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Published in: Digestive Diseases and Sciences 6/2021

01-06-2021 | Ulcerative Colitis | Original Article

Extraintestinal Manifestations in Patients with Inflammatory Bowel Disease: Study Based on the ENEIDA Registry

Authors: Alicia Algaba, Iván Guerra, Elena Ricart, Eva Iglesias, Miriam Mañosa, Javier P. Gisbert, Jordi Guardiola, Miguel Mínguez, Beatriz Castro, Ruth de Francisco, Pilar Nos, Federico Bertoletti, Francisco Mesonero, Jesús Barrio, María Dolores Martín-Arranz, Xavier Calvet, Santiago García-López, Beatriz Sicilia, Gillermo Alcaín, María Esteve, Lucía Márquez, Marta Piqueras, Laura Jiménez, José L. Perez-Calle, Luis Bujanda, Mariana García-Sepulcre, Alejandra Fernández, Irene Moraleja, Rufo Humberto Lorente, Orlando García-Bosch, Ana Lambán, Isabel Blázquez, Esther Rodríguez, José M. Huguet, Alfredo J. Lucendo, Pedro Almela, David Busquets, Patricia Ramírez de la Piscina, Marcela Pérez, Eugeni Domenech, Fernando Bermejo, the Spanish GETECCU Group (ENEIDA Project)

Published in: Digestive Diseases and Sciences | Issue 6/2021

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Abstract

Background

Patients with inflammatory bowel disease (IBD) may present extraintestinal manifestations (EIMs) that affect the joints, skin, eyes, and hepatobiliary area, among others.

Aims

Our aim was to analyse the prevalence and characteristics of EIMs in patients with IBD and to identify the possible risk factors associated with the development of EIMs in the largest series published to date.

Methods

Observational, cross-sectional study including patients from the Spanish ENEIDA registry promoted by GETECCU. We retrospectively identified all cases of EIMs in the ENEIDA registry until January 2018.

Results

The study included 31,077 patients, 5779 of whom had at least one EIM (global prevalence 19%; 95% CI 18.2–19.0). Among the different types of EIMs, rheumatic manifestations had a prevalence of 13% (95% CI 12.9–13.7; 63% of EIMs), with a prevalence of 5% (95% CI 4.7–5.2) for mucocutaneous manifestations, 2.1% (95% CI 1.9–2.2) for ocular manifestations, and 0.7% (95% CI 0.6–0.8) for hepatobiliary manifestations. The multivariable analysis showed that the type of IBD (Crohn’s disease, p < 0.001), gender (female, p < 0.001), the need for an immunomodulator (p < 0.001) or biologic drugs (p < 0.001), a previous family history of IBD (p < 0.001), and an extensive location of IBD (p < 0.001) were risk factors for the presence of EIMs.

Conclusions

One-fifth of patients with IBD may have associated EIMs, with rheumatic manifestations as the most frequent (> 60% of EIMs). Female patients with severe Crohn’s disease represent the group with the highest risk of developing EIMs. These patients should therefore be specially monitored and referred to the corresponding specialist when suggestive symptoms appear.
Literature
1.
go back to reference Magro F, Gionchetti P, Eliakim R, et al. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohn’s Colitis. 2017;11:649–670. https://doi.org/10.1093/ecco-jcc/jjx008.CrossRef Magro F, Gionchetti P, Eliakim R, et al. Third European evidence-based consensus on diagnosis and management of ulcerative colitis. Part 1: definitions, diagnosis, extra-intestinal manifestations, pregnancy, cancer surveillance, surgery, and ileo-anal pouch disorders. J Crohn’s Colitis. 2017;11:649–670. https://​doi.​org/​10.​1093/​ecco-jcc/​jjx008.CrossRef
5.
go back to reference Repiso A, Alcantara M, Munoz-Rosas C, et al. Extraintestinal manifestations of Crohn’s disease: prevalence and related factors. Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva. 2006;98:510–517. Repiso A, Alcantara M, Munoz-Rosas C, et al. Extraintestinal manifestations of Crohn’s disease: prevalence and related factors. Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva. 2006;98:510–517.
9.
go back to reference Mendoza JL, Lana R, Taxonera C, Alba C, Izquierdo S, Diaz-Rubio M. Extraintestinal manifestations in inflammatory bowel disease: differences between Crohn’s disease and ulcerative colitis. Med Clin. 2005;125:297–300.CrossRef Mendoza JL, Lana R, Taxonera C, Alba C, Izquierdo S, Diaz-Rubio M. Extraintestinal manifestations in inflammatory bowel disease: differences between Crohn’s disease and ulcerative colitis. Med Clin. 2005;125:297–300.CrossRef
11.
go back to reference Greenstein AJ, Janowitz HD, Sachar DB. The extra-intestinal complications of Crohn’s disease and ulcerative colitis: a study of 700 patients. Medicine. 1976;55:401–412.CrossRef Greenstein AJ, Janowitz HD, Sachar DB. The extra-intestinal complications of Crohn’s disease and ulcerative colitis: a study of 700 patients. Medicine. 1976;55:401–412.CrossRef
12.
go back to reference Monsen U, Sorstad J, Hellers G, Johansson C. Extracolonic diagnoses in ulcerative colitis: an epidemiological study. Am J Gastroenterol. 1990;85:711–716.PubMed Monsen U, Sorstad J, Hellers G, Johansson C. Extracolonic diagnoses in ulcerative colitis: an epidemiological study. Am J Gastroenterol. 1990;85:711–716.PubMed
13.
go back to reference Rankin GB, Watts HD, Melnyk CS, Kelley ML Jr. National Cooperative Crohn’s Disease Study: extraintestinal manifestations and perianal complications. Gastroenterology. 1979;77:914–920.CrossRef Rankin GB, Watts HD, Melnyk CS, Kelley ML Jr. National Cooperative Crohn’s Disease Study: extraintestinal manifestations and perianal complications. Gastroenterology. 1979;77:914–920.CrossRef
15.
go back to reference Ricart E, Panaccione R, Loftus EV Jr, et al. Autoimmune disorders and extraintestinal manifestations in first-degree familial and sporadic inflammatory bowel disease: a case-control study. Inflamm Bowel Dis. 2004;10:207–214.CrossRef Ricart E, Panaccione R, Loftus EV Jr, et al. Autoimmune disorders and extraintestinal manifestations in first-degree familial and sporadic inflammatory bowel disease: a case-control study. Inflamm Bowel Dis. 2004;10:207–214.CrossRef
16.
go back to reference Su CG, Judge TA, Lichtenstein GR. Extraintestinal manifestations of inflammatory bowel disease. Gastroenterol Clin N Am. 2002;31:307–327.CrossRef Su CG, Judge TA, Lichtenstein GR. Extraintestinal manifestations of inflammatory bowel disease. Gastroenterol Clin N Am. 2002;31:307–327.CrossRef
17.
go back to reference Veloso FT, Carvalho J, Magro F. Immune-related systemic manifestations of inflammatory bowel disease. A prospective study of 792 patients. J Clin Gastroenterol. 1996;23:29–34.CrossRef Veloso FT, Carvalho J, Magro F. Immune-related systemic manifestations of inflammatory bowel disease. A prospective study of 792 patients. J Clin Gastroenterol. 1996;23:29–34.CrossRef
18.
go back to reference Hernandez-Tejero M, Granja Navacerrada A, Bernal Checa P, et al. Prevalence, risk factors and response to treatment of extra-intestinal manifestations in patients with inflammatory bowel disease. Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva. 2017;109:627–633. https://doi.org/10.17235/reed.2017.4845/2017.CrossRef Hernandez-Tejero M, Granja Navacerrada A, Bernal Checa P, et al. Prevalence, risk factors and response to treatment of extra-intestinal manifestations in patients with inflammatory bowel disease. Revista espanola de enfermedades digestivas: organo oficial de la Sociedad Espanola de Patologia Digestiva. 2017;109:627–633. https://​doi.​org/​10.​17235/​reed.​2017.​4845/​2017.CrossRef
21.
go back to reference Lakatos L, Pandur T, David G, et al. Association of extraintestinal manifestations of inflammatory bowel disease in a province of western Hungary with disease phenotype: results of a 25-year follow-up study. World J Gastroenterol. 2003;9:2300–2307.CrossRef Lakatos L, Pandur T, David G, et al. Association of extraintestinal manifestations of inflammatory bowel disease in a province of western Hungary with disease phenotype: results of a 25-year follow-up study. World J Gastroenterol. 2003;9:2300–2307.CrossRef
25.
go back to reference Rodriguez VE, Costas PJ, Vazquez M, et al. Prevalence of spondyloarthropathy in Puerto Rican patients with inflammatory bowel disease. Ethnic Dis. 2008;18:S2-225-9. Rodriguez VE, Costas PJ, Vazquez M, et al. Prevalence of spondyloarthropathy in Puerto Rican patients with inflammatory bowel disease. Ethnic Dis. 2008;18:S2-225-9.
26.
go back to reference Orchard TR, Wordsworth BP, Jewell DP. Peripheral arthropathies in inflammatory bowel disease: their articular distribution and natural history. Gut. 1998;42:387–391.CrossRef Orchard TR, Wordsworth BP, Jewell DP. Peripheral arthropathies in inflammatory bowel disease: their articular distribution and natural history. Gut. 1998;42:387–391.CrossRef
27.
go back to reference Palm O, Moum B, Jahnsen J, Gran JT. The prevalence and incidence of peripheral arthritis in patients with inflammatory bowel disease, a prospective population-based study (the IBSEN study). Rheumatology. 2001;40:1256–1261.CrossRef Palm O, Moum B, Jahnsen J, Gran JT. The prevalence and incidence of peripheral arthritis in patients with inflammatory bowel disease, a prospective population-based study (the IBSEN study). Rheumatology. 2001;40:1256–1261.CrossRef
30.
go back to reference Protzer U, Duchmann R, Hohler T, et al. Enteropathic spondylarthritis in chronic inflammatory bowel diseases: prevalence, manifestation pattern and HLA association. Med Klin. 1996;91:330–335. Protzer U, Duchmann R, Hohler T, et al. Enteropathic spondylarthritis in chronic inflammatory bowel diseases: prevalence, manifestation pattern and HLA association. Med Klin. 1996;91:330–335.
34.
go back to reference Rodriguez-Reyna TS, Martinez-Reyes C, Yamamoto-Furusho JK. Rheumatic manifestations of inflammatory bowel disease. World J Gastroenterol. 2009;15:5517–5524.CrossRef Rodriguez-Reyna TS, Martinez-Reyes C, Yamamoto-Furusho JK. Rheumatic manifestations of inflammatory bowel disease. World J Gastroenterol. 2009;15:5517–5524.CrossRef
35.
go back to reference Keyal U, Liu Y, Bhatta AK. Dermatologic manifestations of inflammatory bowel disease: a review. Discov Med. 2018;25:225–233.PubMed Keyal U, Liu Y, Bhatta AK. Dermatologic manifestations of inflammatory bowel disease: a review. Discov Med. 2018;25:225–233.PubMed
38.
go back to reference Lebwohl M, Lebwohl O. Cutaneous manifestations of inflammatory bowel disease. Inflamm Bowel Dis. 1998;4:142–148.CrossRef Lebwohl M, Lebwohl O. Cutaneous manifestations of inflammatory bowel disease. Inflamm Bowel Dis. 1998;4:142–148.CrossRef
41.
go back to reference Costa Duarte C, Abreu ML, Lemos S, Nascimento E, Parreiras MA, Sales da Cunha A. A cross-sectional study of 130 Brazilian patients with Crohn’s disease and ulcerative colitis: analysis of articular and ophthalmologic manifestations. Clin Rheumatol. 2008;27(4):503–509. https://doi.org/10.1007/s10067-007-0797-5. Epub 2007 Dec 21.CrossRef Costa Duarte C, Abreu ML, Lemos S, Nascimento E, Parreiras MA, Sales da Cunha A. A cross-sectional study of 130 Brazilian patients with Crohn’s disease and ulcerative colitis: analysis of articular and ophthalmologic manifestations. Clin Rheumatol. 2008;27(4):503–509. https://​doi.​org/​10.​1007/​s10067-007-0797-5. Epub 2007 Dec 21.CrossRef
43.
go back to reference Evans PE, Pardi DS. Extraintestinal manifestations of inflammatory bowel disease: focus on the musculoskeletal, dermatologic, and ocular manifestations. MedGenMed Medscape Gen Med. 2007;9:55. Evans PE, Pardi DS. Extraintestinal manifestations of inflammatory bowel disease: focus on the musculoskeletal, dermatologic, and ocular manifestations. MedGenMed Medscape Gen Med. 2007;9:55.
47.
Metadata
Title
Extraintestinal Manifestations in Patients with Inflammatory Bowel Disease: Study Based on the ENEIDA Registry
Authors
Alicia Algaba
Iván Guerra
Elena Ricart
Eva Iglesias
Miriam Mañosa
Javier P. Gisbert
Jordi Guardiola
Miguel Mínguez
Beatriz Castro
Ruth de Francisco
Pilar Nos
Federico Bertoletti
Francisco Mesonero
Jesús Barrio
María Dolores Martín-Arranz
Xavier Calvet
Santiago García-López
Beatriz Sicilia
Gillermo Alcaín
María Esteve
Lucía Márquez
Marta Piqueras
Laura Jiménez
José L. Perez-Calle
Luis Bujanda
Mariana García-Sepulcre
Alejandra Fernández
Irene Moraleja
Rufo Humberto Lorente
Orlando García-Bosch
Ana Lambán
Isabel Blázquez
Esther Rodríguez
José M. Huguet
Alfredo J. Lucendo
Pedro Almela
David Busquets
Patricia Ramírez de la Piscina
Marcela Pérez
Eugeni Domenech
Fernando Bermejo
the Spanish GETECCU Group (ENEIDA Project)
Publication date
01-06-2021
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 6/2021
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-020-06424-x

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