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. 2019 Apr 2;19(1):47.
doi: 10.1186/s12876-019-0963-7.

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

Bryce K Perler  1 , Ryan Ungaro  2 , Grayson Baird  3 , Meaghan Mallette  4 , Renee Bright  4 , Samir Shah  4 , Jason Shapiro  5 , Bruce E Sands  2
Affiliations

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

Bryce K Perler et al. BMC Gastroenterol. .

Erratum in

Abstract

Background: Few data are currently available on the initial presenting symptoms of patients with inflammatory bowel 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.

Keywords: Crohn’s disease; Inflammatory bowel disease; Ocean State Crohn’s and Colitis Area Registry; Presenting symptoms; Principal component analysis; Ulcerative colitis.

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Conflict of interest statement

Ethics approval and consent to participate

The present study was approved by the Ethics Committee of Lifespan affiliated hospitals including Rhode Island Hospital, The Miriam Hospital, and Hasbro Children’s Hospital. Written informed consent was obtained from each patient included in the study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
The 10 most common presenting symptoms in CD (a) and UC (b) captured using the 41-question symptom inventory
Fig. 2
Fig. 2
The 10 most common presenting symptoms in Ileal CD (a), Ileocolonic CD (b), and Colonic CD (c) captured using the 41-question symptom inventory
Fig. 3
Fig. 3
The 10 most common presenting symptoms in Proctitis UC (a), Leftsided UC (b), and Extensive UC (c) captured using the 41-question symptom inventory
Fig. 4
Fig. 4
Scree plots of UC (left) and CD (right). Eigen values denote variance accounted for by a linear combination. As can been seen in the left panel (UC) and right panel (CD), the amount of variance accounted is greatest for the first component, then the second, followed by the third and fourth, but diminishes greatly thereafter; this reveals the 4-component solution is the best
See this image and copyright information in PMC

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