Ulcerative colitis - clinical and paraclinical features

Abstract

Introduction: Ulcerative colitis (UC) represents a major problem in modern gastroenterology, mostly due to the incomplete knowledge on its etiology and pathogenesis and a lack of a “Gold Standard” regarding diagnosis and treatment. Purpose and objectives: To study the signs and symptoms and the main complications, to appreciate the social impact of the disease, to evaluate the level of accuracy of the paraclinical tests in determining the UC phenotype (extension, activity). Materials and methods: This is a retrospective study, which focused on the clinical aspects of UC in 105 patients hospitalized between 2011 and 2013 in the Gastroenterology Department of the Republican Clinical Hospital. The precision of the inflammatory markers (erythrocyte sedimentation rate - ESR, C reactive protein - CRP) in appreciating the UC activity was studied on a cohort of 44 cases. The level of UC extension was determined in 49 cases, comparing two methods - colonoscopy and irrigography. Results: UC affects primarily people of childbearing age and labor force (76.2% - less than 40 y.o.), has a long course (average duration - 4,6 ± 3,9 years) and a high level of impairment (37.1% have a certain degree of disability, out of them 79.4% are less than 40 y.o.). The patients are presenting mostly with local symptoms (abdominal pain 85.7%, bloody diarrhea 80%, tenesmus 68.5%). These are associated with general symptoms (fatigue 100%, weight loss 21.5% , high/slight fever 16.2%). The only extraintestinal manifestation observed was the arthralgia (8.5% ). The most frequent complication in UC is anemia (27.6%), which significantly correlates with disease activity (r = 0,59, p < 0,01). CRP has a higher correlation with UC activity, compared with ESR (r = 0,78 versus r = 0,69, p < 0,01). Colonoscopy has a higher accuracy in determining the level of macroscopical lesions, especially in extended forms of UC (the error rate in irrigography - 33.3%). Conclusion: UC affects equally both men and women, but has a high predom inancy in young people, has a long course of the disease and imposes long-term disability. Any case of UC must be phenotyped, i.e. appreciating the extension, activity and longitudinal pattern. CRP proves to be more informative marker in regards to disease activity. In order to determine the macroscopic extent, it is recommended to use colonoscopy rather than irrigography.