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

Bryce K Perler,Meaghan Mallette,Ryan Ungaro,Bruce E Sands,Jason Shapiro,Renee Bright,Grayson Baird,Samir Shah

doi:10.1186/s12876-019-0963-7

Abstract

BackgroundFew data are currently available on the initial presenting symptoms of patients with inflammatory bowel disease (IBD).MethodsWe 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.ResultsA 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.ConclusionThe 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.

Highlights

Few data are currently available on the initial presenting symptoms of patients with inflammatory bowel disease (IBD)
The two most common presenting symptoms in Crohn disease (CD) were tiredness/fatigue and abdominal pain while passage of blood with bowel movements (BM) and loose/watery BMs were most common in ulcerative colitis (UC) (Fig. 1a and b)
The most common presenting symptoms in CD based on disease location at time of diagnoses were abdominal pain (82.14%) and tiredness/fatigue (72.41%) for ileal CD (Fig. 2a), tiredness/fatigue (91.18%) and abdominal pain (91.04%) for ileocolonic CD (Fig. 2b). and tiredness/ fatigue (78.35%) and loose or watery BMs (77.32%) for colonic CD (Fig. 2c).The most common presenting symptoms in UC based on disease extent at time of diagnosis are passage of blood with BM

Summary

Introduction

Few data are currently available on the initial presenting symptoms of patients with inflammatory bowel disease (IBD). There are few published data on the initial presenting symptoms of patients with IBD. One study looked at symptoms throughout the disease course of IBD and found that the two most common symptoms were diarrhea and fatigue [4]. This study did not explore symptoms at initial disease presentation. Another study described clinical characteristics, incidence, natural history, and symptomatic presentation prior to diagnosis in a pediatric population but focused on extra-intestinal manifestations (EIMs) of IBD at the time of diagnosis. The two most common EIMs at presentation were joint pain (20% in CD and 14% in UC) and oral ulcerations (13% in CD and 6% in UC) [5]. Other studies have explored symptoms associated with IBD after the diagnosis had already been established and typically later in the disease course [6,7,8,9,10,11]

Methods

Results

Discussion

Conclusion