Ulcerative Colitis: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate ulcerative colitis:

  • Bloody-mucopurulent diarrhea (diarrhea; up to 20 times per day) – most important leading symptom (90%).
  • Abdominal pain (abdominal pain/abdominal pain) (60% / 80%).
  • Tenesmus – painful bowel movements (> 70%).
  • Increased stool frequency – up to 30 bowel movements per day.
  • Feeling of incomplete defecation
  • Intestinal colic

Non-specific symptoms include:

  • Fever (10%)
  • Growth retardation: weight stagnation (in children) or weight loss (35% / 40%) possibly also pubertal delay.
  • Dehydration (lack of fluids)
  • General signs of inflammation
  • Performance kink (20% / 35%)
  • Anorexia (loss of appetite) (15%)

(At diagnosis: <10 years in % of cases / >10 years in % of cases).

Notice:

  • In 15-25% of patients, the first symptoms appear before the age of 20, occasionally the disease begins in infancy.
  • Extraintestinal manifestations (signs of disease outside the gastrointestinal tract) may precede the manifestation of ulcerative colitis!

Extraintestinal manifestations (15-20-30% of cases):

  • Eyes and ocular appendages
  • Blood, hematopoietic organs – immune system.
    • Anemia (anemia) (30%)
  • Skin and subcutaneous
    • Erythema nodosum (EN; synonyms: nodular erythema, dermatitis contusiformis, erythema contusiforme; plural: erythemata nodosa) – granulomatous inflammation of the subcutis (subcutaneous fat tissue), also known as panniculitis, associated with painful nodulation (red to blue-red color; later brownish). The overlying skin is reddened. Localization: both extensor sides of the lower leg, on the knee and ankle joints; less commonly on the arms or buttocks (3%).
    • Psoriasisform manifestations (therapy-induced) (1%).
    • Pyoderma gangraenosum (PG) – painful disease of the skin in which ulceration or ulceration (ulceration or ulceration) and gangrene (tissue death due to reduced blood flow or other damage) occurs over a large area, usually in one place (2%)
  • Cardiovascular system
    • Tachycardia (heartbeat too fast: > 100 beats per minute).
  • Liver/biliary tract/pancreas.
    • Cholangitis (inflammation of the bile duct): primary sclerosing cholangitis (PSC) (3%) → increased risk of bile duct and colorectal cancer
  • Musculoskeletal system and connective tissue
    • Arthralgia (joint pain)
    • Arthritis* (inflammation of the joints) (20%)
    • Bekhterev’s disease (ankylosing spondylitis; Latinized Greek: spondylitis “inflammation of the vertebrae” and ankylosans “stiffening”) – chronic inflammatory rheumatic disease with pain and stiffening of joints (2%).
    • Osteoporosis (bone loss)
  • Mouth, esophagus (esophagus), stomach and intestines.

* Joint involvement may occur concurrently with ulcerative colitis, but may precede or follow it by years. A distinction is made between:

  • Type I: <5 joints affected; usually large joints, course strongly associated with disease activity.
  • Type II: > 5 joints affected, mostly symmetrical involvement of finger joints, rather chronic and independent of disease activity

Risk assessment for inflammatory bowel disease (IBD) or colorectal cancer (CRC) (in patients <50 years) [2}

Common features of CED and CRC) are rectal bleeding, abdominal pain (abdominal pain; abdominal pain), diarrhea (diarrhea), weight loss, and iron deficiency anemia. According to one study, 10 parameters are considered significantly associated with CED or CRC:

  • Rectal bleeding (positive predictive value (PPV): 1%).
  • Altered bowel habits (PPV: 1%).
  • Diarrhea (diarrhea)
  • Elevated inflammatory markers
  • Thrombocytosis (abnormal increase in platelets (blood clots)).
  • Abdominal pain
  • Low mean cell volume (MCV)
  • Low hemoglobin
  • Increased leukocyte count
  • Increased liver enzymes

Constellations

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