Identification of a prodromal period in Crohn's disease but not ulcerativecolitis

OBJECTIVES: Irritable bowel syndrome, a common gastrointestinal diagnosis, has not been clearly studied in inflammatory bowel disease. Some of the res idual symptoms in subjects treated with Crohn's disease and ulcerative coli tis are thought to be related to irritable bowel syndrome. The aims of this study were I) to describe the duration and nature of complaints before the diagnosis of Crohn's disease and ulcerative colitis (prodromal period), an d 2) to determine the role of IBS in this prodromal period. METHODS: A total of 66 patients with confirmed inflammatory bowel disease w ere enrolled in the study. The subjects received a questionnaire to ascerta in the nature and duration of symptoms preceding the diagnosis of Crohn's d isease or ulcerative colitis, including features described under the Rome c riteria for irritable bowel syndrome. RESULTS: Of the 66 subjects analyzed, 45 had Crohn's disease and 21 had ulc erative colitis. The prodromal period was 7.7 +/- 10.7 yr for Crohn's disea se and 1.2 +/- 1.8 yr for ulcerative colitis (p < 0.05). Once patients meet ing the Rome criteria for irritable bowel syndrome during the prodrome were excluded, the duration of the prodromal period (non-IBS) for ulcerative co litis dropped to 0.8 +/- 1.3 yr compared to 6.9 +/- 9.8 yr in the Crohn's d isease group (p < 0.05). The symptoms of the non-IBS prodrome in subjects w ith Crohn's disease were bloating, diarrhea, stomach pain, heartburn, fever , weight loss, and fatigue. Further analysis demonstrated that subjects who se Crohn's disease initially began as colonic disease had a longer prodrome than with small bowel. In the non-IBS Crohn's group, there was also a corr elation between the age at the time of diagnosis and the duration of prodro me (r = 0.67, p < 0.0001). CONCLUSIONS: There is a significant prodromal period before the time of dia gnosis of Crohn's disease that is not found in ulcerative colitis even afte r exclusion of subjects with IBS. (C) 2000 by Am. Cell. of Gastroenterology .