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Extraintestinal manifestations and complications in IBD

Abstract

More than one-third of patients with IBD are affected by extraintestinal manifestations or extraintestinal complications beyond the intestinal manifestation of the disease. The most common manifestations include arthropathies, mucocutaneous and ophthalmological manifestations, as well as conditions affecting the hepatobiliary system, both in Crohn's disease and ulcerative colitis. However, less frequent manifestations, such as pulmonary or neurological manifestations, should also be considered in patients with IBD. Several extraintestinal manifestations follow the course of the underlying intestinal activity, whereas others are independent from the intestinal inflammation. Extraintestinal complications such as iron-deficiency anaemia and osteoporosis are consequences of the intestinal disease or of disease-specific treatment. As extraintestinal manifestations and complications strongly influence quality of life, and to avoid severe complications, adequate treatment is mandatory in affected patients. We provide a comprehensive overview of different extraintestinal manifestations and complications, including their management, in patients with IBD.

Key Points

  • Extraintestinal symptoms are common in patients with IBD and include extraintestinal manifestations and extraintestinal complications, which can affect nearly every organ

  • Extraintestinal manifestations include IBD-related diseases that correlate with intestinal disease activity (for example erythema nodosum) and activity-independent diseases such as primary sclerosing cholangitis and ankylosing spondylitis

  • Extraintestinal complications can be subdivided into those caused by the disease itself and treatment-induced complications

  • Early recognition and adequate treatment of extraintestinal symptoms is necessary to prevent severe morbidity and mortality in patients with IBD

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Figure 5: Granulomatous hepatitis in a patient with Crohn's disease.
Figure 6: CT scan of a patient with Crohn's disease and granulomatous bronchitis.

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C. Ott was involved in researching data, discussion of content, writing and reviewing/editing the manuscript. J. Schölmerich was involved in researching data, discussion of content and reviewing/editing the manuscript.

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Ott, C., Schölmerich, J. Extraintestinal manifestations and complications in IBD. Nat Rev Gastroenterol Hepatol 10, 585–595 (2013). https://doi.org/10.1038/nrgastro.2013.117

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