The Gap Between Flare-Up Recognition and Judgment of Need for Physician Visit in Patients With Ulcerative Colitis

Although patients with ulcerative colitis (UC) recognize that their conditions are worsening, they do not always visit a doctor immediately. Our aim was to investigate how patients recognize a flare-up of UC and how significant a gap there is between symptoms recognized as a flare-up and symptoms judged to require physician visit.

Questionnaires were distributed to 1,641 Crohn's and Colitis Foundation of Japan members and returned by 426, with 260 UC patients subsequently analyzable (Crohn's disease patients were excluded). Symptoms recognized as a flare-up of UC and symptoms judged to require physician visit were collected as free descriptions. A gap was determined if descriptions of symptoms judged to require physician visit contained expressions of prolonged symptoms, aggravation of symptoms, or critical symptoms. Furthermore, obvious delay was also determined if described symptoms contained critical symptoms.

Blood in stool was the most significant flare-up symptom recognized in patients with UC. A gap was observed in 134 cases (56.8%) and obvious delay was present in 70 cases (29.7%). Moreover, 52% of subjects debated whether to consult with a doctor when their conditions became subtly worse. Conversely, approximately 50% subjects also reported "If my condition subtly worsens, I want to visit a doctor immediately".

Although patients with UC recognized flare-ups accurately, a gap was observed in half of our subjects. Our data are important evidence that health professionals must educate patients effectively to improve patient outcomes.