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Extra-Gastrointestinal Manifestations of Inflammatory Bowel Disease May Be Less Common Than Previously Reported

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Abstract

Background and Aims

Extra-intestinal manifestations are well recognized in inflammatory bowel disease (IBD). To what extent the commonly recognized extra-intestinal manifestations seen in IBD patients are attributable to IBD is, however, not clear due to the limited number of controlled studies published.

Methods

We have conducted a study of these manifestations using electronic primary care records. We have identified extra-intestinal manifestations in IBD and non-IBD patients and derived odds ratios (ORs) using conditional logistic regression.

Results

A total of 56,097 IBD patients (32.5 % Crohn’s disease, 48.3 % ulcerative colitis (UC) and 19.2 % not classified) were matched to 280,382 non-IBD controls. We found records of pyoderma gangrenosum (OR = 29.24), erythema nodosum (OR = 5.95), primary sclerosing cholangitis (OR = 188.25), uveitis (OR = 2.81), ankylosing spondylitis (OR = 7.07), sacroiliitis (OR = 2.79) and non-rheumatoid inflammatory arthritides (OR = 2.66) to be associated with IBD. One or more of these was recorded in 8.1 % of IBD patients and 2.3 % of controls. Non-specific arthritides were present in many more patients, affecting 30 % of IBD patients and 23.8 % of controls overall. We also found weaker associations with a number of conditions not generally considered to be extra-intestinal manifestations including psoriasis, ischemic heart disease, multiple sclerosis and hay fever.

Conclusion

Although “classical” extra-intestinal manifestations are strongly associated with IBD, most IBD patients remain unaffected. Arthropathies, perceived to be the commonest extra-intestinal manifestation, are not strongly associated with IBD, and the proportion of arthropathies attributable to IBD is likely to be small.

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Abbreviations

IBD:

Inflammatory bowel disease

UC:

Ulcerative colitis

PSC:

Primary sclerosing cholangitis

VTE:

Venous thromboembolism

EIMs:

Extra-intestinal manifestations

CPRD:

Clinical Practice Research Datalink

BMI:

Body mass index

OR:

Odds ratio

CI:

Confidence interval

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Acknowledgments

This work was funded by a grant from Crohn’s and Colitis UK (NACC) (Grant Number M/10/01). This study was conceived and designed collaboratively by all authors. Dr. Card obtained funding. Dr. Chu carried out all analysis. All authors contributed to the interpretation of the results. Drs. Card and Chu jointly wrote the first draft after discussions among all authors, and all authors edited and amended this and all subsequent drafts. All authors approved the final draft. Dr. Langan is funded by an NIHR Clinician Scientist Fellowship (NIHR/CS/010/014). The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the UK Department of Health.

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Authors and Affiliations

  1. Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK

    Timothy R. Card & Thomas P. C. Chu

  2. Nottingham Digestive Diseases Centre Biomedical Research Unit, University of Nottingham, Nottingham, UK

    Timothy R. Card

  3. Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK

    Sinéad M. Langan

Authors
  1. Timothy R. Card
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  2. Sinéad M. Langan
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  3. Thomas P. C. Chu
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Correspondence to Timothy R. Card.

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All authors declare they have no conflict of interest relating to the presented work.

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Card, T.R., Langan, S.M. & Chu, T.P.C. Extra-Gastrointestinal Manifestations of Inflammatory Bowel Disease May Be Less Common Than Previously Reported. Dig Dis Sci 61, 2619–2626 (2016). https://doi.org/10.1007/s10620-016-4195-1

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