Retrospective Study
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World J Gastroenterol. Dec 14, 2014; 20(46): 17463-17467
Published online Dec 14, 2014. doi: 10.3748/wjg.v20.i46.17463
Extraintestinal manifestations in a large series of Italian inflammatory bowel disease patients
Maddalena Zippi, Claudia Corrado, Roberta Pica, Eleonora Veronica Avallone, Claudio Cassieri, Daniela De Nitto, Paolo Paoluzi, Piero Vernia
Maddalena Zippi, Roberta Pica, Daniela De Nitto, Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, 00157 Rome, Italy
Claudia Corrado, Eleonora Veronica Avallone, Claudio Cassieri, Paolo Paoluzi, Piero Vernia, Department of Internal Medicine and Medical Specialties, Gastroenterology Unit, “Sapienza”, University of Rome, 00157 Rome, Italy
Author contributions: Zippi M and Cassieri C made substantial contribution to study concept and design; Corrado C, De Nitto D and Avallone EV were involved in acquisition, analysis and interpretation of data; Pica R and Zippi M were involved in drafting the article and revising it critically for important intellectual content; Paoluzi P and Vernia P gave final approval of the version to be published.
Correspondence to: Maddalena Zippi, MD, PhD, Unit of Gastroenterology and Digestive Endoscopy, Sandro Pertini Hospital, Via dei Monti Tiburtini 385, 00157 Rome, Italy.
Telephone: +39-6-41433310 Fax: +39-6-41733847
Received: March 18, 2014
Revised: May 21, 2014
Accepted: July 15, 2014
Published online: December 14, 2014

AIM: To investigate prevalence, type and time of onset of extraintestinal manifestations (EIMs) in a series of Italian inflammatory bowel disease (IBD) patients.

METHODS: Data of 811 IBD consecutive patients, first referred to our Centre from 2000 to 2011, were retrospectively evaluated.

RESULTS: Eight hundred and eleven IBD patients (437 M, 374 F) were studied: 595 ulcerative colitis (UC) (73.4%) and 216 Crohn’s disease (CD) (26.6%). Among these, 329 (40.6%) showed EIMs: 210 UC (35.3%) and 119 CD (55.1%) (P < 0.0001). Considering the time of the diagnosis of IBD, 37 EIMs (11.2%) were developed before, 229 (69.6%) after and 63 (19.2%) were simultaneous. The type of EIM were as follows: 240 musculoskeletal (29.6%), in 72 CD patients and in 168 UC (P < 0.0001); 47 mucocutaneous (5.8%), in 26 CD and in 21 UC (P = 0.0049); 26 ocular (3.2%), in 16 CD and in 10 UC (CD 7.4% vs UC 1.7%, P = 0.0093); 6 hepatobiliary (0.8%); 10 endocrinological (1.2%). In particular, with regards to the involvement of the musculoskeletal system, arthritis Type 1 was found in 41 CD (19%) and in 61 UC (10.2%) (P = 0.0012) and Type 2 in 25 CD (11.6%) and in 100 UC (16.8%) (P = 0.0012).

CONCLUSION: Mucocutaneous manifestations, arthritis Type 1 and uveitis were significantly more frequent in CD than UC. The complications of the musculoskeletal system were the mostly observed ones, often with symptoms more severe than intestinal ones, confirming the need for close cooperation with rheumatologists.

Keywords: Crohn’s disease, Extraintestinal manifestations, Inflammatory bowel diseases, Musculoskeletal manifestations, Ulcerative colitis

Core tip: Extraintestinal manifestations (EIMs) are commonly seen in association with inflammatory bowel disease (IBD), both in patients with ulcerative colitis and in those ones with Crohn’s disease. The reported prevalence of EIMs in IBD is highly variable, ranging from 25% to 40%. EIMs can involve any organ or system, even if the musculoskeletal and the dermatologic are the most common ones. Hepatopancreatobiliary, ocular, renal and pulmonary systems may also be affected.