Nonspecific ulcerative colitis - Symptoms.

The main symptoms of ulcerative colitis are the following.

Diarrhea with blood, mucus and pus. In the pronounced clinical picture of the disease, frequent loose stools with blood, mucus and pus are characteristic. Stool up to 20 times a day, and in severe cases up to 30-40, mainly at night and in the morning. In many patients, the amount of blood in the stool is quite significant, sometimes defecation occurs with almost pure blood. The amount of blood lost by patients during the day can be from 100 to 300 ml. Feces contain a large amount of pus and can have a foul odor.

The onset of the disease may vary depending on the time of appearance of blood in the stool; the following options are possible:

• At first, diarrhea appears, and after a few days, mucus and blood;
• the disease immediately begins with rectal bleeding, and the stool may be formed or mushy;
• Diarrhea and rectal bleeding begin simultaneously, while patients experience other symptoms of the disease (abdominal pain, intoxication).

Diarrhea and bleeding are considered the main clinical manifestations of nonspecific ulcerative colitis. Diarrhea is caused by extensive inflammatory lesions of the colon mucosa and a sharp decrease in its ability to reabsorb water and sodium. Bleeding is a consequence of ulceration of the colon mucosa and the development of loose connective tissue with a richly developed vascular network.

Abdominal pain. A constant symptom of nonspecific ulcerative colitis. The pain is cramping and localized mainly in the projection of the colon, most often in the sigmoid, transverse colon, rectum, less often in the cecum, in the umbilical region. Usually the pain intensifies before defecation and subsides or weakens after stool. It is possible that the pain intensifies after eating.

It should be noted that extremely severe pain and symptoms of peritonitis are not typical for nonspecific ulcerative colitis, since the inflammatory process in this disease is limited to the mucous membrane and submucous layer. In complicated cases of nonspecific ulcerative colitis, the inflammatory process spreads to the deep layers of the intestinal wall.

Abdominal pain on palpation. A characteristic sign of nonspecific ulcerative colitis. Palpation reveals clearly expressed pain in the sigmoid, transverse colon and cecum. The more pronounced the inflammatory process in the large intestine, the more significant the pain on palpation of its sections. Symptoms of peritoneal irritation, muscle tension in uncomplicated cases of the disease are usually not observed, however, in severe cases, resistance of the muscles of the anterior abdominal wall may occur.

Intoxication syndrome. Characteristic of severe nonspecific ulcerative colitis and acute fulminant forms of the disease. Intoxication syndrome is manifested by severe weakness, adynamia, increased body temperature (often to high numbers), weight loss, decreased or even complete lack of appetite, nausea, depression, severe emotional lability, tearfulness, irritability.

Syndrome of systemic manifestations. Systemic manifestations of nonspecific ulcerative colitis are typical for severe course of the disease and in some cases occur in moderate form. Typical systemic manifestations include:

• polyarthritis - usually the ankle, knee, interphalangeal joints are affected, the intensity of pain and the degree of limitation of joint movement are usually small. With the onset of remission, joint changes completely disappear, deformations and dysfunction of the joints do not develop. Some patients develop transient spondyloarthritis and sacroiliitis. Sacroiliitis is more common and is more severe with more extensive and severe lesions of the large intestine. Symptoms of sacroiliitis can precede the clinical manifestations of nonspecific ulcerative colitis by many years;
• erythema nodosum - develops in 2-3% of patients, manifests itself in multiple nodes, most often on the extensor surface of the leg. The skin over the nodes has a purple-violet color, then becomes greenish, yellowish and then acquires a normal color;
• skin lesions - possible development of gangrenous pyoderma (in severe septic course of the disease); skin ulcerations; focal dermatitis; postular and urticarial rashes. Gangrenous pyoderma is especially severe;
• eye damage - noted in 1.5-3.5% of patients, characterized by the development of iritis, iridocyclitis, uveitis, episcleritis, keratitis and even panophthalmitis;
• Liver and extrahepatic bile duct lesions are of great importance for assessing the course of the disease, treatment tactics and prognosis. In nonspecific ulcerative colitis, the following forms of liver damage are observed: fatty degeneration, portal fibrosis, chronic active hepatitis, liver cirrhosis. According to research, liver damage practically does not change under the influence of conservative therapy of nonspecific ulcerative colitis, and in severe forms it progresses and leads to the development of liver cirrhosis. After colectomy, changes in the liver regress. A characteristic lesion of the extrahepatic bile ducts is sclerosing cholangitis;
• damage to the oral mucosa is characterized by the development of aphthous stomatitis, glossitis, gingivitis, which occur with very severe pain; ulcerative stomatitis is possible;
• nephrotic syndrome is a rare complication of ulcerative colitis;
• autoimmune thyroiditis;
• autoimmune hemolytic anemia.

The development of the syndrome of systemic manifestations is caused by autoimmune disorders and reflects the activity and severity of the pathological process in ulcerative colitis.

Dystrophic syndrome. The development of dystrophic syndrome is typical for the chronic form, as well as the acute course of nonspecific ulcerative colitis. Dystrophic syndrome is manifested by significant weight loss, pale and dry skin, hypovitaminosis, hair loss, changes in nails.

Clinical forms of the course

Most gastroenterologists distinguish the following forms of nonspecific ulcerative colitis: acute (including fulminant) and chronic (recurrent, continuous).

Acute course

The acute form of the disease is characterized by rapid development of the clinical picture, severity of general and local manifestations, early development of complications, involvement of the entire colon in the pathological process. Acute ulcerative colitis is characterized by severe diarrhea, significant intestinal bleeding. With severe diarrhea, discharge from the rectum almost does not contain feces, blood, mucus, pus, tissue detritus are released from the rectum every 15-20 minutes. Severe exhaustion develops (weight loss can reach 40-50%). Patients are adynamic, pale, symptoms of intoxication are sharply expressed (dry skin and oral mucosa; tachycardia; increased body temperature; loss of appetite; nausea). Palpation of the abdomen reveals severe pain in the colon. The acute course of the disease is characterized by complications (toxic dilatation of the colon, perforation, peritonitis).

The fulminant form is the most severe form of nonspecific ulcerative colitis and usually requires surgical treatment. It is characterized by a sudden onset, rapid development of the clinical picture (sometimes within a few days or 1-2 weeks). In the fulminant form, severe diarrhea, significant intestinal bleeding, high body temperature, severe intoxication are observed, and life-threatening complications often develop. In the fulminant form of nonspecific ulcerative colitis, total damage to the colon and rapid development of systemic manifestations of the disease are noted.

Chronic forms

Chronic continuous form is diagnosed if remission of the process does not occur within 6 months after the initial manifestations. In this form, exacerbations follow one another frequently, remissions are very unstable, short-term, systemic manifestations of the disease are quickly formed, complications often develop.

The chronic relapsing form is the most common and is characterized by remissions lasting 3-6 months or more, followed by exacerbations of varying severity.

Severity levels

In non-specific ulcerative colitis, the severity of the disease is determined by the degree of involvement of the large intestine in the pathological process. The most common is proctosigmoiditis (70% of patients), isolated lesion of the rectum is recorded in 5% of patients, total colitis - in 16% of patients.

Classification of non-specific ulcerative colitis

The course of nonspecific ulcerative colitis	Severity	Prevalence of the lesion
Acute (lightning) Chronic continuous Chronic recurrent	Heavy Medium-heavy Easy	Total colitis with or without retrograde ileitis Left-sided colitis Distal colitis (proctosigmoiditis, proctitis)

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ], [ 8 ]