Anemia in a 66-Year-Old Woman

Jun H. Lee, MD; Marc D. Basson, MD, PhD

Disclosures

December 02, 2015

Discussion

The combination of the history and clinical workup suggests ulcerative colitis (UC) as the most likely diagnosis. UC is the most common inflammatory bowel disease (IBD). It is most prevalent in the developed world, such as Europe and North America, where the incidence ranges from 0.6 to more than 20 cases per 100,000 person years. This means that 1 in 200 people have UC in developed countries. The prevalence of the disease worldwide is 5-500 people per 100,000 person years and rising.[1] UC onset has a bimodal distribution; the first peak occurs in the thirties, and the second peak occurs between 50 and 70 years. Twelve percent of patients present for the first time with symptoms when older than 60 years.[2] No sex-based differences are noted.[1]

Smoking has been known to be protective of developing UC.[1] However, greater proportions of elderly patients were ex-smokers compared with their younger counterparts. In contrast, genetic factors seem to play a greater role in the younger UC population, where a stronger family history of UC is noted compared with the elderly patient population.[3]

The rectum is involved in 95% of cases. Thus, the commonest presenting complaints are bloody diarrhea with or without mucus, urgency, and tenesmus.[1,4] However, elderly patients more frequently present with bleeding, weight loss, fever, and constipation.[5,6] Extraintestinal involvement is present in 10%-30% of patients. This includes the skin (5%), eye (5%), small and large joints (20%), and the liver (5%).[1,4] Although these manifestations occur later in the disease process, one study showed that more than 30% of patients had one of the extraintestinal abnormalities present at the time of diagnosis.[7] A thorough examination of the patient when suspecting UC as a potential diagnosis is important.

Extraintestinal involvement is as follows:

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