title: Identification of symptom domains in ulcerative colitis that occur frequently during flares and are responsive to changes in disease activity.
abstract: BACKGROUND
  Ulcerative colitis disease activity is determined by measuring symptoms and signs. Our aim was to determine which symptom domains are frequent and responsive to change in the evaluation of disease activity, which are those defined by three criteria: 1) they occur frequently during flares; 2) they improve during effective therapy for ulcerative colitis; and 3) they resolve during remission.
  
  
  METHODS
  Twenty-eight symptom domains, 16 from standard indices and 12 novel domains identified by ulcerative colitis patient focus groups, were evaluated. Sixty subjects with ulcerative colitis were surveyed, rating each symptom on the three criteria with a 100 mm Visual Analogue Scale. Frequent and responsive symptoms were defined a priori as those whose median Visual Analogue Scale rating for all 3 criteria was significantly greater than 50.
  
  
  RESULTS
  Thirteen of the 28 symptom domains were identified as both frequent in ulcerative colitis flares and responsive to changes in disease activity. Seven of these 13 symptom domains were novel symptoms derived from ulcerative colitis patient focus groups including stool mucus, tenesmus, fatigue, rapid postprandial bowel movements, and inability to differentiate liquid or gas from solid stool when rectal urgency occurs. Ten of the 16 symptom domains from standard indices were either infrequent or unresponsive to changes in disease activity.
  
  
  CONCLUSIONS
  Only some of the symptoms of ulcerative colitis that are important to patients are included in standard indices, and several symptoms currently measured are not frequent or responsive to change in ulcerative colitis patients. Development of survey measures of these symptom domains could significantly improve the assessment of disease activity in ulcerative colitis.
authors.affiliation: Medical School, University of Michigan, Ann Arbor, MI, USA. joeljz@umich.edu
authors.forename: Joel C
authors.initials: JC
authors.lastname: Joyce
authors.forename: Akbar K
authors.initials: AK
authors.lastname: Waljee
authors.forename: Tahira
authors.initials: T
authors.lastname: Khan
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Wren
authors.forename: Maneesh
authors.initials: M
authors.lastname: Dave
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Zimmermann
authors.forename: Sijian
authors.initials: S
authors.lastname: Wang
authors.forename: Ji
authors.initials: J
authors.lastname: Zhu
authors.forename: Peter D R
authors.initials: PD
authors.lastname: Higgins
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D003093:Colitis, Ulcerative / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012008:Recurrence; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires