Extraintestinal Manifestations of Inflammatory Bowel Disease: Common and Manageable

By Alan C Moss, MD | December 13, 2012

Extraintestinal manifestations (EIMs) of inflammatory bowel disease (IBD) are common in both ulcerative colitis and Crohn’s disease. The systems most often involved are the musculoskeletal and dermatologic systems. Ocular, renal, and pulmonary manifestations also are seen. For the physician managing these already complex patients, an additional diagnosis—erythema nodosum, psoriasis, purpura, arthritis—can be a significant challenge.

In this short podcast, Dr Alan Moss answers several important questions for primary care physicians that address signs and symptoms to watch for in your patients with IBD and how first-line therapy impacts both the GI disease and the extraintestinal presentations.

Extraintestinal Manifestations of IBD
Extraintestinal Manifestations of IBD

Dr Moss is Assistant Professor of Medicine at Harvard Medical School and is a gastroenterologist at Beth Israel Deaconess Medical Center in Boston, Massachusetts. He will be discussing diagnosis and management of extraintestinal manifestations of IBD in his presentation at the 2012 Advances in Inflammatory Bowel Diseases, the Crohn’s & Colitis Foundation’s Clinical & Research Conference, to be held December 13-15 in Hollywood, Florida.

Take home points
•Patients with IBD who present with new eye, skin, joint, or pulmonary symptoms should be evaluated for the possibility of either an associated inflammatory processes, or adverse effects of their immunosuppressant medications
•Extraintestinal symptoms usually correlate with intestinal disease activity; they typically present when the patient’s IBD is active
•Steroids and anti-TNF drugs can also improve inflammatory arthritis or the skin or ocular manifestations of IBD, but specialist care should be sought in these cases to prevent complications

For Further Information
Peyrin-Biroulet L, Loftus EV Jr, Colombel JF, Sandborn WJ. Long-term complications, extraintestinal manifestations, and mortality in adult Crohn's disease in population-based cohorts. Inflamm Bowel Dis. 2011;17:471-478. http://onlinelibrary.wiley.com/doi/10.1002/ibd.21417/pdf.

Barrie A, Regueiro M. Biologic therapy in the management of extraintestinal manifestations of inflammatory bowel disease. Inflamm Bowel Dis. 2007;13:1424-1429. http://onlinelibrary.wiley.com/doi/10.1002/ibd.20196/pdf.

by Cassandra Clarke-Belgrave | December 14, 2012 9:55 PM EST

My husband had multiple bouts of uveitis and was worked-up for sarcoidosis with negative results. The uveitis was always treated successfully for a few years and then on an annual physical assessment he was found to be anemic. He had negative stool guaiacs and long-story-short eventually had a bone marrow biopsy which was absent of iron stores and then had a colonoscopy which revealed idiopathic inflammatory bowel disease (IBD). The IBD has also been treated successfully and no more uveitis. As the physician-wife this was a lesson for me and for his treating physician. In reality my husband did have abnormal bowel habits but they became normal to him and he never complained. The time he that he tried stopping Asacol he experienced the difference. His last 2 scopes have been normal.

by Chagai Dubrawsky | December 14, 2012 6:20 PM EST

If one recognizes inflammatory bowel disease,as part of; Pellagra,vitamin B-3 deficiency disease,management of
it is very easy and straight forward.
Extraintestinal Manifastation (EIMs) of Inflammatory Bowel Disease(IBS),make the diagnosis of Pellagra,easy
and complete.
Pellagra is known as the 4-D disease:Dermatitis,Diarrhea,Dementia,Death.
The incidence of Pellagra in the whole world,today,is ~ 9.000.000(Nine million) people.Most of the people present
as Atypical-Subclinical(References? Pubmed)
It is about time that the Medical community will recognize the fact that Pellagra, is here to stay.Prevention and treatment is available and affordable to all.