Impact of bowel rest on hospitalized patients with ulcerative colitis

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 pre-biologic era. So, 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: Total 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. Venous thromboembolism and catheter-related bloodstream infection rates did not differ between the two groups. Conclusions: Bowel rest provided no clinical advantage in hospitalized UC patients. Early oral intake was associated with shorter hospitalization and reduced CVC use, supporting its adoption as standard inpatient care.