Extraintestinal manifestations (EIMs) of inflammatory bowel disease (IBD) can complicate treatment regimens and reduce patient quality of life. An understanding of the clinical presentations and treatment options for this disease may aid in improving patient outcomes, according to an article published in Gastroenterology.

Unlike extraintestinal complications of IBD, EIMs are not a sequela of intestinal inflammation, and may present before or after the development of gastrointestinal symptoms. Evidence suggests the likelihood of developing EIMs is tied to genetic variants and smoking. The presence of EIMs is common in both ulcerative colitis and Crohn disease. The relationship between EIMs and immune system response, as well as microbiota, is hypothesized but requires more research.

Musculoskeletal EIMs, affecting up to 46% of patients with IBD, are the most prevalent type. Categorized within the spondyloarthritis family, there may be axial or peripheral involvement. Treatment of the underlying IBD often improves musculoskeletal EIMs, though symptoms may persist despite adequate control of intestinal inflammation.


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Cutaneous, ocular, and hepatobiliary EIMs are present in up to 15%, 7%, and 5%, of patients with IBD, respectively. Episcleritis, a common ocular EIM, is closely tied to intestinal inflammation and treatment of the underlying IBD is key. Other manifestations, such as the cutaneous EIM pyoderma gangrenosum, require treatment independent of IBD control.

Patients diagnosed with IBD have an approximately threefold increased risk of developing venous thromboembolic events. Patients also have an increased risk for heart failure and acute myocardial infarction, though currently there are no specific guidelines for mitigating these risks.

The presentation of EIMs varies widely, and patients may be affected by more than one EIM. Addressing EIMs, in addition to the burden of IBD, is important for improving the quality of life for patients with IBD.

Reference

Rogler G, Singh A, Kavanaugh A, et al. Extraintestinal manifestations of inflammatory bowel disease: current concepts, treatment, and implications for disease management. Gastroenterol. Published online August 3, 2021. doi: 10.1053/j.gastro.2021.07.042

This article originally appeared on Gastroenterology Advisor