Abstract
Objectives: Thus far, few attempted to characterize the temporal onset of extraintestinal manifestations (EIM) in inflammatory bowel diseases (IBD). We sought to determine the time of onset of these findings in a patient cohort with IBD. Methods: We reviewed the electronic health records of 508 IBD patients (303 CD, 205 UC) and summarized general patient characteristics and the temporal relationship and order of presentation of extraintestinal manifestations. Results: CD patients were younger at diagnosis. CD patients with ileocolonic involvement (L3) were younger, and UC patients with pancolitis (E3) were slightly younger at diagnosis. A total of 127 out of 303 (41.91%) CD and 81 out of 205 (39.51%) UC patients had EIMs (p = 0.5898). Some patients presented with EIMs before the diagnosis of IBD (9.45% of Crohn’s disease and 17.28% of ulcerative colitis patients with EIMs, respectively). Of these, seven cases (four in CD and three in UC) were visible by inspection of the patients (either dermatologic or ocular findings). The diagnosis of IBD and extraintestinal symptoms often occurred within a year (22.83% of CD and 16.04% of UC patients). Typically, the diagnosis of the first extraintestinal symptoms happened after the onset of bowel disease (+4.3 (±6.3) years, range: 10 years before to 30 years after in Crohn’s disease and +3.8 (±10) years, range: 24 years before to 30 years after) in ulcerative colitis. UC patients with pancolitis (E3) usually had EIMs earlier in the disease course and displayed EIMs more frequently before IBD diagnosis. Furthermore, patients with pancolitis developed EIMs more frequently than other sub-groups. Conclusion: Extraintestinal manifestations in inflammatory bowel diseases can present at any time, relative to the bowel symptoms. In cases, the presence of a characteristic EIM might be a harbinger of the development of IBD.
Highlights
We found that having more extraintestinal manifestations (EIM) was common in Crohn’s disease (CD) and ulcerative colitis (UC)
Patients often experience more than one extraintestinal manifestation during the disease course
Though generally diagnosed after inflammatory bowel diseases (IBD) onset, EIMs could be present before bowel symptoms
Summary
Inflammatory bowel diseases (IBD: Crohn’s disease (CD) and ulcerative colitis (UC)). Are chronic immune-inflammatory disorders, with predominantly gastrointestinal complaints [1,2]. CD can affect any part of the gastrointestinal tract; UC is restricted to the large bowel. Even though IBD patients mostly present with gastrointestinal complaints, they are known to display symptoms beyond the bowels [2,3,4,5]. The extraintestinal phenomena might have a secondary origin to chronic inflammation, medication, and nutrient malabsorption (these are known as extraintestinal complications—EC). Extraintestinal manifestations (EIMs) are not a direct consequence of medications or nutritional status and have an immune-inflammatory origin. Some of the extraintestinal manifestations (EIMs) are known to be associated with disease relapses, whereas others have a course independent of IBD
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