Beyond the Bowel: Extraintestinal Manifestations of Inflammatory Bowel Disease

Abstract

Inflammatory bowel disease (IBD) is a chronic, relapsing immune-mediated inflammation of the gastrointestinal tract. IBD includes two major disease entities: Crohn disease and ulcerative colitis. Imaging plays an important role in the diagnosis and surveillance of these complex disorders. Computed tomographic and magnetic resonance enterographic techniques have been refined in recent years to provide a superb means of evaluating the gastrointestinal tract for suspected IBD. Although the intestinal imaging manifestations of IBD have been extensively discussed in the radiology literature, extraintestinal imaging manifestations of IBD have received less attention. Multiple extraintestinal manifestations may be seen in IBD, including those of gastrointestinal (hepatobiliary and pancreatic), genitourinary, musculoskeletal, pulmonary, cardiac, ocular, and dermatologic disorders. Although many associations between IBD and extraintestinal organ systems have been well established, other associations have not been fully elucidated. Some extraintestinal disorders may share a common pathogenesis with IBD. Other extraintestinal disorders may occur as a result of unintended treatment-related complications of IBD. Although extraintestinal disorders within the abdomen and pelvis may be well depicted with cross-sectional enterography, other musculoskeletal and thoracic disorders may be less evident with such examinations and may warrant further investigation with additional imaging examinations or may be readily apparent from the findings at physical examination. Radiologists involved in the interpretation of IBD imaging examinations must be aware of potential extraintestinal manifestations, to provide referring clinicians with an accurate and comprehensive profile of patients with these complex disorders. RSNA, 2017.

Systems pharmacology approach reveals the antiinflammatory effects of Ampelopsis grossedentata on dextran sodium sulfate-induced colitis

“…Inflammation in UC can lead to the occurrence of multifocal ulcers on the wall of the large intestine, causing nausea, cramps, diarrhea, pus, bleeding and fatigue. In general, patients with UC may develop varying degrees of extra-intestinal manifestations, which are attributed to the inflammatory cascade in the colorectum, including skin, mucosal, joint, ocular, hepatic and pulmonary disorders[ 2 , 3 ]. Meanwhile, the increasing prevalence of UC brings a considerable challenge to health care systems worldwide[ 4 ].…”

Impact of comorbidities on anti-TNFα response and relapse in patients with inflammatory bowel disease: the VERNE study

“…Furthermore, immune-mediated inflammatory disorders associated with IBD have been proven to incur higher healthcare costs. 14 In addition, up to 50% of patients with IBD may develop extraintestinal manifestations (EIMs) of the disease, 17 involving multiple organ systems throughout the body, 17 18 and sometimes being even more debilitating than the intestinal disease itself. 19 In recent decades, the objective of IBD treatment has evolved from a symptomatic relief to symptomatic and endoscopic deep remission.…”

Takotsubo Syndrome and Inflammatory Bowel Diseases: Does a Link Exist?

“…Given the unclear etiology, IBD have been erroneously considered as psychosomatic disorders for several years [8]. At present, immune system dysregulation, genetic and environmental factors, and possibly microbiota alterations are considered the main causal mechanisms [9,10]. However, psychological distress could play a significant role during disease exacerbation [11][12][13].…”

“…However, psychological distress could play a significant role during disease exacerbation [11][12][13]. Beyond the bowel, IBD show several extraintestinal manifestations including urinary, musculoskeletal, pulmonary, ocular, cutaneous, and cardiac involvement [9,14]. Pericarditis, myocarditis, endocarditis, valvulopathies, arrhythmias, arterial and venous thromboembolism, Takayasu arteritis, and heart failure represent the most known cardiovascular manifestations [10].…”