Highlights From Section 3: Diagnosis and Imaging
ECCO statement 3A
Symptoms of ulcerative colitis are dependent upon extent and severity of disease and include bloody diarrhoea, rectal bleeding, tenesmus, urgency, and faecal incontinence. Nocturnal defaecation and fatigue are often reported. Increasing bowel frequency, abdominal pain, anorexia, and fever suggest severe colitis [EL5]
ECCO statement 3B
A family history of ulcerative colitis or Crohn’s disease increases the risk for developing ulcerative colitis [EL2]. Appendicectomy for proven appendicitis before adulthood, and smoking, reduce the risk and severity of UC [EL3]. Smoking cessation may predispose to ulcerative colitis [EL3]
ECCO statement 3C
A full medical history should include detailed questioning about the onset of symptoms, rectal bleeding, stool consistency and frequency, urgency, tenesmus, abdominal pain, incontinence, nocturnal diarrhoea, and extraintestinal manifestations. Recent travel, possible contact with enteric infectious illnesses, medication [including antibiotics and non-steroidal anti-inflammatory drugs], smoking habit, sexual behaviour, family history of inflammatory bowel disease or colorectal cancer, and previous appendectomy should be recorded [EL5]
ECCO statement 3D
Physical examination should include pulse, blood pressure, temperature, weight and height, and abdominal examination for distension and tenderness. Perianal inspection and digital rectal examination may be performed if appropriate. Physical examination may be unremarkable in patients with mild or moderate disease [EL5]
ECCO statement 3E
A ‘gold standard’ for diagnosis of ulcerative colitis does not exist. It is established by clinical, laboratory, imaging, and endoscopic parameters, including histopathology. An infective cause should be excluded. Repeat endoscopy with histopathological review after an interval may be necessary if diagnostic doubt remains [EL5]
ECCO statement 3F
Initial investigations should include full blood count, electrolytes, liver and renal function, iron studies, vitamin D level, C-reactive protein, and faecal calprotectin [EL5]. The immunisation status should be assessed [EL5]. Infectious diarrhoea including C. difficile should be excluded [EL2]. Endoscopy and histology should be performed
ECCO statement 3G
Microbial testing is recommended in patients with colitis relapse. This includes testing for C. difficile and Cytomegalovirus infection [EL3]
