Abstract
Introduction
Bowel rest has traditionally been practiced for hospitalized patients with severe ulcerative colitis (UC). Most available evidence for bowel rest in UC originates from the prebiologic era. Therefore, this study evaluated the clinical impact of bowel rest in hospitalized patients with UC under modern therapy.
Methods
A retrospective study was performed at a single tertiary hospital, where a change in institutional policy for hospitalized UC patients replaced essential bowel rest with early oral feeding in October 2019. Hospitalized UC patients were classified according to the timing of admission into a bowel rest group (group BR; February 2017–September 2019) and a non-bowel rest group (group non-BR; October 2019–October 2023). The primary outcome was colectomy avoidance. Secondary outcomes included hospital length of stay (LOS), central venous catheter (CVC) use, and related complications such as venous thromboembolism (VTE) and catheter-related bloodstream infection (CRBSI).
Results
A total of 76 patients were analyzed (38 per group). Colectomy avoidance rate was similar in both groups (84.2% each, p = 0.98, log-rank test). Median LOS was shorter in group non-BR (22 vs. 31 days; p = 0.002). CVC use was more frequent (84.2% vs. 31.6%; p < 0.001) and longer (26 vs. 15 days; p = 0.001) in group BR. VTE and CRBSI rates did not differ between the two groups.
Conclusions
Among UC patients able to tolerate oral intake, oral intake was associated with shorter hospitalization and reduced CVC use, suggesting that routine bowel rest may not provide additional benefit.
Keywords: Ulcerative colitis, Bowel rest, Hospitalization, Colectomy, Nutritional management
Introduction
Ulcerative colitis (UC) is a chronic inflammatory disorder of the colon and rectum characterized by relapsing and remitting mucosal inflammation [1]. During hospitalization for moderate-to-severe disease, nutritional management plays an essential role in overall treatment, as malnutrition has been associated with prolonged hospital stay and poor outcomes in UC [2–5]. Despite advances in pharmacologic therapy, nutritional support strategies for UC remain largely empirical, and the optimal balance between bowel rest and oral feeding during acute disease flares has not been clearly defined.
Historically, bowel rest was adopted as a supportive measure for patients with acute or severe colitis, under the assumption that it might promote reduction of disease activity. However, clinical trials conducted in the 1980s demonstrated no therapeutic advantage of bowel rest compared with oral feeding in patients receiving corticosteroid-based therapy [6, 7]. These studies were conducted in an era preceding modern immunosuppressants and biologics, when colectomy rates were substantially higher, and nutritional practices often relied on total parenteral nutrition (TPN).
In recent years, the therapeutic landscape for severe UC has changed dramatically, with the introduction of calcineurin inhibitors, biologic agents, and small molecule therapies that enable medical rescue in many cases previously destined for surgery. The availability of these advanced agents has led to higher clinical remission rates and substantially reduced colectomy rates in moderate-to-severe disease [8–10]. However, few studies have reevaluated the role of bowel rest under these modern treatment standards. Whether bowel rest is beneficial – or even necessary – under modern multimodal therapy thus remains an open question.
More recently, Park et al. [11] investigated the impact of bowel rest (implemented as fasting) in hospitalized patients with inflammatory bowel disease (IBD), including UC, and found no significant benefit in terms of disease activity reduction or readmission rates. However, their cohort included a heterogeneous mix of UC, Crohn’s disease, and intestinal Behçet’s disease, and fasting was not implemented under a standardized institutional policy.
At our institution, a policy shift in October 2019 replaced the previous bowel rest-centered approach with an early oral feeding (non-bowel rest) policy, providing a unique opportunity to assess the clinical impact of these contrasting nutritional strategies within a consistent institutional framework. Therefore, the present study aimed to evaluate the clinical effects of bowel rest compared with non-bowel rest management in hospitalized patients with UC. We compared colectomy avoidance, hospital length of stay (LOS), and central venous catheter (CVC)-related outcomes, including venous thromboembolism (VTE) and catheter-related bloodstream infection (CRBSI), to clarify the contemporary significance of bowel rest in the biologic era.
Methods
Study Background and Design
This was a single-center, retrospective cohort study conducted at Chiba University Hospital, Japan. Patients hospitalized with UC between February 2017 and October 2023 were included. Before September 2019, institutional practice supported bowel rest as the standard nutritional management for hospitalized UC patients. In October 2019, a revised policy introduced a non-bowel rest approach, encouraging early oral intake unless contraindicated. Food was provided upon admission, but patients could decline intake based on personal preference. Patients were categorized into two groups according to admission timing: the bowel rest group (group BR; admitted between February 2017 and September 2019) and the non-bowel rest group (group non-BR; admitted between October 2019 and October 2023). In group BR, TPN was considered as standard practice. In group non-BR, TPN was administered only when clinically necessary, such as in cases of poor oral intake, persistent ileus, refractory nausea or vomiting, or preexisting CVC placement prior to referral.
In the group BR, no predefined numerical criteria or standardized protocol for resumption of oral intake were established. In routine clinical practice, oral intake was resumed based on a comprehensive clinical assessment considering overall patient status, including symptoms (e.g., abdominal pain, diarrhea, rectal bleeding) and inflammatory markers such as C-reactive protein (CRP), through multidisciplinary physician judgment. In contrast, in the group non-BR, the institutional policy was to confirm whether the patient wished to continue oral intake, and if the patient did not refuse, oral intake was generally continued as the default approach. Thus, although some patients in the non-BR group experienced temporary fasting during hospitalization, this did not represent an intentional or protocol-based bowel rest strategy.
This study was approved by the Research Ethics Committee of Chiba University Hospital (Approval No. M10678) and conducted in accordance with the Ethical Guidelines for Medical and Health Research Involving Human Subjects in Japan.
Definitions
Our criteria of hospitalization for UC patients were as follows: (i) fulfillment of the Truelove and Witts criteria for severe UC (≥6 bloody stools/day plus at least one systemic feature: fever >37.8°C, pulse >90/min, hemoglobin (Hb) <10.5 g/dL, or ESR >30 mm/h) [12], or (ii) documentation by the attending physician of at least one high-risk feature requiring hospitalization, including moderate-to-severe abdominal pain requiring clinical attention, bloody stools with Hb ≤10 g/dL, ≥8 bloody stools/day, fever ≥38°C, CRP ≥4.5 mg/dL, or clinically significant electrolyte/glucose abnormalities.
Exclusion criteria included toxic megacolon, intra-abdominal abscess, or ≥20 bowel movements per day at admission, as early enteral intake in these conditions were considered highly risky. The period of bowel rest was defined as the duration from admission until the initiation of oral intake. For patients who underwent colectomy before oral intake was resumed, the bowel rest period was defined as lasting until the day of surgery.
In addition to the primary grouping based on admission period (policy-based grouping), a sensitivity analysis was performed by stratifying patients according to actual fasting duration. As the shortest fasting duration in the BR group was 6 days, patients were reclassified into group SF (short fasting; ≤5 days) and group LF (long fasting; ≥6 days) for supplementary analyses.
Outcome Measures
The primary outcome was the rate of colectomy avoidance. Secondary outcomes included LOS, frequency and duration of CVC placement, and the incidence of VTE and CRBSI. Outcomes were compared between the two groups to evaluate the clinical effects of bowel rest versus non-bowel rest nutritional strategies. VTE events were analyzed only if they newly occurred during hospitalization. Patients who had evidence of VTE on admission imaging were excluded from the VTE incidence analysis. Diagnosis of VTE during hospitalization was based on either elevated D-dimer levels or clinical suspicion prompting contrast-enhanced CT, with confirmation by visualization of thrombi. CRBSI was diagnosed based on international standards [13] in patients with CVC who developed fever with positive blood cultures or when defervescence was observed after catheter removal despite negative cultures and no other identified source of infection.
As exploratory supportive analyses, the trajectories of inflammatory and nutritional markers during hospitalization were examined. Median CRP and serum albumin levels were calculated at days 0, 3, 7, 10, 14, 17, and 21 after admission in each group, and their time courses were plotted descriptively as supplementary figures. Because laboratory measurements were obtained as part of routine clinical care, the number of evaluable patients varied across time points due to discharge or missing data.
Statistical Analysis
Continuous variables were assessed for normality. Normally distributed data were compared using the unpaired t test, while non-normally distributed data – including LOS and duration of CVC placement – were analyzed using the Mann-Whitney U test. Categorical variables were compared using the chi-square test or Fisher’s exact test, as appropriate. Colectomy-free survival was analyzed using the Kaplan-Meier method, and differences between groups were evaluated with the log-rank test.
To identify independent predictors of colectomy, univariate logistic regression analyses were first performed using the following variables: age, sex, disease duration, bowel rest duration, use of corticosteroids, calcineurin inhibitors, and biologic agents or JAK (Janus kinase) inhibitors after admission, Mayo endoscopic subscore, disease extent, baseline Lichtiger Index, and laboratory parameters at admission including Hb, white blood cell count (WBC), platelet count (PLT), CRP, and serum albumin. Variables with a p value <0.05 in the univariate analyses were subsequently included in the multivariate logistic regression model, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.
All statistical analyses were performed using the Statistical Package for the Social Sciences version 29.0.2.0 (SPSS Inc., Chicago, IL, USA). A two-sided p value of <0.05 was considered statistically significant.
Results
Patient Selection and Group Allocation
During the study period, 87 patients were hospitalized for UC. Of these, 11 were excluded according to predefined criteria – 3 with toxic megacolon, 1 with an intra-abdominal abscess, and 7 with ≥20 bowel movements per day – leaving 76 patients for the final analysis. Among them, 38 patients were admitted before September 2019 and assigned to group BR, while 38 admitted after October 2019 were assigned to group non-BR (Fig. 1).
Fig. 1.
Flow diagram of patient selection and cohort allocation. Hospitalized ulcerative colitis (UC) patients between February 2017 and October 2023 were screened for eligibility. After applying exclusion criteria, 76 patients were included in the final analysis. Based on the institutional shift in nutritional management policy, patients were divided into two groups: the bowel rest group (group BR, n = 38) and the non-bowel rest group (group non-BR, n = 38).
Characteristics of Group BR versus Group Non-BR
Characteristics are summarized in Table 1. Both groups were comparable in age, sex, disease extent, and Lichtiger Index scores at hospitalization. Baseline CRP levels were slightly higher in group non-BR, suggesting that these patients may have presented with more active inflammation. The use of biologic agents or JAK inhibitors during hospitalization was higher in group non-BR, reflecting more recent treatment trends.
Table 1.
Characteristics of patients in group BR and group non-BR
| Variables | Group BR (n = 38) | Group non-BR (n = 38) | p value |
|---|---|---|---|
| Age, median (IQR), years | 41.0 (23.0–58.3) | 38.0 (25.8–57.3) | 0.91 |
| Female, n (%) | 16 (42.1) | 18 (47.4) | 0.65 |
| Disease duration, median (IQR), months | 24.3 (7.2–107.2) | 20.4 (1.1–86.6) | 0.62 |
| Type of UC, n (%) | |||
| Pancolitis | 28 (73.7) | 31 (81.6) | 0.41 |
| Left-sided Colitis | 7 (18.4) | 6 (15.8) | 0.76 |
| Proctitis | 2 (5.3) | 0 (0) | 0.25 |
| Right-sided Colitis | 1 (2.6) | 1 (2.6) | 0.75 |
| Lichtiger Index, median (IQR) | 11 (9–13) | 11 (9–12) | 0.92 |
| Mayo endoscopic subscore at the time of hospitalization (0, 1, 2, 3, unknown), n (%) | |||
| Mayo 0 | 0 (0) | 0 (0) | |
| Mayo 1 | 4 (10.5) | 0 (0) | 0.06 |
| Mayo 2 | 12 (31.6) | 10 (26.3) | 0.61 |
| Mayo 3 | 20 (52.6) | 17 (44.7) | 0.49 |
| Unknown | 2 (5.3) | 11 (29.0) | 0.006 |
| Laboratory findings, median (IQR) | |||
| Serum albumin, g/dL | 3.0 (2.5–3.8) | 2.9 (2.5–3.5) | 0.35 |
| Hb, g/dL | 11.4 (10.2–12.6) | 11.5 (9.9–13.1) | 0.83 |
| CRP, mg/dL | 4.1 (2.2–6.0) | 5.1 (2.6–11.2) | 0.006 |
| Medication during hospitalization, n (%) | |||
| Corticosteroids | 23 (60.5) | 26 (68.4) | 0.47 |
| Biologic agents or JAK inhibitors | 10 (26.3) | 20 (52.6) | 0.02 |
| Calcineurin inhibitors | 20 (52.6) | 19 (50.0) | 0.82 |
BR, bowel rest; IQR, interquartile range; UC, ulcerative colitis; Hb, hemoglobin; CRP, C-reactive protein; JAK, Janus kinase.
To further clarify treatment patterns, biologic and JAK inhibitor use was re-evaluated by distinguishing therapies introduced before admission and continued during hospitalization from those newly initiated during hospitalization. Infliximab was the most frequently used agent in both groups. Detailed data are provided in online supplementary Table 1 (for all online suppl. material, see https://doi.org/10.1159/000552264).
No significant differences were observed in corticosteroid exposure between groups. The median initial corticosteroid dose was 40 mg/day in both group BR and group non-BR (p = 0.65). The median total duration of corticosteroid therapy was 78 days in group BR and 68.5 days in group non-BR (p = 0.60).
Clinical Outcomes according to Bowel Rest Status
The median duration of bowel rest was significantly longer in group BR than in group non-BR (18 days [IQR: 13–29] vs. 1 day [IQR: 1–4]; p < 0.001) (Fig. 2). Of the 76 patients, colectomy was avoided in 64 (84.2%). Both group BR and group non-BR had 32 of 38 patients (84.2%) who avoided colectomy, showing comparable colectomy avoidance rates between the two groups. Kaplan-Meier analysis of colectomy-free survival revealed no significant difference between the two groups (log-rank p = 0.98) (Fig. 3). Among patients who avoided colectomy, the median LOS was significantly shorter in group non-BR than in group BR (22 days [IQR: 15–26] vs. 31 days [IQR: 22–40]; p = 0.002) (Table 2).
Fig. 2.
Distribution of bowel rest duration after admission in group BR and group non-BR. Bar graph showing the number of patients by the duration of bowel rest (days) after admission; the blue bars represent the bowel rest group (group BR), and the red bars represent the non-bowel rest group (group non-BR).
Fig. 3.
Kaplan-Meier curves for colectomy-free survival after admission. Colectomy-free survival was compared between the bowel rest group (group BR) and the non-bowel rest group (group non-BR). No significant difference was observed (log-rank p = 0.98).
Table 2.
Comparison of clinical outcomes between group BR and group non-BR
| Variables | Group BR (n = 38) | Group non-BR (n = 38) | p value |
|---|---|---|---|
| LOS, excluding colectomy cases, median (IQR), days | 31 (22–40) | 22 (15–26) | 0.002 |
| CVC, n (%) | 32 (84.2) | 12 (31.6) | <0.001 |
| VTE, n (%) | 2 (5.3) | 4 (10.5) | 0.34 |
| CRBSI, n (%) | 1 (2.6) | 2 (5.3) | 0.50 |
| Duration of CVC placement, median (IQR), days | 26 (18–36) | 15 (12–18) | 0.001 |
BR, bowel rest; LOS, length of hospital stay; IQR, interquartile range; CVC, central venous catheter; VTE, venous thromboembolism; CRBSI, catheter-related bloodstream infection.
The proportion of patients requiring CVC placement was significantly higher in group BR than in group non-BR (84.2% vs. 31.6%; p < 0.001). The duration of CVC placement was also significantly longer in group BR compared with group non-BR (26 days [IQR: 18–36] vs. 15 days [IQR: 12–18]; p = 0.001). The incidence of VTE (5.3% vs. 10.5%, p = 0.34) or CRBSI (2.6% vs. 5.3%, p = 0.50) did not differ significantly between group BR and group non-BR (Table 2).
Sensitivity Analysis Excluding JAK Inhibitor Users
To evaluate whether differences in JAK inhibitor use influenced the primary outcomes, we performed an additional analysis excluding patients treated with JAK inhibitors. After exclusion, 38 patients remained in group BR and 33 in group non-BR.
Kaplan-Meier analysis demonstrated no significant difference in colectomy-free survival between the two groups (log-rank p = 0.68). Among patients who avoided colectomy, the median length of hospital stay remained significantly shorter in group non-BR than in group BR (22 days vs. 31 days, p = 0.04). These findings were consistent with the results of the primary analysis including JAK inhibitor users.
Sensitivity Analysis Based on Actual Fasting Duration
Patients were reclassified according to actual fasting duration into group SF (short fasting; ≤5 days, n = 31) and group LF (long fasting; ≥6 days, n = 45). Colectomy-free survival, VTE incidence, and CRBSI incidence did not differ significantly between groups. LOS was significantly shorter in group SF, and CVC duration was also shorter in this group (p = 0.049). These findings were consistent with the primary analysis. Baseline characteristics, treatment patterns, and clinical outcomes for this sensitivity analysis are summarized in online supplementary Table 2.
Exploratory Analysis of Inflammatory and Nutritional Markers
Median CRP levels at Days 0, 3, 7, 10, 14, 17, and 21 were plotted for each group (online suppl. Fig. 1). Both groups demonstrated a progressive decline over time. Median serum albumin levels at the same time points were also examined (online suppl. Fig. 2). No marked deterioration was observed in either group during hospitalization. The number of evaluable patients varied across time points due to discharge or missing measurements.
Predictors of Colectomy
Multivariate logistic regression analysis was conducted to identify independent predictors of colectomy among the 76 patients. Prolonged bowel rest was independently associated with an increased likelihood of colectomy (OR 1.05, 95% CI: 1.01–1.10, p = 0.01), whereas the use of calcineurin inhibitors (OR: 0.16, 95% CI: 0.03–0.93, p = 0.04) and biologic agents or JAK inhibitors (OR: 0.12, 95% CI: 0.02–0.63, p = 0.01) were associated with lower odds of colectomy (Table 3).
Table 3.
Multivariate logistic regression analysis identifying factors associated with colectomy in hospitalized patients with UC
| Variables | Univariate analysis | Multivariate analysis | ||
|---|---|---|---|---|
| OR (95% CI) | p value | OR (95% CI) | p value | |
| Age, years | 1.00 (0.97–1.04) | 0.84 | | |
| Female | 0.36 (0.09–1.43) | 0.15 | | |
| Disease duration, months | 1.00 (1.00–1.00) | 0.25 | | |
| Bowel rest duration, days | 1.05 (1.01–1.09) | 0.01 | 1.05 (1.01–1.10) | 0.02 |
| Endoscopy: Mayo 3 vs. others | 2.13 (0.58–7.79) | 0.25 | | |
| Disease extent: pancolitis vs. others | 0.65 (0.13–3.32) | 0.61 | | |
| Lichtiger Index at admission | 1.21 (0.97–1.50) | 0.09 | | |
| Hb, g/dL | 0.95 (0.70–1.28) | 0.73 | | |
| WBC, ×103/μL | 0.92 (0.81–1.06) | 0.25 | | |
| PLT, mg/dL | 1.00 (0.99–1.00) | 0.47 | | |
| CRP, mg/dL | 0.97 (0.86–1.09) | 0.59 | | |
| Serum albumin, g/dL | 0.65 (0.27–1.55) | 0.33 | | |
| Use of corticosteroids | 3.08 (0.87–10.90) | 0.08 | | |
| Use of calcineurin inhibitors | 0.17 (0.03–0.82) | 0.03 | 0.16 (0.03–0.93) | 0.04 |
| Use of biologic agents or JAK inhibitors | 0.26 (0.07–0.97) | 0.04 | 0.12 (0.02–0.63) | 0.01 |
Hb, hemoglobin; WBC, white blood cell count; PLT, platelet count; CRP, C-reactive protein; JAK, Janus kinase.
Discussion
In this retrospective cohort study, bowel rest did not provide any clinical advantage for hospitalized patients with UC. Kaplan-Meier analysis demonstrated comparable colectomy-free survival between the two groups, while early oral intake was associated with shorter hospitalization period and reduced CVC use, without increasing the risk of surgery. Prolonged bowel rest was independently associated with a higher likelihood of colectomy, whereas the use of calcineurin inhibitors and biologic agents or JAK inhibitors reduced the odds of surgery. These findings suggest that withholding oral intake does not improve outcomes and could delay recovery. Importantly, our findings should not be interpreted to mean that oral intake is appropriate regardless of disease severity. Rather, they suggest that in patients in whom early oral intake is clinically feasible, routine imposition of bowel rest may not provide additional benefit.
Earlier randomized controlled trials conducted in the 1980s found no therapeutic benefit of bowel rest compared with oral feeding in patients with acute or severe colitis treated with corticosteroids [6, 7]. However, these trials predated the widespread use of calcineurin inhibitors, biologics, and small molecule therapies. Contemporary evidence indicates that modern agents have substantially improved clinical remission rates and, at a population level, are associated with a declining risk of colectomy in moderate-to-severe UC, although causal attribution should be made cautiously [8–10]. Accordingly, the clinical relevance of bowel rest under current standards of care has remained uncertain. Our study addresses this gap by reassessing bowel rest in the biologic era, demonstrating that prolonged bowel rest does not improve outcomes and, in fact, prolong hospitalization.
The higher use of biologic agents and JAK inhibitors in group non-BR warrants careful interpretation. Detailed review of treatment patterns revealed that infliximab – the most commonly used rescue agent in the acute setting – was utilized in both groups with broadly comparable patterns of continuation from preadmission therapy and initiation during hospitalization. The observed difference in advanced therapy use was primarily driven by upadacitinib, which became available in the later study period. Thus, the increased proportion of advanced therapy use in group non-BR largely reflects temporal expansion of therapeutic options rather than a fundamental shift in acute rescue strategy. To further evaluate whether the observed outcomes were influenced by JAK inhibitor use, we conducted an additional sensitivity analysis excluding patients treated with JAK inhibitors. The results of this analysis were consistent with the primary findings, suggesting that the main study outcomes were unlikely to be explained solely by differences in JAK inhibitor use between groups.
Recent investigations have also questioned the clinical value of bowel rest or dietary restriction in IBD. A recent retrospective study including patients with UC, Crohn’s disease, and intestinal Behçet’s disease found that fasting did not improve short-term disease activity, inflammatory markers, or readmission rates [11]. However, that study mainly assessed short-term inflammatory responses within 1 week of admission, rather than inpatient clinical outcomes. In contrast, our study specifically evaluated hospitalized UC patients and assessed clinically meaningful endpoints – such as colectomy avoidance, LOS, and CVC dependence – under modern biologic-based therapy. This design enabled a more direct and clinically relevant assessment of the impact of bowel rest in the current therapeutic era. Consistent with our findings, contemporary clinical reviews recommend maintaining enteral nutrition whenever feasible and discouraging routine use of bowel rest or clear liquid diets in the absence of specific contraindications [14]. Observational studies have also shown that fasting behaviors are common among patients with IBD but are largely driven by patient perceptions rather than objective clinical benefit [15]. Collectively, these data reinforce that bowel rest offers limited therapeutic value and should not be considered a standard component of inpatient management.
The absence of benefit from bowel rest is biologically and clinically plausible. Enteral nutrition supports mucosal integrity and epithelial tight junction function, whereas prolonged enteral deprivation or TPN-based strategies have been associated with disruption of the intestinal barrier and increased susceptibility to infection [16]. Clinically, prolonged bowel rest increases dependence on parenteral nutrition and CVC use, exposing patients to CRBSI and VTE. Prior evidence indicated that CVC placement itself increases morbidity among hospitalized IBD patients [17, 18]. Thus, early resumption of oral intake may represent a practical and safe approach to minimize CVC dependence and related complications.
Our multivariate analysis also suggested that prolonged bowel rest was a risk of surgery rather than an effective intervention. Patients requiring extended fasting likely had more severe or slow-to-respond inflammation, which may explain the observed association with colectomy. This interpretation emphasizes the importance of early optimization of medical therapy, including calcineurin inhibitors and biologics, rather than reliance on nutritional restriction.
A major strength of this study is its real-world design, reflecting actual clinical practice before and after an institutional change in nutritional policy. By defining patient groups according to a clear shift in policy and including only hospitalized UC cases meeting severe or high-risk criteria, the study captures contemporary management patterns with strong external validity.
However, several limitations should be acknowledged. This was a retrospective single-center study with a relatively small sample size, which may limit statistical power and generalizability. Residual confounding cannot be excluded, even after multivariable adjustment. Although no statistically significant differences were observed in initial corticosteroid dose or total duration of corticosteroid therapy between groups, we cannot completely exclude the possibility that unmeasured differences in treatment intensity or tapering strategies may have influenced clinical outcomes. Regarding calcineurin inhibitor therapy, most patients received intravenous cyclosporine during the acute phase. Among tacrolimus-treated patients (n = 9), in whom the trough levels could be affected by presence or absence of oral intake, additional exploratory analyses showed no significant difference between groups in the time required to achieve a trough level ≥10 ng/mL (median 2 vs. 5 days, p = 0.22), and clinical outcomes such as length of hospital stay were also comparable. However, given the small number of tacrolimus-treated patients, these findings should be interpreted cautiously.
Propensity score matching was considered but not feasible given the limited cohort size. Therefore, these results should be interpreted with caution, and larger prospective studies are warranted to confirm these findings.
In conclusion, this study provides contemporary real-world evidence that bowel rest does not confer clinical benefit in hospitalized UC patients. Early oral intake was associated with shorter hospitalization and reduced CVC use without compromising safety. These findings support a shift toward evidence-based, nutrition-conscious inpatient care that prioritizes early enteral feeding whenever clinically feasible.
Acknowledgments
We would like to thank all the members of the Department of Gastroenterology, Graduate School of Medicine, Chiba University, for their valuable support and discussion.
Statement of Ethics
This study protocol was reviewed and approved by the Research Ethics Committee of Chiba University Hospital, Chiba, Japan (Approval No. M10678). This was a retrospective study using existing clinical data, and the requirement for written informed consent was waived by the Research Ethics Committee of Chiba University Hospital.
Conflict of Interest Statement
Takashi Taida received research grants from AbbVie G.K. Jun Kato received honoraria from Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd., AbbVie G.K., Zeria Pharmaceutical Co., Ltd., Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Corporation, and JIMRO Co., Ltd., and Mochida Pharmaceutical Co., Ltd. The other authors have no conflicts of interest to declare.
Funding Sources
This study was not supported by any sponsor or funder.
Author Contributions
N.S. and Y.Oh. contributed to data acquisition and statistical analysis. N.S., Y.Oh., and J.K. contributed to study design, interpretation of data, and drafting of the manuscript. K.S., H.A., Y.M., T.Oh., T.Oz., T.It., R.S., Y.Oz., M.I., M.F., C.G., R.H., A.K., M.S., T.Is., H.O., T.K., T.T., K.O., K.S., and T.M. contributed to data acquisition and critical review of the manuscript. All authors read and approved the final version of the manuscript.
Funding Statement
This study was not supported by any sponsor or funder.
Data Availability Statement
The datasets generated and analyzed during this study were obtained from the electronic medical records of Chiba University Hospital and contain confidential patient information. Due to institutional and ethical restrictions, these data are not publicly available. Anonymized data may be shared upon reasonable request and with approval from the Ethics Committee of Chiba University Hospital. Further inquiries can be directed to the corresponding author.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets generated and analyzed during this study were obtained from the electronic medical records of Chiba University Hospital and contain confidential patient information. Due to institutional and ethical restrictions, these data are not publicly available. Anonymized data may be shared upon reasonable request and with approval from the Ethics Committee of Chiba University Hospital. Further inquiries can be directed to the corresponding author.