Symptoms of inflammatory bowel disease

The clinical symptoms of inflammatory bowel diseases can be grouped into several main syndromes:

• intestinal syndrome;
• syndrome of extraintestinal changes;
• endotoxemia syndrome;
• syndrome of metabolic disorders.

Intestinal Syndrome

Features of the intestinal syndrome depend on the localization of the pathological process.

• The admixture of blood in the stool is noted in 95-100% of patients with ulcerative colitis. With Crohn's disease, visible blood in fecal masses is not necessary, especially with a high location of the focus in the right sections of the large and small intestine. The amount of blood can be different - from veins to profuse intestinal bleeding.
• Diarrhea is noted in 60-65% of patients with inflammatory bowel diseases; the frequency of stools varies from 2-4 to 8 times a day or more. Diarrhea is typical of common forms of ulcerative colitis, the intensity depends on the extent of the lesion. The most pronounced diarrhea syndrome is in the right part of the large intestine (total or subtotal colitis). In left-sided forms, diarrhea is moderately expressed. With Crohn's disease, diarrhea occurs in most patients with a lesion of the thick and / or small intestine.
• Tenesmus - false desires for defecation with the release of blood, mucus and pus ("rectal spitting") with little or no feces, are characteristic of nonspecific ulcerative colitis and indicate a high activity of inflammation in the rectum.
• Liquid stools and / or tenesmus occur during inflammatory bowel diseases mainly at night, which is typical for organic but not functional lesions of the colon.
• Constipation (usually in combination with tenesmus) is characteristic of limited distal forms of ulcerative colitis and is caused by a spasm of the intestinal segment lying above the lesion.
• Pain in the abdomen is a typical symptom of Crohn's disease, for non-specific ulcerative colitis is atypical. With nonspecific ulcerative colitis, spasmodic pain associated with defecation can occur sporadically.

The frequency of clinical symptoms in Crohn's disease, depending on the location

Clinical symptom	The incidence of the symptom depending on the localization of the pathological process,%
	Ileitis	Ileolite	Colitis
Diarrhea	= 100	= 100	= 100
Abdominal pain	65	62	55
Bleeding	22	10	46
Weight loss	12	19	22
Perianalnsi defeat	14	38	36
Internal fistulae	17th	34	16
Intestinal obstruction	35	44	17th
Megacolon	0	2	Eleven
Arthritis	4	4	16
Spondylitis	1	2	5

Syndrome of extraintestinal changes

Extraintestinal systemic disorders are characteristic for both ulcerative colitis and Crohn's disease, occur in 5-20% of cases and are usually accompanied by severe forms of diseases. All extraintestinal symptoms can be conditionally divided into 2 groups: immune (autoimmune) origin and due to other causes (malabsorption syndrome and its consequences, prolonged inflammatory process, violation of hemocoagulation).

Endotoxemia Syndrome

Endotoxemia is due to the high activity of the inflammatory process and the violation of the barrier function of the intestine. The main symptoms: general intoxication, febrile fever, tachycardia, anemia, increased ESR, leukocytosis with a shift of the leukocyte formula to immature forms, toxic neutrophil granules, an increase in the level of acute phase proteins (C-reactive protein, seromucoid fibrinogen).

Syndrome of metabolic disorders

Metabolic disorders - a consequence of diarrhea, toxemia, excessive loss of protein with feces, provoked by exudation and impaired absorption. Clinical symptoms are similar to the malabsorption syndrome of any etiology: weight loss, dehydration, hypoproteinemia, hypoalbuminemia with the development of edematous syndrome, electrolyte disorders, hypovitaminosis.

Systemic signs of inflammatory bowel disease

Symptoms	Frequently occurring (5-20%)	Rarely occurring (less than 5%)
Associated with activity	Aphthous stomatitis Nodal erythema Arthritis Eye disease Thrombosis and thromboembolism	Gangrenous pyoderma
The consequences of malabsorption, inflammation, etc.	Steatohepatitis Osteoporosis Anemia Cholelithiasis	Amyloidosis
Not related to activity	Sacroiliitis Psoriasis	Rheumatoid arthritis Ankylosing spondylitis Sclerosing cholangitis Cholangiogenic carcinoma

Features of the clinical picture of inflammatory bowel disease

Clinical symptoms	Nonspecific ulcerative colitis	Crohn's disease
Pain (localization, character)	Bowl over the entire abdomen, with defecation	More common in the right iliac region, after eating
Tenesmus	There are often	Not always
Diarrhea	Not always	Not always
Constipation	Very rarely during remission	Can be
Flatulence	It happens	Rarely
Blood in the stool	At an exacerbation always	Not always
Disturbance of absorption	In severe forms	With lesions of the small intestine
Anal zone	Maceration of perianal skin	Frequent damage in the form of cracks and condylomas
Extraintestinal symptoms (listed in descending order of incidence)	There are almost 60% of patients, and M - combined. Possible jet and autoimmune lesions of the liver, kidneys, pancreas, biliary system; arthritis; ankylosing spondylitis; erythema nodosum, stomatitis, eye damage, thrombohemorrhagic symptoms, impaired physical and sexual maturation	Less common, lesions of the biliary system, joints, eyes, anemia, general intoxication prevail

[1], [2], [3], [4], [5], [6]