GETTY helpful for those with mild disease and are unlikely to help individuals with severe disease .
Q What are the symptoms experienced by those with ulcerative colitis ?
A Typically , Dr Panés described how patients with ulcerative colitis experience increased stool frequency , diarrhoea , and rectal bleeding , which is a particularly alarming symptom that prompts individuals to seek medical advice . Another and perhaps more disturbing symptom is faecal urgency which often necessitated a considerable degree of lifestyle adaptation . In more severe disease , he explained , urgency can lead to incontinence , which has a significant impact on patients ’ quality of life . Additionally , patients with more severe disease may also have abdominal pain fever or even anaemia .
In the absence of a specific disease marker , a holistic assessment that combines symptoms , findings from colonoscopy and a biopsy , is needed to make a diagnosis of ulcerative colitis .
In contrast , diagnosing Crohn ’ s disease is more difficult because diarrhoea is not always present , although abdominal pain is the most common symptom but often leads to a delay in patients being diagnosed .
Q How common is ulcerative colitis ?
A Dr Panés mentioned that ulcerative colitis affects around 4 in 1000 patients in Europe which equates to around 1.5 million sufferers . He added that around half of these patients will have mild to moderate disease and among those with moderate to severe disease , roughly one third will require hospitalisation at some point .
The onset of the disease he said , ‘ typically occurs around adolescence or early adulthood ’ although it can occur at any age . He added how one of the more alarming findings from epidemiological studies is that the prevalence of IBD appears to be on the increase at both ends of the age spectrum . As he continued : ‘ it was very rare 25 years ago to diagnose IBD in a patient older than 60 or 70 and also paediatric cases were very infrequent .’ The increasing prevalence within the early-onset group , he described as both monogenic or polygenic in nature and more severe .
How is disease severity assessed ?
A Disease severity in ulcerative colitis is , as Dr Panés described , based on both the intensity of an individual flare as well as disease course over time . For example , ‘ more severe disease is characterised by more stools per day and more prominent bleeding , with the intensity of bleeding being an important determinant of severity .’ Typically , those with severe disease might have more than 8 episodes of passing stools throughout the day but in those with the most severe disease , this can be as high as 25 episodes . Clinical
signs associated with more severe disease include anaemia and hypoalbuminaemia , and which are factors warranting hospitalisation .
Q What are the healthcare burdens associated with ulcerative colitis ?
A The noticeable increasing disease prevalence has a huge impact on healthcare expenditure given how management requires input from a multi-disciplinary team including nurses , physicians , psychologists and surgeons . Furthermore , although the episodic nature of the disease is characterised by intermittent flares , teams still need to be ready and able to rapidly respond to a patient ’ s needs , because , as Dr Panés explained ‘ if treatment is not started quickly , the patient can deteriorate rapidly .’ He added that despite the effectiveness of current therapies , around “ 20 % of patients at some point have uncontrolled disease and require surgery .’ A further and longer-term consequence of ulcerative colitis is an increased risk of cancer , especially when the disease has been present for 8 – 10 years and in those with chronic and active disease . The risk of cancer in ulcerative colitis is further increased among patients with primary sclerosing cholangitis . As Dr Panés said , ‘ the risk in patients who also have primary sclerosing cholangitis is so high that patients have an annual colonoscopy
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