Prevalence of Extra Intestinal Manifestations in Inflammatory Bowel Disease and Associated Risk Factors

Abstract

Background and Aim: Ulcerative colitis (UC) is a subtype of inflammatory bowel disease that can develop extra-intestinal manifestations (EIMs) in a subgroup of patients. There is a scarcity of data on the prevalence of extra-intestinal manifestations (EIMs) in inflammatory bowel disease and their risk factors analyses. The present study aimed to evaluate the prevalence of extra-intestinal manifestations in ulcer colitis and its associated risk factors. Methodology: This prospective study was conducted on 334 inflammatory bowel disease patients who were followed for identification of EIMs associated risk factors in the Department of Medicine and Pulmonology, Ghulam Muhammad Medical College and Hospital (GMMCH)/ Civil Hospital, Sukkur for the duration of six months; from April 2021to September 2021. All the patients above 16 years and who had ulcerative colitis and Crohn’s disease (CD) were enrolled. Patient’s demographic and clinical details such as gender, education, age, smoking history, diagnosis of EMIs, age at IBD, different IBDs, surgical, and treatment details were recorded. Results: Out of 334 IBD patients, the prevalence of ulcerative colitis (UC) and Crohn’s disease (CD) was 38.9% (n=130) and 61.1% (n=204) respectively. The overall mean age of UC and CD patients was 38.6±6.8 and 42.7±8.5 years respectively. Of the total 130 CD patients, the prevalence of arthritis, aphthous stomatitis, uveitis, erythema nodosum, ankylosing spondylitis, pyoderma gangrenosum, primary sclerosing cholangitis and psoriasis was 20.8% (n=27), 3.8% (n=5) 4.6% (n= 6), 3.1% (n=4) , 2.3% (n=3), 3.8% (n=5), and 1.5% (n=2) respectively. Out of 204 CD patients, the incidence of arthritis, aphthous stomatitis, uveitis, erythema nodosum, ankylosing spondylitis, pyoderma gangrenosum, primary sclerosing cholangitis, and psoriasis was 32.8% (n=67), , 9.8% (n=20) , 5.9% (n=12) , , 6.4% (n=13) , 2% (n=4) , 1% (n=2) and 2% (n=4) respectively. Risk factors for EMIs were identified using multiple logistic regression. In ulcerative colitis patients, no risk factors were identified. Conclusion: Our study concluded that extra-intestinal manifestations are a major issue in ulcerative colitis and Crohn’s disease patients. Moreover, the ongoing EIMs in Crohn’s disease patients are significantly associated with inflammatory bowel disease positive family history, and active disease. Therapeutic management and diagnostic facilities can be improved with the determination of extra-intestinal manifestation prevalence and related risk factors. Keywords: Crohn’s Disease, Extra-intestinal Manifestation, Inflammatory Bowel Disease