Comprehensive Approach to Medical History Taking in Ulcerative Colitis
A thorough medical history in ulcerative colitis patients must include detailed questioning about symptom onset, rectal bleeding, stool patterns, and extra-intestinal manifestations to properly assess disease severity, guide treatment decisions, and monitor disease progression. 1
Core Symptom Assessment
- Bowel symptoms: Document stool frequency, consistency, presence of rectal bleeding, urgency, tenesmus, abdominal pain, incontinence, and nocturnal diarrhea 1
- Extra-intestinal manifestations: Inquire about joint pain/swelling, skin lesions, eye inflammation, and liver problems 1
- Symptom timeline: Establish onset, duration, pattern (continuous vs. intermittent), and progression of symptoms 1
- Severity indicators: Document fever, weight loss, fatigue, and impact on daily activities 1
Risk Factors and Disease Modifiers
- Family history: Ask about inflammatory bowel disease or colorectal cancer in relatives, as first-degree relatives have significantly higher risk (IRR: 4.08) 1
- Smoking status: Document current smoking (protective effect), former smoking (70% higher risk), or never smoked 1
- Previous appendectomy: Record if performed, particularly before adulthood (protective effect) 1
- Medication history: Document current and past medications, especially antibiotics and NSAIDs (may exacerbate disease) 1
Exposure and Travel History
- Recent travel: Document destinations and timing relative to symptom onset 1
- Infectious exposures: Ask about contact with individuals with enteric infections 1
- Sexual behavior: Document as relevant for certain infectious differential diagnoses 1
Treatment History and Response
- Previous treatments: Document all prior UC treatments including 5-ASA compounds, corticosteroids, immunomodulators, and biologics 2, 3
- Treatment response: Assess efficacy, side effects, and reasons for discontinuation of previous treatments 4, 5
- Corticosteroid use: Document frequency, duration, and response to steroid therapy, noting steroid-dependent or steroid-refractory status 3, 6
Immunization Status
- Vaccination history: Assess immunization status, particularly important before initiating immunosuppressive therapy 1
Disease Complications and Severity Assessment
- Hospitalization history: Document previous hospitalizations for severe flares (approximately 20% of UC patients experience severe flares requiring hospitalization) 6
- Surgical interventions: Record any previous UC-related surgeries 1
- Complications: Document history of toxic megacolon, perforation, or severe bleeding 2
Common Pitfalls and Caveats
- Don't neglect microbial testing: Always consider infectious causes during flares, especially C. difficile and Cytomegalovirus, which can mimic or exacerbate UC 1
- Avoid assuming symptoms are always due to UC: Consider irritable bowel syndrome, infectious colitis, medication side effects, or colorectal cancer in the differential diagnosis 1
- Remember disease extent impacts management: Document previous endoscopic findings regarding disease extent (proctitis, left-sided, or extensive colitis) as this influences treatment approach and cancer surveillance requirements 1
- Consider cancer surveillance needs: For patients with longstanding disease (>8 years for extensive colitis, >12 years for left-sided disease), document previous surveillance colonoscopies and findings 4, 5
By systematically addressing these areas in the medical history, clinicians can properly assess disease severity, guide appropriate treatment decisions, and monitor disease progression in patients with ulcerative colitis.