Abdominal Pain in Colitis

Pain Characteristics

The American Gastroenterological Association recognizes that 50-70% of inflammatory bowel disease (IBD) patients experience pain during disease flares, which can be colicky in nature 2, 3
Colicky abdominal pain is a hallmark symptom of colitis, particularly in ulcerative colitis, and is often accompanied by urgency and tenesmus 1
Abdominal pain is frequently the first symptomatic presentation of newly diagnosed or exacerbating disease, affecting 50-70% of IBD patients 2, 3

The American Gastroenterological Association recommends obtaining stool frequency and character, presence of blood, urgency, and rectal bleeding, as well as performing laboratory investigations including complete blood count, inflammatory markers, and serum albumin 4, 6
Measuring fecal calprotectin is essential, as levels >250 μg/g strongly correlate with active inflammation and ulceration 1, 7
Flexible sigmoidoscopy or colonoscopy with biopsy is the gold standard for confirming colitis, according to the American Gastroenterological Association 4, 1, 7

The American College of Gastroenterology recognizes that gallbladder disease typically presents with right upper quadrant abdominal pain, Murphy's sign, fever, and abdominal tenderness 5
Colitis, on the other hand, is characterized by bloody diarrhea, increased stool frequency, urgency, and elevated fecal calprotectin, as recommended by the American Gastroenterological Association 1, 7

The European Crohn’s and Colitis Organisation recommends considering extra-intestinal factors, including gallstones, when evaluating abdominal pain in IBD patients, as the cause may be multifactorial and not always linked to disease activity 2, 3
The American Gastroenterological Association advises against assuming all abdominal pain in IBD patients is from active colitis and recommends excluding infectious triggers, such as C. difficile, before escalating immunosuppression 7