Extraintestinal Manifestations of Inflammatory Bowel Disease: Current Concepts, Treatment, and Implications for Disease Management

Abstract

Inflammatory bowel diseases (IBDs) are systemic diseases that manifest not only in the gut and gastrointestinal tract, but also in the extraintestinal organs in many patients. The quality of life for patients with IBD can be substantially affected by these extraintestinal manifestations (EIMs). It is important to have knowledge of the prevalence, pathophysiology, and clinical presentation of EIMs in order to adapt therapeutic options to cover all aspects of IBD. EIMs can occur in up to 24% of patients with IBD before the onset of intestinal symptoms, and need to be recognized to initiate appropriate diagnostic procedures. EIMs most frequently affect joints, skin, or eyes, but can also affect other organs, such as the liver, lung, and pancreas. It is a frequent misconception that a successful therapy of the intestinal inflammation will be sufficient to treat EIMs satisfactorily in most patients with IBD. In general, peripheral arthritis, oral aphthous ulcers, episcleritis, or erythema nodosum can be associated with active intestinal inflammation and can improve on standard treatment of the intestinal inflammation. However, anterior uveitis, ankylosing spondylitis, and primary sclerosing cholangitis usually occur independent of disease flares. This review provides a comprehensive overview of epidemiology, pathophysiology, clinical presentation, and treatment of EIMs in IBD.

Temporal Relationship of Extraintestinal Manifestations in Inflammatory Bowel Disease

“…As the total number of patients was 508, of whom 51 had been diagnosed with sacroiliitis during their disease course, the prevalence of sacroiliitis was roughly 10% in our study group. This is lower, than we expected, as other studies reported greater prevalence [21][22][23][24][25]. Vertebral column involvement in the form of spondylitis or ankylosing spondylitis was seen in 25 patients total-18 females and 7 males.…”

IL-33 as a Critical Cytokine for Inflammation and Fibrosis in Inflammatory Bowel Diseases and Pancreatitis

“…Although cellular sources of IL-33 are different in IBD and pancreatitis, IL-33 mediates tissue fibrosis in both disorders through induction of pro-fibrogenic factors such as IL-13. Moreover, pancreatitis sometimes develops as an extraintestinal manifestation of IBD ( Rogler et al, 2021 ). IL-33 might be one of pathogenic cytokines accounting for simultaneous occurrence of colitis and pancreatitis though further studies are required.…”

Exploration of the Potential Mechanisms of Wumei Pill for the Treatment of Ulcerative Colitis by Network Pharmacology

“…UC is an urgent global public health concern. Although conventional drugs such as 5-aminosalicylates, hormones, and immunosuppressive agents have played a good role in the treatment of UC, they still failed to achieve ideal effects and were often accompanied by side effects [ 5 ]. In China, CHM prescriptions have been widely used to treat UC and show beneficial preventive and therapeutic effects [ 6 ].…”

“…UC is a dynamic disease with severity that can change over time [ 4 ], and the etiologies have not been fully elucidated. The therapeutic armamentarium for UC is expanding [ 1 ]; however, common therapies have been reported to be far less effective than ideal [ 5 ].…”