Symptoms of inflammatory bowel disease

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

• intestinal syndrome;
• extraintestinal changes syndrome;
• endotoxemia syndrome;
• metabolic disorder syndrome.

Intestinal syndrome

The characteristics of intestinal syndrome depend on the localization of the pathological process.

• Blood in the stool is observed in 95-100% of patients with nonspecific ulcerative colitis. In Crohn's disease, visible blood in the feces is not necessary, especially with a high location of the lesion in the right sections of the large and small intestine. The amount of blood may vary - from streaks to profuse intestinal bleeding.
• Diarrhea is observed in 60-65% of patients with inflammatory bowel diseases; stool frequency ranges from 2-4 to 8 times a day or more. Diarrhea is typical for common forms of nonspecific ulcerative colitis, the intensity depends on the extent of the lesion. Diarrhea syndrome is most pronounced with damage to the right sections of the colon (total or subtotal colitis). With left-sided forms, diarrhea is moderate. With Crohn's disease, diarrhea occurs in most patients with damage to the colon and / or small intestine.
• Tenesmus - a false urge to defecate with the release of blood, mucus and pus ("rectal spitting") practically without feces, is characteristic of nonspecific ulcerative colitis and indicates high inflammatory activity in the rectum.
• Loose stools and/or tenesmus occur in 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 nonspecific ulcerative colitis and is caused by spasm of the intestinal segment lying above the affected area.
• Abdominal pain is a typical symptom of Crohn's disease, but not typical for nonspecific ulcerative colitis. With nonspecific ulcerative colitis, spastic pain associated with defecation may occasionally occur.

Frequency of clinical symptoms in Crohn's disease depending on localization

Clinical symptom	Frequency of symptom occurrence depending on the localization of the pathological process, %
	Ileitis	Ileocolitis	Colitis
Diarrhea	=100	=100	=100
Abdominal pain	65	62	55
Bleeding	22	10	46
Weight loss	12	19	22
Perianal lesion	14	38	36
Internal fistulas	17	34	16
Intestinal obstruction	35	44	17
Megacolon	0	2	11
Arthritis	4	4	16
Spondylitis	1	2	5

Extraintestinal changes syndrome

Extraintestinal systemic disorders are characteristic of both nonspecific ulcerative colitis and Crohn's disease, occur in 5-20% of cases and are usually accompanied by severe forms of the disease. All extraintestinal symptoms can be conditionally divided into 2 groups: immune (autoimmune) origin and those caused by other reasons (malabsorption syndrome and its consequences, long-term inflammatory process, hemocoagulation disorder).

Endotoxemia syndrome

Endotoxemia is caused by high activity of the inflammatory process and disruption of the intestinal barrier function. The main symptoms are: general intoxication, febrile fever, tachycardia, anemia, increased ESR, leukocytosis with a shift in the leukocyte formula to immature forms, toxic granularity of neutrophils, increased levels of acute phase proteins (C-reactive protein, seromucoid, fibrinogen).

Metabolic disorder syndrome

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

Systemic manifestations of inflammatory bowel disease

Symptoms	Frequently encountered (5-20%)	Rare (less than 5%)
Activity related	Aphthous stomatitis Erythema nodosum Arthritis Eye damage Thrombosis and thromboembolism	Gangrenous pyoderma
Consequences of malabsorption, inflammation, etc.	Steatohepatitis Osteoporosis Anemia Gallstone disease	Amyloidosis
Not activity related	Sacroiliitis Psoriasis	Rheumatoid arthritis Ankylosing spondylitis Sclerosing cholangitis Cholangiogenic carcinoma

Features of the clinical picture in inflammatory bowel diseases

Clinical symptoms	Non-specific ulcerative colitis	Crohn's disease
Pain (localization, character)	Most often throughout the abdomen, during defecation	Most often in the right iliac region, after eating
Tenesmus	They happen often	Inconstant
Diarrhea	Inconstant	Inconstant
Constipation	Extremely rare during remission	There may be
Flatulence	Happens	Extremely rare
Blood in stool	Always during an exacerbation	Not always
Malabsorption	In severe forms	In case of damage to the small intestine
Anal area	Maceration of perianal skin	Frequent lesions in the form of cracks and condylomas
Extraintestinal symptoms (listed in order of decreasing frequency of occurrence)	Occurs in almost 60% of patients, and in M - combined. Possible reactive 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, predominantly lesions of the biliary system, joints, eyes, anemia, general intoxication

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