Because patients often present with nonspecific GI symptoms, initial diagnostic evaluation includes methods to characterize the disease and rule out other potential etiologies. This may include stool cultures to examine for infectious causes of diarrhea.

Endoscopic approaches are typically used and may include colonoscopy, proctosigmoidoscopy, or possibly upper GI endoscopy in patients with suspected CD. En-doscopy is useful for determining the disease distribution, pattern and depth of inflammation, and to obtain mucosal biopsy specimens. Supplemental information from imaging procedures, such as CT, abdominal x-ray, abdominal ultrasound, or intestinal barium studies may provide evidence of complications such as obstruction, abscess,

perforation, or colonic dilation.

After the diagnosis is made, the information derived from diagnostic testing and the patient's medical history and symptoms are used to gauge disease severity. The severity of active UC is generally classified as mild, moderate, severe, or fulminant.1 Mild UC typically involves up to four bloody or watery stools per day without systemic signs of toxicity or elevation of erythrocyte sedimentation rate (ESR). Moderate disease is classified as more than four stools per day with evidence of systemic toxicity. Severe disease is considered more than six stools per day and evidence of anemia, tachycardia, or an elevated ESR or C-reactive protein (CRP). Lastly, fulminant UC may present as more than 10 stools per day with continuous bleeding, signs of systemic toxicity, abdominal distention or tenderness, colonic dilation, or a requirement for blood transfusion.

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