Extra-Intestinal Manifestations in Patients with Inflammatory Bowel Disease

Introduction: Extra-intestinal manifestations (EIMs) significantly contribute to morbidity in patients with inflammatory bowel diseases (IBDs). This study aimed to determine the prevalence and distribution of EIMs in patients with ulcerative colitis (UC) and Crohn’s disease (CD) and to evaluate associations between EIMs, disease activity, and demographic factors.
Methods: This single-center, descriptive observational study included 121 adult IBD patients (65 UC, 56 CD). EIMs were systematically assessed through specialist consultations (rheumatology, dermatology, ophthalmology) and review of laboratory, imaging, and clinical data. Disease activity was classified using standardized indices (CD Activity Index for CD; Truelove and Witts/Mayo Score for UC). Statistical analyses were performed to identify associations between variables.
Results: At least one EIM was identified in 57.0% (n=69) of patients. The most frequent EIMs were hepatobiliary (33.9%), bone-joint (28.9%), and skin-mucosal (24.8%). EIM prevalence was not associated with age or gender. However, differences were observed between disease types: Urinary involvement (29.2% in UC vs. 8.9% in CD; p=0.005) and cardiovascular involvement (16.9% in UC vs. 1.8% in CD; p=0.005) were both more common in UC. Oral cavity (p=0.018), cardiovascular (p=0.032), and urinary (p=0.046) manifestations were significantly associated with active disease. In contrast, hepatobiliary manifestations were more frequently observed in patients in remission.
Discussion and Conclusion: EIMs are highly prevalent in IBD, affecting over half of this patient cohort. The findings reveal that specific EIMs are associated with distinct disease phenotypes (e.g., urinary/cardiovascular in UC) and disease activity status (e.g., oral/cardiovascular in active disease vs. hepatobiliary in remission). This underscores the necessity of routine, multidisciplinary screening for EIMs, even in patients with asymptomatic or inactive intestinal disease, to ensure comprehensive management.

Keywords: Crohn’s disease; Disease activity; Extraintestinal manifestations; Inflammatory bowel disease; Ulcerative colitis