What are the systemic symptoms associated with inflammatory bowel disease (IBD)?

Updated: Apr 10, 2020
  • Author: William A Rowe, MD; Chief Editor: BS Anand, MD  more...
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Systemic symptoms are common in IBD and include weight loss, fever, sweats, malaise, and arthralgias. A low-grade fever may be the first warning sign of a flare. Patients are commonly fatigued, which is often related to the pain, inflammation, and anemia that accompany disease activity. Recurrences may occur with emotional stress, infections or other acute illnesses, pregnancy, dietary problems, use of cathartics or antibiotics, or nonadherence to therapy. Children may present with growth retardation and delayed or failed sexual maturation. In 10%-20% of cases, patients present with extraintestinal manifestations, including arthritis, uveitis, or liver disease (see Complications).

Grossly bloody stools, occasionally with tenesmus, although typical of ulcerative colitis, are less common in Crohn disease. Stools may be formed, but loose stools predominate if the colon or the terminal ileum is involved extensively. Fifty percent of patients with Crohn disease may present with perianal disease (eg, fistulas, abscesses). Occasionally, acute right lower quadrant pain and fever, mimicking appendicitis or intestinal obstruction, may be noted. Weight loss is observed more commonly in Crohn disease than in ulcerative colitis because of the malabsorption associated with small bowel disease, or small bowel disease may act as an appetite deterrent. In addition, patients may reduce their food intake in an effort to control their symptoms.

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