Peripheral neuropathy in patients with inflammatory bowel disease

Abstract

Peripheral neuropathy (PN) in inflammatory bowel disease (IBD) patients has been reported as individual cases or small series; however, its clinical and electrodiagnostic features have not been well characterized. We conducted a retrospective review of patients with PN and either Crohn's disease (CD) or ulcerative colitis (UC). Eighteen patients with CD and 15 patients with UC were identified after other PN causes were excluded. Male predominance and mean age of PN presentation in the fifties was seen in both groups. Demyelinating neuropathy (CIDP or MMN) occurred in close to 30% of the patients, in a higher percentage of women, than in the non-demyelinating patients. One-third of CD and UC patients had small-fibre or large-fibre sensory axonal PN, while approximately 40% of the CD and UC patients had large-fibre axonal sensorimotor PN. PN symptoms began earlier in the course of CD than in UC (P < 0.05). Patients with large-fibre axonal PN were older than patients with small-fibre sensory axonal PN (P < 0.05). Close to 60% of each group received immunotherapy with different agents. Half of those treated with CD and 40% with UC had demyelinating PN. Most of the patients who completed immunotherapy in both groups improved; all the patients with demyelinating neuropathy had either moderate or major improvement. The PN syndromes in IBD patients are diverse. Demyelinating forms may occur at any time, but early in the IBD course, pure sensory neuropathy is more common. Response to immunotherapy may occur in both demyelinating and axonal neuropathies.

A Case-Control study of the prevalence of neurological diseases in inflammatory bowel disease (IBD)

“…Our present results prospectively confirm the fact that peripheral neuropathy is the most consistently reported neurological condition in IBD patients 1,4,8,9,12,13,14 . However, even the subject of peripheral neuropathy in IBD patients has been challenged by a recent retrospective study with important methodological limitations 11 .…”

“…They may be part of the spectrum of extraintestinal manifestations of Chron's disease (CD) and ulcerative colitis (UC) or secondary to nutritional or treatment/iatrogenic complications 1 .…”

Small fiber dysfunction in patients with Wilson's disease

“…Unfortunately, we don't have skin biopsy testing available for evaluation of small fiber neuropathies in our institution. This is the gold standard technique at most centers worldwide to evaluate small fiber function 17 . In addition, we could not perform other reliable autonomic tests, such as QSART/ QSweat or quantitative sensory testing, or other tests such as evaluation of the presence of sympathetic skin responses (although this latter technique is neither sensitive nor specific for the evaluation of small fiber dysfunction).…”

Neurological Manifestations of Inflammatory Bowel Disease

“…malabsorption-related vitamin deicit) and adverse efects of IBD therapeutic agents (e.g. metronidazole or anti-TNF agents) [48][49][50]. Whenever these causes are ruled out, the frequency of PN in IBD patients varies from 0 to 39% [51].…”