Pathogenesis and clinical perspectives of extraintestinal manifestations in inflammatory bowel diseases

Abstract

A considerable number of patients with inflammatory bowel disease (IBD) experience extraintestinal manifestations (EIMs), which can present either before or after IBD diagnosis. Unraveling the pathogenic pathways of EIMs in IBD is challenging because of the lack of reliable criteria for diagnosis and difficulty in distinguishing EIMs from external pathologies caused by drugs or other etiologies. Optimizing treatment can also be difficult. Early diagnosis and management of EIM revolve around multidisciplinary teams, and they should have the resources necessary to make and implement appropriate decisions. In addition, specialists of the affected organs should be trained in IBD treatment. Furthermore, patient awareness regarding the extraintestinal symptoms of IBD is of paramount importance for improving patient understanding of disease and health outcomes. Herein, we review the pathogenesis and clinical perspectives of EIMs in IBD.

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

“…21 In addition, there is a considerable overlap between genetic risk loci for EIMs and IBD. 5,22 The first risk variant identified in patients with CD, NOD2/CARD15, has also been associated with sacroiliitis and uveitis 23,24 (Figure 3). Weizman and coworkers 25 investigated skin EIMs and found associations between PG and known IBD loci, such as IL8RA, PRDM1, USP15, and TIMP3 (Figure 3).…”

Crohn’s disease at radiological imaging: focus on techniques and intestinal tract

“…Their onset relies on a combination of genomic predisposition and environmental factors that lead to an altered immunoresponse to the intestinal microbiota. [1][2][3][4] In particular, CD is characterized by transmural involvement of the bowel wall and it can affect any section of the gastrointestinal tract, with higher prevalence in the ileocolonic segments. Typical symptoms include fever, chronic diarrhea, fatigue and weight loss.…”

Pancreatic Associated Manifestations in Pediatric Inflammatory Bowel Diseases

“…IBDs are currently considered as multi-systemic conditions with a bowel involvement, but wherein chronic inflammation may potentially affect other organs and systems [ 2 , 3 ]. In the clinical setting, it is mandatory to distinguish between true extraintestinal manifestations (EIMs) that are the result of inflammatory or autoimmune phenomena, and extraintestinal complications, due to metabolic disorders (growth failure, anemia, osteoporosis) or to drugs used for the management of the disease [ 4 , 5 ]. Depending on type and inter-individual variability, EIMs may have a mild and transient course or could be disabling for the patients, contributing to a higher morbidity and reduced quality of life [ 6 ].The most common sites affected are joints (axial and/or peripheral arthritis), skin (erythema nodosum, pyoderma gangrenosum, or aphthous stomatitis), eyes (episcleritis and uveitis), hepatobiliary system and pancreas [ 5 , 6 , 7 ].…”

“…Depending on type and inter-individual variability, EIMs may have a mild and transient course or could be disabling for the patients, contributing to a higher morbidity and reduced quality of life [ 6 ].The most common sites affected are joints (axial and/or peripheral arthritis), skin (erythema nodosum, pyoderma gangrenosum, or aphthous stomatitis), eyes (episcleritis and uveitis), hepatobiliary system and pancreas [ 5 , 6 , 7 ]. Increasing evidence links IBD and pancreatic inflammation in terms of genetic susceptibility, microflora alteration and immunological features [ 1 , 2 , 3 , 4 , 5 ]. Among the broad spectrum of EIMs, pancreatic involvement is considered rare (0.7–1.6% of all EIMs), but anyhow more frequent than in the general population [ 8 ], since the IBD patients present an increased risk of pancreatic abnormalities over time.…”