Inflammatory bowel disease (IBD) is a type of chronic inflammation of the gastrointestinal tract. Ulcerative colitis, which is characterized by continuous inflammation of the large intestine, and Crohn’s disease, which causes patches of inflammation and can occur anywhere in the gastrointestinal tract, are both types of IBD. People with IBD may experience a variety of gastrointestinal symptoms, including abdominal pain, diarrhea, blood in the stool, bloating, and weight loss.
What symptoms may occur outside the gastrointestinal tract in patients with IBD?
Symptoms of IBD can occur both inside and outside the gastrointestinal tract. The latter are known as extraintestinal manifestations (EIMs) of IBD. These symptoms occur in nearly half of his IBD patients and may be present before and/or after IBD is diagnosed. EIM occurs more frequently in people who are diagnosed at a younger age and generally also occurs early in the course of IBD. In fact, approximately 24% of EIM symptoms are present before he is diagnosed with IBD. The causes of EIM are not well understood, but like IBD, it may be caused by a combination of genetic risk factors, immune response, and lifestyle factors such as smoking.
What are some examples of extraintestinal symptoms of IBD?
Patients may undergo multiple EIMs of varying severity simultaneously. EIM can be difficult to detect, nearly every organ system can be affected. The severity of EIM symptoms may reflect the severity of intestinal symptoms, but in certain situations EIM acts independently. Below are some common examples of extraintestinal symptoms.
Musculoskeletal system: Musculoskeletal symptoms of IBD are the most common, occurring in up to 46% of IBD patients. These can manifest as inflammatory back pain (ankylosing spondylitis), inflammation of tendons and ligaments, arthritis, non-arthritic joint pain, or swelling of fingers and toes (dactylitis). Arthritis can occur both within the axial skeleton (hips, hips, spine) or peripherally (fingers, wrists, elbows, knees, ankles).
Skin mucosa: IBD can cause changes in the skin and mucous membranes (the moist lining that lines certain organs and cavities in the body). Oral aphthous ulcers (seen in Crohn’s disease), erythema nodosum (purple raised nodules, usually on the front of the legs, occurring in 10% to 15% of patients), and pyoderma gangrenosum (painful). An example of this is skin ulcers associated with the disease. IBD can affect the skin. Sweet syndrome, which is accompanied by a tender lump under the skin, increased white blood cell count, fever, arthritis, and eye symptoms, is a rare EIM.
Eyeball: Inflammation of one part of the eye (episcleritis, scleritis, or anterior uveitis) affects 2% to 7% of people with IBD. If patients experience eye pain, redness, sensitivity, or visual changes, they may need urgent evaluation by an ophthalmologist, as uncontrolled inflammation can lead to blindness.
Blood vessels: People with IBD are up to three times more likely to develop blood clots than people without IBD. In some cases, these blood clots can travel to the lungs, which is called a pulmonary embolism. Symptoms of a blood clot include swelling in the legs and shortness of breath. Poorly controlled inflammation within the gastrointestinal tract is thought to be responsible for the increased risk of clotting.
Stomach: Less commonly, patients develop liver diseases associated with IBD, such as primary sclerosing cholangitis (inflammation and scarring of the bile ducts) and autoimmune hepatitis (in which the immune system attacks liver cells, causing hepatitis). may develop. Autoimmune pancreatitis has also been reported. These conditions can be diagnosed by symptoms, blood tests, or imaging findings (sometimes using MRI).
How is EIM handled?
Effective treatment of intestinal inflammation is important as it may reduce the activity of extraintestinal symptoms. In some cases, EIM may require additional specific processing. For example, corticosteroids, sulfasalazine (an anti-inflammatory drug), or certain biological therapies may be considered to treat arthritis. The skin and eye symptoms of IBD can be treated with topical or systemic corticosteroids, immunosuppressants, or certain biologic therapies. Vascular conditions such as blood clots may be treated with anticoagulants. Treatment of EIM is complex and often requires collaboration with multiple health care providers.
What should I do if I have symptoms?
Recognizing EIM is important because it can have a significant impact on quality of life and may also influence physicians’ long-term approach to IBD treatment and monitoring.
Whether you’ve been diagnosed with IBD or not, it’s important to see your primary care physician or gastroenterologist (if you have one) to discuss any symptoms you may be experiencing. Your doctor will discuss your medical and family history to determine your risk for IBD or other medical conditions.
For patients diagnosed with IBD or at risk for IBD, EIM can be the first clue to the need for diagnostic or treatment review and adjustment. It is important to communicate both gastrointestinal and non-gastrointestinal symptoms to your gastroenterologist so that appropriate treatment can be initiated promptly and you can be connected to a specialist for the affected organ system. Lifestyle changes such as quitting smoking may also be considered. reduce risk E.I.M.
With targeted treatments and the right medical team in place, both IBD and EIM can be managed to improve patients’ quality of life.