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This retrospective chart review was conducted at the King Abdulaziz University Hospital and covered the data for the period 2010–2019. The clinical data included the presenting symptoms, extraintestinal symptoms, time elapsed from the onset of the symptoms to the confirmed diagnosis of ulcerative colitis, and endoscopic severity. A total of 413 patients with a confirmed diagnosis of ulcerative colitis were included. Approximately 94.3% (n = 299) of the patients were presented with diarrhea, with 86.9% of the cases had bloody stools, and 64.5% reported lower abdominal pain. About 4.8% of the patients (n = 18) lost >10% of their body weight within six months. Extraintestinal manifestations were documented in 127 (30.8%) patients, including the most common manifestations, such as aphthous ulcers (n = 41, 9.9%), large joint arthralgia/arthritis (n = 34, 8.2%), and erythema nodosum (n = 25, 6.0%). Based on the Montreal classification, 76 (18.5%) patients had ulcerative proctitis, 211 (51.0%) had left-sided ulcerative colitis, and 126 (30.5%) had extensive or pancolitis. The clinical presentation of ulcerative colitis is variable, resulting in the delay of their diagnoses. Research and clinical efforts should be directed to facilitate the conduct of early diagnosis.
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