Extraintestinal manifestations of inflammatory bowel diseases

Öz

Background and Aims: The reported frequency of extraintestinal manifestations in inflammatory bowel disease varies from 6% to 47%. We evaluated extraintestinal manifestations of inflammatory bowel disease patients who were followed up in our clinic.Materials and Methods: The epidemiological findings, disease duration, extraintestinal manifestations, and complications were evaluated between April 1998 and April 2008, retrospectively. Results:Four hundred and ninety-four patients (254 males; mean age, 38,63±13,32 years; range, 16-78) were evaluated: 283 (57,3%) with ulcerative colitis, 194 (39,3%) with Crohn's disease and 17 (3.4%) with indeterminate colitis. The mean disease duration was 70,66±75,93 months (1-1008 months), and the mean follow-up was 36,40±45,09 months (1-288 months). The extraintestinal manifestation rate was 19.2% (95/494) in the whole group, and included arthritis in 32 (6,5%), hepatobiliary in 13 (2,6%), skin in 13 (2,6%), multiple extraintestinal manifestations in 16 (3,2%), renal calculus in 12 (2,4%), thromboembolic events in 5 (1%), and eye involvement in 4 (0,8%). Complications were observed in a total of 78 patients (15,8%). Complication rates were as follows: 29 (5,9%) abscess, 15 (3%) perforation, 5 (1%) malignancy, 1 (0,2%) toxic megacolon, and 15 (2,6%) others. The complication rate was higher in Crohn's disease than ulcerative colitis (29,3% vs 3,6%). There was a positive correlation between extraintestinal manifestations and the complication rate in ulcerative colitis (p=0,007, r=0,173), and a positive correlation was observed between colonic involvement and extraintestinal manifestations in Crohn's disease (p=0,04, r=0,144). Conclusions: The most common extraintestinal manifestation was arthritis, and the most frequently seen complications were abscess and perforation. The complication rate was higher in Crohn's disease than ulcerative colitis. Extraintestinal manifestations may enhance the complication rate in UC. In Crohn's disease, the extraintestinal manifestations rate is higher in colonic involvement than in ileocolonic and ileal involvement. Colonic involvement in Crohn's disease is a predictive factor for extraintestinal manifestations

Anahtar Kelimeler

• Inflammatory bowel disease, extraintestinal manifestation.

İnflamatuvar barsak hastalığının ekstraintestinal tutulumu

Öz

Giriş ve Amaç: İnflamatuvar barsak hastalığında ekstraintestinal bulguların sıklığı %6-47 olarak bildirilmiştir. Kliniğimizde takip edilen inflamatuvar barsak hastalarında görülen ekstraintestinal bulguları değerlendirdik. Gereç ve Yöntem:Nisan 1998 ve Ocak 2008 arasında takip edilen hastalar ekstraintestinal bulgular, epidemiyolojik veriler, hastalık süreleri, komplikasyonları açısından retrospektif olarak değerlendirildi. Bulgular:494 hasta (254 erkek, yaş ortalaması 38,63±13,32 yıl, yaş dağılımı 16-78) değerlendirmeye alındı. Bu hastalardan 283'ü (%57,3) ülseratif kolit, 194'ü (%39,3) Crohn hastalığı ve 17'si (%3.4) indetermine kolit idi. Hastalık yaşı ortalama 70,66±75,93 (1-1008) ay idi. Ortalama takip süresi 36,40±45,09 ay (1-288 ay) idi. Tüm inflamatuvar barsak hastalarında ekstraintestinal bulguların sıklığı %19,2 (95/494) olup dağılımı: seronegatif artrit 32 (%6,5), hepatik tutulum 13 (%2,6), deri tutulumu 13 (%2,6), kombine 16 (%3,2), renal kalkül 12 (%2,4), tromboemboli 5 (%1), göz tutulumu 4 (%0,8) idi. 78 hastada (%15,8) komplikasyon görüldü: [29 abse (%5,9), 15 perforasyon (%3), 5 malignite (%1), 1 toksik megakolon (%0,2) ve 15 diğer komplikasyonlar (%2,6)]. Crohn hastalığında komplikasyon oranı ülseratif kolitten fazla idi (%29,3'e %3,6). Ülseratif kolitli hastalarda ekstraintestinal bulgular ile komplikasyon sıklığı arasında (p=0,007, R=0,173), Crohn hastalarında kolonik tutulum ile ekstraintestinal bulgular arasında (p=0,04, R=0,144) pozitif korelasyon tesbit edildi. Sonuç: İnflamatuvar barsak hastalarında en sık ekstraintestinal bulgu seronegatif artrittir. En sık komplikasyon ise abse ve perforasyondur. Ekstraintestinal bulguların varlığı ülseratif kolit seyrinde komplikasyon riskini arttırır. Crohn hastalığında kolonik tutulum, ekstraintestinal bulguların varlığını gösteren prediktif bir faktördür.

Anahtar Kelimeler

• İnflamatuvar barsak hastalığı, ekstraintestinal bulgular

Kaynakça

1. Karlinger K, Györke T, Makö E, et al. The epidemiology and the pathogenesis of inflammatory bowel disease. Eur J Radiol 2000; 35: 154-67.
2. Andrisani G, Guidi L, Papa A, Armuzzi A. Anti-TNF alpha therapy in the management of extraintestinal manifestation of inflammatory bowel disease. Eur Rev Med Pharmacol Sci 2012; 16: 890-901.
3. Konduk BT, Hülagü S. İnflamatuvar bağırsak hastalıklarında tanı. Turkiye Klinik J Int Med Sci 2005; 1: 16-53.
4. Agrawal D, Rukkannagari S, Kethu S. Pathogenesis and clinical approach to extraintestinal manifestations of inflammatory bowel disease. Minerva Gastroenterol Dietol 2007; 53: 233-48.
5. Veloso FT, Carvalho J, Magro F. Immune-related systemic manifes- tations of inflammatory bowel disease. A prospective study of 792 patients. J Clin Gastroenterol 1996; 23: 29-34.
6. Levine JS, Burakoff R. Extraintestinal manifestations of inflamma- tory bowel disease. Gastroenterol Hepatol 2011; 7: 235–41.
7. Siemanowski B, Regueiro M. Efficacy of infliximab for extraintesti- nal manifestations of inflammatory bowel disease. Curr Treat Op- tions Gastroenterol 2007; 10: 178-84.
8. Barrie A, Regueiro M. Biologic therapy in the management of extraintestinal manifestations of inflammatory bowel disease. In- flamm Bowel Dis 2007; 13: 1424-9.

9. Ardizzone S, Puttini PS, Cassinotti A, Porro GB. Extraintestinal mani- festations of inflammatory bowel disease. Dig Liver Dis 2008; 40 (Suppl 2): S253-9.
10. Veloso FT. Extraintestinal manifestations of inflammatory bowel disease: Do they influence treatment and outcome? World J Gas- troenterol 2011; 17: 2702-7.
11. Das KM. Relationship of extraintestinal involvements in inflamma- tory bowel disease: new insights into autoimmune pathogenesis. Dig Dis Sci 1999; 44: 1-13.
12. Şentürk Ö, Öztürk T, Çelebi A, et al. İnflamatuar barsak hastalığı olan hastaların değerlendirilmesi ve ekstraintestinal manifestasyon- lar: Sürmekte olan prospektif çalışmanın ön sonuçları. Turk J Gas- troenterol 2010; 21(Suppl 1): S49.
13. Ozdil S, Akyuz F, Pinarbasi B, et al. Ulcerative colitis: analyses of 116 cases (do extraintestinal manifestations affect the time to catch remission?). Hepatogastroenterology 2004; 51: 768-70.
14. Rogler G, Schölmerich J. Extraintestinal manifestations of inflam- matory bowel disease. Med Klin (Munich) 2004; 99: 123-30.
15. Kethu SR. Extraintestinal manifestations of inflammatory bowel dis- eases. J Clin Gastroenterol 2006; 40: 467-75.
16. Mendoza JL, Lana R, Taxonera C, et al. Extraintestinal manifesta- tions in inflammatory bowel disease: differences between Crohn’s disease and ulcerative colitis. Med Clin (Barc) 2005; 125: 297-300.
17. Bernstein CN, Blanchard JF, Rawsthorne P, Yu N. The prevalence of extraintestinal diseases in inflammatory bowel disease: a popu- lation-based study. Am J Gastroenterol 2001; 96: 1116-22.
18. Lakatos L, Pandur T, Dávid G, et al. Extra-intestinal manifestation of IBD in Veszprém county (of Hungary): results of a 25-years follow- up study. Orv Hetil 2003; 144: 1965-75.
19. Barreiro-de Acosta M, Domínguez-Muñoz JE, Nşñez-Pardo de Vera MC, et al. Relationship between clinical features of Crohn’s disease and the risk of developing extraintestinal manifestations. Eur J Gas- troenterol Hepatol 2007; 19: 73-8.
20. Vavricka SR, Brun L, Ballabeni P, et al. Frequency and risk factors for extraintestinal manifestations in the Swiss Inflammatory Bowel Disease Cohort. Am J Gastroenterol 2011; 106: 110-9.
21. Jiang L, Xia B, Li J, et al. Retrospective survey of 452 patients with inflammatory bowel disease in Wuhan city, central China. Inflamm Bowel Dis 2006; 12: 212-7.
22. Tavarela Veloso F. Review article: skin complications associated with inflammatory bowel disease. Aliment Pharmacol Ther 2004; 20 (Suppl 4): 50-3.
23. Tozun N, Atug O, Imeryuz N, et al.; Members of the Turkish IBD Study Group. Clinical characteristics of inflammatory bowel disease in Turkey: a multicenter epidemiologic survey. J Clin Gastroenterol 2009; 43: 51-7.
24. Lakatos PL, Szalay F, Tulassay Z, et al.; Hungarian IBD Study Group. Clinical presentation of Crohn’s disease. Association between fa- milial disease, smoking, disease phenotype, extraintestinal manifes- tations and need for surgery. Hepatogastroenterology 2005; 52: 817-22.
25. Rankin GB, Watts HD, Melnyk CS, Kelley ML Jr. Gastroenterology. National Cooperative Crohn’s Disease Study: extraintestinal mani- festations and perianal complications. 1979; 77: 914-20.