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
- Episcleritis – inflammation of the connective tissue between the sclera and conjunctiva of the eye.
- Iridocyclitis – inflammation of the iris (iris) and ciliary body.
- Uveitis, anterior (inflammation of the anterior vascular ocular structures) (4%).
- 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.
- Stomatitis aphtosa (oral thrush) – disease of the oral mucosa and gingiva (gums) caused by the herpes virus (herpes simplex virus type 1 (HSV-1)) (4%).
* 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
- Altered bowel habits + low hemoglobin (PPV: 9.6%).
- Diarrhea + thrombocytosis (PPV: 6.9%).
- Rectal bleeding + thrombocytosis (PPV: 5.3%).
- Rectal bleeding + increased inflammatory parameters (PPV: 5.2%).
Authors recommend:
- Wait-and-see attitude: <1
- Calprotectin determination: 1 – 3 %.
- Colonoscopy (colonoscopy): > 3 %.