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What Are Extraintestinal Manifestations of IBD?

Inflammatory Bowel Disease is a systemic disease – it is not limited to just one area of the body (the digestive system) but can affect nearly every organ system in the body. 

Extra + Intestinal + Manifestation

What are extraintestinal manifestations (EIMs)? Extraintestinal manifestations is a name used to describe what I just said up above. Remember how I said (I hope you do; I just said it!) that IBD is a systemic disease involving nearly every organ system in the body? Extraintestinal manifestations are those complications of IBD that show up in other areas of your body, outside of how IBD affects the digestive tract. 

Think of them as all the “extras” that may come with having Crohn’s disease or ulcerative colitis. In addition to the digestive tract a person with IBD may have problems with their eyes, skin, joints, mouth, liver, and so on. These are the “extras” that may come along with having IBD. For example: many people with IBD experience joint pain and/or arthritis. These manifestations are ‘extraintestinal’ because they occur outside of the intestines. 

Extra + Intestinal:
 the "extras" that occur outside of the bowel
Manifestation:
 to display or show by act or appearance

Over 100 EIMs of IBD have been described but most of them are rare. You can hover over the image above to see some of them. Some EIMs are caused by Inflammatory Bowel Disease itself (primary EIMs) but others can be a complication of it (secondary EIMs). For example getting drug induced Lupus from a biologic, growth failure from malnutrition, gallstones from loss of bile salts, or glaucoma from corticosteroid use. 

This post is a general overview of EIMs but you can find additional posts on this site broken down by organ system that go more in-depth. You can read my first one, Joint Pain and Inflammation in IBDright here

Who Gets EIMs?

Extraintestinal manifestations of IBD are common, affecting about 25-40% of patients. Having one EIM increases the likelihood of developing more. They occur more often in people who have Crohn’s disease vs folks with ulcerative colitis. They also affect people who have disease activity located in the colon more so than they do IBD patients without colonic involvement. EIMs can even preceed an IBD diagnosis and is sometimes what brings the patient into the doctor’s office in the first place. A skilled physician may assume IBD after doing a full work up and then refer the patient to a gastroenterologist for confirmation of diagnosis and then treatment if a diagnosis is made. 

Which Extraintestinal Manifestions are most common?

Extraintestinal manifestations most often affect the:

Musculoskeletal System

  • Peripheral Arthritis (Type 1 and 2)
  • Axial Arthritis (Sacroiliitis, Ankylosing Spondylitis)
  • Osteoporosis

Dermatologic System

  • Pyoderma Gangrenosum
  • Erythema Nodosum
  • Aphthous Ulcers

Ocular 

  • Episcleritis
  • Scleritis
  • Uveitis

Arthritis being the most common of all the extraintestinal manifestations. You can view some EIMs of IBD in the slides above.

Which Extraintestinal Manifestations Parallel Intestinal Disease Activity?

Many EIMs parallel disease activity which means they occur at the same time you have active IBD in your digestive system and usually they resolve when the inflammation in the gut is brought under control. Some of these extraintesitnal manifestations are: 

  • Episcleritis
  • Peripheral arthritis type 1: pauciarticular arthritis
  • Aphthous ulcers
  • Erythema Nodosum
  • Pyoderma Gangrenosum? (Debatable)

Which Extraintestinal Manifestations Run Independent of Disease Activity?

IBD is a systemic disease. It not only affects the digestive tract but can affect nearly every organ system in the body.

Then there are these assholes who don’t care about whether you got intestinal inflammation or not because they will show up any time they damn well please even if your intestine is so spic and span that you won an award for histological remission. Some of them are:

  • Peripheral arthritis type 2: polyarticular arthritis
  • Axial arthritis
  • Uveitis
  • Primary Sclerosing Cholangitis

Conclusion and Review

Extraintestinal manifestations are complications of IBD that occur outside of the intestines. EIMs are common in people who have Crohn’s disease and ulcerative colitis and having one EIM increases the risk of developing more. Most extraintestinal manifestations occur at the same time as underlying intestinal inflammation and respond to the therapies used to treat IBD.

As patients it is important to be aware of EIMs and report any changes in the way your body looks, feels, and functions to your GI. Some EIMs need immediate attention (scleritis for example) because permanent damage can be done. Being an informed patient can help you recognize these complications and bring them up to your doctor so that you can prevent bigger problems in the future.

What We Learned

Take the quiz below to review what we learned today! 

Extraintestinal Manifestations of IBD Quiz

Let me know if you have any extraintestinal manifestations in the comments. 

Sara

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