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Extraintestinal manifestations of inflammatory bowel disease and intestinal tuberculosis: Frequency and relation with disease phenotype

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Abstract

Background

Extraintestinal manifestations (EIMs) in inflammatory bowel disease (IBD) including ulcerative colitis (UC) and Crohn’s disease (CD), as well as intestinal tuberculosis (ITB) from Asia, are underreported. We, therefore, describe the prevalence of EIMs in Indian IBD and ITB patients and study their relationship with disease extent and severity in IBD.

Methods

This retrospective single-center study included all IBD and ITB patients evaluated from January 2005 to July 2012. Disease profile and frequencies of arthropathies (peripheral and central) and ocular (episcleritis, iritis/uveitis), oral (aphthous stomatitis), skin (erythema nodosum, pyoderma gangrenosum, psoriasis), hepatobiliary (primary sclerosing cholangitis), and thromboembolic manifestations were analyzed.

Results

Of 1,652 patients (1146 UC, 303 CD, 203 ITB), frequency of any EIM was 33.2 %, 38.3 %, and 14.3 % in UC, CD, and ITB patients, respectively. Thromboembolism was more common among UC patients with pancolitis than proctitis (p < 0.001) and left-sided colitis (p = 0.02). Primary sclerosing cholangitis was seen in 0.4 % UC patients. Steroid-dependent UC patients had higher frequency of any EIM, peripheral arthropathy, or thromboembolism than patients with no or infrequent steroid requirement (p < 0.05). Peripheral arthropathy (p = 0.02), erythema nodosum (p = 0.01), and aphthous stomatitis (p = 0.004) were more common with CD than with UC patients. Patients with colonic CD had higher frequency of peripheral arthropathy, any EIM, and multiple EIMs than ileal or ileocolonic disease (p < 0.05). Relative to ITB, CD patients had higher frequencies of peripheral arthropathy (p < 0.001), aphthous stomatitis (p = 0.01), any EIM (p < 0.001), and multiple EIMs (p < 0.001).

Conclusions

In Indian IBD and ITB patients, EIMs appear to be related to disease severity in UC and disease location in CD and are significantly more common in CD than in ITB. Overall prevalence of EIMs in these patients is similar to that of the West.

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Conflict of interest

BS, SK, GK, VPM, RD, LK, SS, RP, GM, and VA confirm that they have no conflicts of interest to declare.

Ethics statement

The study was performed in a manner to conform with the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning Human and Animal Rights, and the authors followed the policy concerning informed consent as shown on Springer.com.

Financial support

The study did not receive any financial support.

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Authors and Affiliations

  1. Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India

    Bikramjit Singh, Saurabh Kedia, Venigalla Pratap Mouli, Rajan Dhingra, Lalit Kurrey, Saurabh Srivastava, Rajesh Pradhan, Govind Makharia & Vineet Ahuja

  2. Gastrointestinal Unit, Massachusetts General Hospital, Boston, USA

    Gauree Konijeti

Authors
  1. Bikramjit Singh
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  2. Saurabh Kedia
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  3. Gauree Konijeti
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  4. Venigalla Pratap Mouli
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  5. Rajan Dhingra
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  6. Lalit Kurrey
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  7. Saurabh Srivastava
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  9. Govind Makharia
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  10. Vineet Ahuja
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Corresponding author

Correspondence to Vineet Ahuja.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Table 1

Baseline clinical and demographic features in patients with ulcerative colitis (UC), intestinal tuberculosis (ITB) and Crohn’s disease (CD) (DOCX 13 kb)

Supplementary Table 2

Frequency of extraintestinal manifestations (EIMs) with respect to disease severity and disease extent in ulcerative colitis (DOCX 14 kb)

Supplementary Table 3

Frequency of extraintestinal manifestations (EIMs) with respect to disease location and disease behavior in CD (DOCX 14 kb)

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Singh, B., Kedia, S., Konijeti, G. et al. Extraintestinal manifestations of inflammatory bowel disease and intestinal tuberculosis: Frequency and relation with disease phenotype. Indian J Gastroenterol 34, 43–50 (2015). https://doi.org/10.1007/s12664-015-0538-7

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  • DOI: https://doi.org/10.1007/s12664-015-0538-7

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