Presenting symptoms in inflammatory bowel disease: descriptive analysis of a community-based inception cohort

Perler B1, Ungaro R2, Baird G3, Mallette M4, Bright R4, Shah S4, Shapiro J5, Sands BE2. BMC Gastroenterol. 2019 Apr 2;19(1):47. doi: 10.1186/s12876-019-0963-7.


Author information

Department of Medicine, Warren Alpert Medical School of Brown University, Providence, USA. bryce_perler@brown.edu.

Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA.

Lifespan Biostatistics Core, Rhode Island Hospital, Providence, USA.

Department of Gastroenterology, Warren Alpert Medical School of Brown University, Providence, USA.

Department of Pediatric Gastroenterology, Warren Alpert Medical School of Brown University, Providence, USA.


BACKGROUND: Few data are currently available on the initial presenting symptoms of patients with inflammatorybowel disease (IBD).

METHODS: We evaluated the initial symptom presentation of patients with IBD in the Ocean State Crohn's and Colitis Area Registry (OSCCAR), a community-based inception cohort that enrolled Rhode Island IBD patients at time of diagnosis with longitudinal follow up. A 41-question symptom inventory was administered at time of enrollment to capture symptoms experienced during the 4 weeks preceding diagnosis of IBD. Frequencies of presenting symptoms were calculated. Principal component analysis (PCA) with promax rotation was used to examine possible symptom profiles among Crohn's disease (CD) and ulcerative colitis (UC) patients, respectively. Using the Scree plot, the 4-component solution was found to be optimal for both CD and UC.

RESULTS: A total of 233 CD and 150 UC patients were included. The most common presenting symptoms in CD were tiredness/fatigue (80.6%) and abdominal pain (80.4%) while passage of blood with bowel movements (BM) (86.6%) and loose/watery BMs (86.5%) were most common in UC. The 5 symptoms with greatest differences between UC and CD were passage of blood with BM (UC 86.6%/CD 45.3%), urgent BM (UC 82.5%/CD 63.9%), passage of mucus with BM (UC 67.7%/CD 36.9%), passage of blood from the anus (UC 59.7%/CD 32.1%), and anxiety about distance from bathroom (UC 59%/CD 38.7%). The PCA analysis yielded a 4 symptom components solution for CD and UC.

CONCLUSION: The most common presenting symptoms in CD are fatigue and abdominal pain while in UC bloody BM and diarrhea are most common. Distinct symptom phenotypes are seen with PCA analysis. Our study demonstrates symptomatic similarities and differences between CD and UC and suggests that patients may also be classified by symptom phenotype at time of diagnosis.

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