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. 2008 Sep 20:6:69.
doi: 10.1186/1477-7525-6-69.

Identification of symptom domains in ulcerative colitis that occur frequently during flares and are responsive to changes in disease activity

Joel C Joyce  1 , Akbar K Waljee, Tahira Khan, Patricia A Wren, Maneesh Dave, Ellen M Zimmermann, Sijian Wang, Ji Zhu, Peter D R Higgins
Affiliations

Identification of symptom domains in ulcerative colitis that occur frequently during flares and are responsive to changes in disease activity

Joel C Joyce et al. Health Qual Life Outcomes. .

Abstract

Background: Ulcerative colitis disease activity is determined by measuring symptoms and signs VSports手机版. 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 V体育安卓版. 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 V体育ios版. Ten of the 16 symptom domains from standard indices were either infrequent or unresponsive to changes in disease activity. .

Conclusion: 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. VSports最新版本.

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Figure 1
Figure 1
Flow diagram of 28 symptom domains in questionnaire and criteria for determining frequent and responsive symptom domains. Sixteen symptom domains were included from commonly used indices of ulcerative colitis disease activity (Truelove and Witts, St. Mark's Index, CAI, SCCAI, UCSS, Mayo, and UCDAI), and twelve novel symptom domains were included from previously conducted focus group input [15]. The questionnaire required ratings of the three criteria listed on a 100 mm Visual Analogue Scale for each of the 28 symptom domains. Symptom domains were determined to be either frequent and responsive or infrequent or unresponsive for evaluation of disease activity based on significance of the sign test.
Figure 2
Figure 2
Visual analogue scale used on questionnaire for assessing each of three endpoints for all 28 symptom domains. An example of the 100 mm Visual Analogue Scales (VAS) used in the questionnaire to rate the three criteria for each of the 28 symptom domains.
Figure 3
Figure 3
Visual analogue scale ratings of symptoms present during a flare. A box plot of the VAS ratings of symptoms present during flares for the 28 symptom domains is presented. Each box bounds the region from the 25th to 75th percentile of responses. The vertical line in each box is the median. Lines connect the boxes to the next observation beyond the box and the dots represent remaining outliers. The vertical line at VAS = 50 signifies the a priori cut-off rating establishing symptoms that are frequent during flares. The symptoms presented in dark gray boxes are those that met all 3 criteria for symptom importance. Only the 13 highest rated symptoms had VAS ratings significantly greater than 50 for presence during flares.
Figure 4
Figure 4
Visual analogue scale ratings of symptoms that improve during therapy. A box plot of the VAS ratings of symptoms is presented that improve during therapy All but the lowest-rated symptom, mouth ulcers, had VAS ratings significantly greater than 50 for improvement during therapy. Additional more stringent cutoffs at 60 and 80 points are presented for illustration.
Figure 5
Figure 5
Visual analogue scale ratings of symptoms that are absent during remission. A box plot of the VAS ratings of symptoms that are absent during remission. All of the symptoms evaluated had VAS ratings significantly greater than 50 for absence during remission.
Figure 6
Figure 6
Example of a symptom domain that meets a frequent symptom with good dynamic range. A dot plot of a symptom domain (stool mucus) that meets criteria for a frequent and responsive symptom (one that is frequent with good dynamic range). VAS ratings are from the 100 mm scale. Each dot represents one individual's response. The horizontal lines on the graphs are as follows: 25 is the 25th percentile, M is the median, and 75 is the 75th percentile. The horizontal line at VAS = 50 signifies the a priori cut-off rating for frequent and responsive symptoms.
Figure 7
Figure 7
Example of a symptom domain that did not meet criteria for a frequent symptom with good dynamic range. Dot plot of a symptom domain (anorexia) that did not meet the criteria for a frequent and responsive symptom. VAS ratings are from the 100 mm scale. Each dot represents one individual's response. The horizontal lines on the graphs are as follows: 25 is the 25th percentile, M is the median, and 75 is the 75th percentile. The horizontal line at VAS = 50 signifies the a priori cut-off rating for frequent and responsive symptoms.
Figure 8
Figure 8
Cluster analysis of symptom domains. Using single clustering, a dendrogram of the 28 symptom domains is presented to illustrate the likely redundancy in some items, and the potential for item reduction in future development of a UC activity index.
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