Ulcerative Colitis - Primary Care Update

So let's get to some of these questions.

PAs are often on the front lines for diagnosing and treating patients with bowel disease.

What are some of the most commonly missed early signs of ulcerative colitis, and how do you think PAs can distinguish it from things like IBS, infectious diarrhea, or even Crohn's disease early on?

Joe, I'm happy to, to field this question, and it's an important one.

Certainly, the identification of, of UC is really essential in primary care and certainly where patients first often present.

And so Early UC can be subtle or potentially misdiagnosed as IBS, irritable bowel syndrome, infectious diarrhea, or even potentially like postprandial food insensitivities, lactose and gluten intolerance.

And so I think it's really important as primary care providers that we're taking a very good, thorough history.

So querying for constitutional symptoms, querying for gastrointestinal luminal symptoms, but also those extra intestinal symptoms that may be associated with inflammatory bowel disease.

And this is in concert with also specifically inquiring about alarm features, red flag symptoms, and so unintentional weight loss, rectal bleeding, iron deficiency anemia.

These can really help distinguish inflammatory bowel disease, ulcerative colitis from other conditions such as IBS, celiac disease.

And also we're wanting to distinguish too and potentially identify for potential colorectal cancer.

So, so that's...

Those three things are important.

The other thing too is when we think about infectious diarrhea, we want to make sure that we're inquiring about risk exposures that the patient may have, things that could increase our pretest probability that this patient might have an infectious exposure.

So travel history, antibiotic use, sick contacts, all of that is important, and that can help support or refute our, our differential.

I think it's important for providers to recognize that there are potentially some symptoms that may be minimized or normalized.

Um, so rectal bleeding and that potentially being attributed to hemorrhoids, and that being a concern for potential ulcerative colitis.

Patients may have fecal urgency or tenesmus, which may be attributed to postprandial food insensitivities.

And so, [lips smack] and then of course, extra intestinal symptoms.

I think sometimes arthralgias, eye pain, rash, those things may be overlooked.

But in concert with luminal symptoms really should be raising our clinical suspicion for inflammatory bowel disease.

And so I think it's important that we're looking at all of that and then understanding the episodes that the patient has.

If these are recurrent episodes, I start to think more about that relapsing, remitting nature of inflammatory bowel disease.

And so I think, you know, all of that together raises our clinical suspicion and things that we should be on the lookout for.

Thanks, Kim.