Extra-Intestinal Manifestations of Inflammatory Bowel Disease

Sange, Aliya H; Srinivas, Natasha; Sarnaik, Mubashira K; Modi, Srimy; Pisipati, Yasaswi; Vaidya, Sarayoo; Gaggatur, Naqvi Syed; Sange, Ibrahim

doi:10.7759/cureus.17187

Cited by 16 publications

(16 citation statements)

References 44 publications

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“…IBD typically affects the intestinal tract but also exhibits many extraintestinal manifestations. IBD typically affects joints, skin, and eyes most frequently ( 32 ). GD primarily affects the thyroid gland; however, it is also accompanied by GO and dermopathy ( 2 ).…”

Section: Discussionmentioning

confidence: 99%

Graves Disease and Inflammatory Bowel Disease: A Bidirectional Mendelian Randomization

Xian

Liu³

et al. 2022

The Journal of Clinical Endocrinology &Amp; Metabolism

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Context Both Graves’ disease (GD) and inflammatory bowel disease (IBD) are common autoimmune diseases that severely damage patients’ quality of life. Previous epidemiological studies have suggested associations between GD and IBD. However, whether a causal relationship exists between these two diseases remains unknown. Objective To infer a causal relationship between GD and IBD using bidirectional two-sample Mendelian randomization(MR). Methods We performed bidirectional two-sample MR to infer a causal relationship between GD and IBD using GWAS summary data obtained from Biobank Japan (BBJ) and the International Inflammatory Bowel Disease Genetic Consortium (IIBDGC). Several methods (random-effect inverse variance weighted, weighted median, MR‒Egger regression, and MR-PRESSO) were used to ensure the robustness of the causal effect. Heterogeneity was measured based on Cochran’s Q value. Horizontal pleiotropy was evaluated by MR‒Egger regression and leave-one-out analysis. Results Genetically predicted IBD may increase the risk of GD by 24% (OR 1.24, 95% CI 1.01-1.52, p = 0.041). Crohn’s disease (CD) may increase the risk of GD, whereas ulcerative colitis (UC) may prevent patients from developing GD. Conversely, genetically predicted GD may slightly increase the risk of CD, although evidence indicating that the presence of GD increased the risk of UC or IBD was lacking. Outlier-corrected results were consistent with raw causal estimates. Conclusions Our study revealed a potentially higher comorbidity rate for GD and CD. However, UC might represent a protective factor for GD. The underlying mechanism and potential common pathways await discovery.

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Section: Discussionmentioning

confidence: 99%

Graves Disease and Inflammatory Bowel Disease: A Bidirectional Mendelian Randomization

Xian

Liu³

et al. 2022

The Journal of Clinical Endocrinology &Amp; Metabolism

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“…Some of these can improve once disease is under control on IBD therapy. However, others such as anterior uveitis, ankylosing spondylitis, and primary sclerosing cholangitis usually occur independent of disease activity (2,3). In a Swiss Inflammatory Bowel Disease Cohort, 29% of the patients had extraintestinal manifestations (EIM).…”

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confidence: 99%

Prevalence of Exocrine Pancreatic Dysfunction Based on Direct Function Testing in Pediatric Inflammatory Bowel Disease

Fernandez

Hopson

Patel

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: Patients with inflammatory bowel disease (IBD) frequently have extraintestinal manifestations. The goal of this pilot study was to assess exocrine pancreatic function in cases with suspicion for or an established diagnosis of IBD. Methods: Direct stimulated endoscopic pancreatic function test (ePFT) was performed in 74 children with IBD, in both newly diagnosed and established cases. Demographic, clinical, and laboratory parameters were entered into a database and analyzed. Results: Among the 74 children, 49 were newly diagnosed and 25 had an established diagnosis of IBD. A majority had the diagnosis of Crohn disease (CD) (n = 48; 32 new and 16 established cases) with male predominance (64.6%). Altogether, 42 (56.7%) children had either generalized or partial exocrine pancreatic insufficiency (EPI). Twenty-four of the 48 CD children (50%) had abnormal ePFT. In those with ulcerative colitis (UC), 18 of the 26 (62.9%) had abnormal ePFT. The highest abnormality rate was in lipase enzyme activity. Weight z scores were significantly lower in those with abnormal ePFT (Crohn cases: P = 0.008; UC cases: P = 0.046). Peak protein concentration in collected pancreatic fluid was significantly lower in children with CD who had abnormal ePFT (P = 0.013). Conclusions: This pilot study revealed a relatively high prevalence of EPI in children with IBD through use of ePFT. EPI can result in maldigestion, with decreased capacity to digest fat. Further prospective studies are needed to assess need and efficacy of pancreatic enzyme replacement therapy in children with IBD and abnormal ePFT.

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“…EIMs are characterized by the enteric flora playing a critical role in activating the immune system against bacterial antigens and the colonic mucosa based on an antigenic cross-reactivity process known as “antigen mimicry”. [ 18 ] When bacteria translocate across the intestinal barrier, which is often permeable in IBD patients, an adaptive immune response is triggered. [ 18 ] However, this immune response is unable to distinguish between bacterial epitopes and epitopes of joints or skin, attacking other systems in the body, and thus result in EIMs.…”

Section: Discussionmentioning

confidence: 99%

“…[ 18 ] When bacteria translocate across the intestinal barrier, which is often permeable in IBD patients, an adaptive immune response is triggered. [ 18 ] However, this immune response is unable to distinguish between bacterial epitopes and epitopes of joints or skin, attacking other systems in the body, and thus result in EIMs. [ 18 ]…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of Classical Extraintestinal Manifestations among Inflammatory Bowel Disease Patients in Saudi Arabia: A Single Tertiary Center Experience

Alotaibi,

Alhubayshi,

Allehibi

et al. 2024

Saudi Journal of Medicine &Amp; Medical Sciences

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Background: Patients with inflammatory bowel disease (IBD) may also experience extraintestinal manifestations (EIMs), which can affect various organ systems, and their occurrence is based on disease activity. Objectives: To determine the prevalence of EIMs and their most common types among IBD patients from Saudi Arabia. Materials and Methods: This retrospective study included all IBD patients aged 14–80 years who visited the Gastroenterology and Hepatology clinics at King Fahad Medical City, Riyadh, between February 2017 and December 2022. The collected data included demographic characteristics, disease characteristics, EIMs, and treatment. Results: The study included 578 IBD patients, of which 65 (11.2%) had at least one EIM, with primary sclerosing cholangitis (46.2%) and sacroiliitis (16.9%) being the most common. Patients with ulcerative colitis were more likely to have EIMs than those with Crohn’s disease (15.1% vs. 9%; P = 0.026). Patients with ileocolonic (L3) Crohn’s disease reported a higher prevalence of EIMs (7.5%) than those with other disease locations (P = 0.012), while in patients with ulcerative colitis, those with extensive colitis (E3) reported higher prevalence of EIMs (19.2%) (P = 0.001). Patients receiving 6 MP had a significantly high prevalence of EIMs (P = 0.014). Conclusion: The prevalence of extraintestinal manifestations among IBD patients in Saudi Arabia is 11.2%. These findings suggest the need for clinicians to screen for EIMs and manage them early. Further research is needed to understand the mechanisms underlying EIMs for the development of more effective treatments.

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Extra-Intestinal Manifestations of Inflammatory Bowel Disease

Cited by 16 publications

References 44 publications

Graves Disease and Inflammatory Bowel Disease: A Bidirectional Mendelian Randomization

Graves Disease and Inflammatory Bowel Disease: A Bidirectional Mendelian Randomization

Prevalence of Exocrine Pancreatic Dysfunction Based on Direct Function Testing in Pediatric Inflammatory Bowel Disease

Prevalence of Classical Extraintestinal Manifestations among Inflammatory Bowel Disease Patients in Saudi Arabia: A Single Tertiary Center Experience

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