Prevalence, clinical and anorectal function characterization of faecal incontinence and rectal urgency in ulcerative colitis patients (HOPE Study)

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Abstract Background and aims Faecal incontinence (FI) and rectal urgency (RU) are underestimated and underdiagnosed in ulcerative colitis (UC) patients. Our primary aim is to evaluate the prevalence and severity of FI and/or RU in UC patients. Secondary aims include investigating the causes of FI and/or RU, identifying factors associated with FI and/or RU, and describing anorectal function in UC patients in remission who report these symptoms. Methods This is a prospective, multicentre study with two parts. The first part is an epidemiological analysis involving 667 UC patients, in whom the prevalence of FI and/or RU will be assessed. The second part focuses on characterizing anorectal function in patients who report FI and/or RU while in remission. As per clinical practice, an endoscopic study will rule out disease activity as a cause of symptoms in all patients reporting FI and/or RU in the first part. Those confirmed to be in remission will proceed to the second part, where anorectal function will be evaluated using high-resolution anorectal manometry. Therapeutic strategies for FI and RU will be proposed following clinical practice guidelines, and we will record responses to these treatments and their impact on symptom severity. Additionally, we will assess the impact of these therapeutic strategies on patients' quality of life. Anticipated impact To provide effective therapy for FI and/or RU in UC patients, it is essential to understand their prevalence during both active disease and remission, as well as the underlying mechanisms in remission. Our study aims to reveal the true prevalence of FI and RU in UC patients, expand knowledge of anorectal function in those in remission, and help identify therapeutic targets to alleviate these burdensome symptoms, ultimately improving quality of life for affected individuals.

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