Ulcerative colitis is a continuous inflammation of the large intestine. Crohn’s disease causes patches of inflammation anywhere from the mouth to the colon. Both of these, along with many other gastrointestinal diseases come from Inflammatory bowl disease. Inflammatory bowel disease (IBD) is characterized as chronic inflammation of the gastrointestinal tract. Patients with IBD can experience a variety of GI symptoms including abdominal pain, diarrhea, bloody stool, bloating, and weight loss.
The conditions that occur outside of the GI tract
IBD symptoms can occur both in the gastrointestinal tract, but also the organ systems that are not directly related to the GI system. Extraintestinal manifestations (EIMs) of IBD is the classification of the harmful inflammation that occurs outside of the gastrointestinal tract. EIMs are found in half of IBD patients, they are found more frequently in younger indiviuals, and generally also occur earlier in the course of IBD. The causes of EIMs are poorly understood, just like all chronic inflammatory diseases, but they may be due to a certain genetic risk factors, immune responses/reactions, and lifestyle choices such as cigarette smoking and radiation.
Examples of extraintestinal manifestations of IBD
Diagnosis of EIM are quite difficult, as patients may experience EIMs at once, they may have varying severities, and can affect almost any organ system. Below are some examples of extraintestinal manifestations.
Musculoskeletal: Around 46% of IBD patiens will have an inflammatory issue relating to their tendons, ligaments, or bones. This EIM is the most common. Inflammatory back pain, inflammation of tendons or ligaments, arthritis, joint pain without arthritis, or swelling of fingers or toes, are all found in patients struggling with this manifestation.
Mucocutaneous: IBD can cause changes in the skin and the moist lining surrounding organs and cavities in the body (the mucosa). Oral aphthous ulcers (commonly known as canker sores), erythema nodosum (tender purple nodules found under the skin), and pyoderma gangrenosum (painful skin ulcers) are some examples of how IBD can casue inflammatory issues within the skin and mucosa. Sweet syndrome is rare EIM that involves sensitive lumps under the skin. It also raises white blood cell count, causes fevers, creates a higher risk of arthritis, and eye symptoms are dected.
Ocular: Episcleritis, scleritis, or anterior uveitis are common inflammatory conditions in the eye. It affects 2% to 7% of IBD patients. If eye pain, redness, sensitivity, or visual changes, are experiened, quickly get an evaluation by an ophthalmologist, as there is a risk of blindness from uncontrolled ocular inflammation.
Vascular: Patients with IBD are at up to three times greater risk of developing blood clots compared to patients without IBD. This high risk is believed to be associated with the poorly controlled inflammation in the GI tract. These clots can travel to the lungs, brain, or get stuck in any artery, causing pulmonary embolisms, ischemic strokes, and atrial thrombosis. Blood clots are hard to detect on one's own, but some symptoms include leg swelling or shortness of breath.
Gastrointestinal: While not very common, IBD can cause liver diseases. These commonly include primary sclerosis cholangitis, an inflammation and scarring of the bile ducts, and autoimmune hepatitis, when the immune system attacks the liver cells, causing liver inflammation. Another more rare condition is autoimmune pancreatitis, which results in the body attacking pancreatic cells. These conditions can be diagnosed by symptoms, blood tests, or imaging findings (sometimes using MRI).
Treatment of EIMs
Effectively treating IBD is extremely important, as this may reduce activity of extraintestinal manifestations. Sometimes however, EIMs may require additional treatments. The majority of these treatments work to suppress the immune system and reduce inflammation. For example, corticosteroids, anti-inflammatory medication, or specific biologic therapies can be used to help arthritis symptoms. Skin and ocular issues may be treated with immunosuppressants or specific biologic agents. Blood clots and other vascular manifestations are generally prescribed with anticoagulation medications. All in all, treatment of EIMs are complex, and generally need a multifaceted approach for relief.
What to do now
EIMs are crucial to recognize, as they may alter your doctors’ approach and towards IBD, and they can be detrimental to your life.
It is important to see your primary care doctor or gastroenterologist to discuss any symptoms you may be experiencing, whether or not you have IBS. Your medical and family history are very important to determine a risk factor for IBD or any other medical conditions.
For those diagnosed with IBD or at risk for IBD, EIMs may aid in diagnosis or cause for a treatment review and/or adjustment. Communicate both your GI and non-gastrointestinal symptoms with your gastroenterologist, so that the appropriate treatment can occur.
Proper symptom communication, blood panels, and imaging scans are highly important in order to manage and treat IBD and EIMs.
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