Clinical Features

Signs and symptoms

Crohn’s disease

Ulcerative colitis

Abdominal pain

Often, severe

Less increased

Hemorrhage

Seldom

Very common

Palpable tumor in abdomen

Common

Absence

Fistulae

Common

Seldom

Stenosic lesions

Common

Seldom

Perianal changes

Common

Seldom

Rectum occupation

Seldom

Very common

Distribution of lesions

Continuous

Discontinuous

Toxic megacolon

Seldom

Common

Perforation

Seldom

Common

Pseudopolyps

Quite common

Seldom

Box 7.1 A full medical history of IBD should include answers to the following questions:

When did the disease begin? When were the first symptoms?
Are there recurrent episodes of rectal bleeding or bloody diarrhea?
Does abdominal pain occur?
Have you had any problems with stools (tenesmus/incontinence/nocturnal diarrhea)?
Have you travelled recently?
Have you got food intolerance?
Does anyone in your family suffer from inflammatory bowel diseases?
Have you ever had appendectomy?
Do you take any medicines, especially antibiotics or non-steroidal anti-inflammatory drugs?
Do you smoke?
Have you had any contact with enteric infectious illness recently?
Have you ever had any problems with your skin, eyes, joints?
Have you ever had any changes in your mouth or anal area?

Box 7.2 A general psychical examination should include

general well-being
body weight and height
body temperature
pulse rate
blood pressure
abdominal examination (attention for tenderness, distension and palpable masses)
digital rectal examination
perianal and oral inspection
check for eye/skin/joint involvements

7.3 The Course of Disease

Crohn’s disease is a chronic, longstanding condition with alternating periods of remission and exacerbation as characteristic features. Longstanding persistent remission after first episode of the disease occurs only in 10–20 % of patients. Progression of the disease proceeds to the fibrosis, formation of stenoses and fistulae. A risk of fistulae formation is estimated at 20–40 % of patients during the overall duration of CD. Young age during onset of the disease, presence of perianal changes and an early beginning of aggressive treatment are negative prognostic factors.

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