Ulcerative Colitis Associated With Lower Rectal Compliance

Ulcerative Colitis, The photo of large intestine is on the woman’s body against gray background, Female anatomy, Concept with healthcare and medicine
Investigators assessed rectal compliance among adult patients with ulcerative colitis vs those without.

Rectal compliance is significantly lower in patients with ulcerative colitis (UC) compared against control individuals without UC, researchers reported in Gastroenterology.

The prospective, controlled study included patients with UC who were scheduled for routine sigmoidoscopies or colonoscopies and then underwent a barostat examination. Clinical and demographic data were obtained from patients’ electronic medical records, along with Simplified Clinical Colitis Activity Index (SCCAI) scores, Mayo endoscopic subscores, and biopsies of the rectum. The study authors compared static rectal compliance between patients with UC and controls using a validated power exponential model and assessed the effects of disease-related factors on the compliance parameters.

The analysis included 93 individuals β€” 73 patients with UC and 20 control individuals without UC. The control group had a mean age of 61.1 (SD, 11.3) years, 55% were men, and 55% were White. The UC group had a mean age of 51.5 (SD, 14.4) years, 50.7% were women, and 78.1% were White. Patients with UC had a mean disease duration of 16.9 (SD, 11.9) years, and 71% had extensive disease.

Static rectal compliance was lower among patients with UC vs the control group (π‘‰π‘šπ‘Žπ‘₯ = 265.7 mL vs π‘‰π‘šπ‘Žπ‘₯ = 311.1 mL, respectively; P =.047), which remained significant after adjustment for age differences in the 2 groups (P =.043).

Patients with UC who had an SCCAI score of β‰₯5 had lower compliance compared with those who had a score <5 (π‘‰π‘šπ‘Žπ‘₯ = 226.7 mL vs π‘‰π‘šπ‘Žπ‘₯ = 271.7 mL, respectively; P =.0379). Stool frequency and Mayo endoscopic subscore had a negative effect on compliance. Biologic therapy use was associated with reduced compliance (π‘‰π‘šπ‘Žπ‘₯ = 244.07 mL vs π‘‰π‘šπ‘Žπ‘₯ = 290.64 mL; P =.043).

Regarding analysis of histologic disease, 28 patients had active inflammation, 22 had quiescent disease, and 23 patients had normalized their histology. Rectal compliance was lower among patients who had active histologic disease (π‘‰π‘šπ‘Žπ‘₯ = 247.6 mL; SE = 16.9) vs healthy controls (π‘‰π‘šπ‘Žπ‘₯ = 311.1 mL; SE = 20.0; P =.01) and those with quiescent histologic disease (π‘‰π‘šπ‘Žπ‘₯ = 265.3 mL; SE = 19.1; P =.03).

A significant difference was observed in rectal compliance between control individuals and all patients with UC (π‘‰π‘šπ‘Žπ‘₯ = 311.07 mL, SE = 20.25 vs π‘‰π‘šπ‘Žπ‘₯ = 265.7 mL, SE = 10.6, respectively; P =.045)

β€œOne of the most remarkable findings of our study was the identification that patients with UC who had normalized their histology had improved rectal compliance compared with those with histologic quiescence, and that these patients had compliance similar to that of healthy controls,” the investigators commented. β€œWe propose rectal compliance as a functional outcome and a marker of increased disease severity and quality of life for patients with UC,” the researchers concluded.

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Cleveland NK, Rai V, El Jurdi K, Rao SS, Giurcanu MC, Rubin DT. Ulcerative colitis patients have reduced rectal compliance compared with non-IBD controls. Gastroenterol. Published online September 28, 2021. doi: 10.1053/j.gastro.2021.09.052