Patient-Reported Outcomes Despite Disease Severity

Regardless of disease severity, management of active UC leads to more favorable patient-reported outcomes.

Managing active ulcerative colitis (UC) symptoms can improve patient-reported outcomes regardless of the stage of UC remission, according to study findings in the Journal of Gastroenterology.

Addressing the overall disease burden is important in chronic illnesses such as UC. Some modifiable risk factors in patients with UC include lifestyle, psychosocial, and patterns of clinical practice. Researchers conducted a cross-sectional analysis to assess the effect of symptoms and proctocolectomy on patient-reported outcomes for patients with UC.

The researchers gathered data from the YOu and Ulcerative colitis: Registry and Social network (YOURS), a Japanese large-scale, multicenter registry for patients diagnosed with UC. Patients were enrolled from May 2019 through January 2019, and the researchers compared surveys at baseline, at 3 months if in remission, and each year for up to 3 years.

Patients included in the study were aged at least 16 years and diagnosed with UC. Disease remission was defined based on a 2-item patient-reported outcomes (PRO-2) questionnaire, with a total PRO-2 score of 0 to 1 considered remission. Abdominal pain was measured on a numerical rating scale (NRS), with a score ranging from 0 to 10, with higher scores indicating worse pain.

The impact on PROs was found even in mild UC, suggesting that management of UC may improve PROs at all stages of disease severity.

A total of 2,731 patients were in the database, and 2006 (73.5%) patients were enrolled in the study. Of the 1,971 patients included in the analysis, 1346 (68.3%) patients were in remission, 583 (29.6%) had active disease, and 42 (2.1%) underwent a

proctocolectomy. The median age of patients was 44 years for patients in remission, 42 years for patients with active disease, and 45 years for patients who underwent a proctocolectomy. Among patients in remission and with active disease, 52% to 56% were men, and 78.6% of patients who underwent a proctocolectomy were men.

Results for the Short Inflammatory Bowel Disease Questionnaire (SIBDQ) showed a median score of 5.9 for patients in remission, 5.2 for patients with active disease, and 5.0 for those who had undergone proctocolectomy.

The Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) revealed a median score of 44.0 in patients in remission, 40.0 in patients with active disease, and 38.0 in those who underwent a proctocolectomy.

Depression and anxiety sub-scores were measured using Hospital Anxiety and Depression Scale (HADS), and the median HADS scores were 3.0 and 4.0 for patients in remission, 4.0 and 5.0 for patients with active disease, and 6.0 for both scores in patients who had undergone proctocolectomy, respectively.

In patients with mild, moderate, and severe symptom scores, the level of fatigue was assigned as severe in 6.6%, 13.8%, and 11.5% of patients, respectively. Fatigue was severe in 3.3% of patients in remission and 14.3% in patients who underwent a proctocolectomy.

Severe work productivity was defined by a loss of at least 50% and was reported as 3.4% in patients in remission and 38.5% in patients who had undergone proctocolectomy. Based on mild, moderate, and severe symptoms scores, patients reported a severe productivity loss of 9.1%, 29.7%, and 60.0% respectively. Linear associations were reported between symptom severity and most patient-reported outcomes scores.

“The impact on PROs [patient-reported outcomes] was found even in mild UC, suggesting that management of UC may improve PROs at all stages of disease severity,” the study authors wrote. Study limitations include the feasibility of using all PRO assessment tools in clinical practice, the different disability assessments available for use, and the potential underrepresentation of patients with favorable surgical outcomes.

This article originally appeared on Gastroenterology Advisor


Matsuoka K, Yamazaki H, Nagahori M, et al. Association of ulcerative colitis symptom severity and proctocolectomy with multidimensional patient-reported outcomes: a cross-sectional studyJ Gastroenterol. 2023; 58(1):751-765. doi:10.1007/s00535-023-02005-7