Abstract
Background
The data on prevalence of extraintestinal manifestations (EIM) in ulcerative colitis (UC) are scanty and highly variable.
Methods
Consecutive patients with UC were prospectively evaluated from November 2016 to August 2017. A detailed history was obtained and physical examination was done. Presence of EIM was confirmed by a consultant rheumatologist, ophthalmologist and dermatologist. Tests performed were hemogram, liver function test, abdominal ultrasound, slit lamp examination, X-ray and magnetic resonance imaging when deemed necessary.
Results
A total of 227 patients with UC were enrolled in this study. The prevalence of EIM was 7.92%. Mucocutaneous (4.84%) manifestations were the commonest, followed by musculoskeletal (1.32%) and ocular (0.88%). Hepatobiliary (0.44%) and vascular (0.44) manifestations were present in equal frequency. History of appendicectomy was associated with EIM.
Conclusion
The prevalence of EIM in UC was low in our study. History of appendicectomy was a risk factor for EIM.

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References
Zippi M, Corrado C, Pica R, et al. Extraintestinal manifestations in a large series of Italian inflammatory bowel disease patients. World J Gastroenterol. 2014;20:17463–7.
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. 2015;34:43–50.
Das KM. Relationship of extraintestinal involvements in inflammatory bowel disease: new insights into autoimmune pathogenesis. Dig Dis Sci. 1999;44:1–13.
Lakatos L, Pandur T, David G, et al. Association of extraintestinal manifestations of inflammatory bowel disease in a province of western Hungary with disease phenotype: results of a 25-year follow-up study. World J Gastroenterol. 2003;9:2300–7.
Bernstein CN, Blanchard JF, Rawsthorne P, Yu N. The prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study. Am J Gastroenterol. 2001;96:1116–22.
Habeeb MA, Rajalingam R, Dhar A, Kumar A, Sharma MP, Mehra NK. HLA association and occurrence of autoantibodies in Asian-Indian patients with ulcerative colitis. Am J Gastroenterol. 1997;92:772-6.
Ricart E, Panaccione R, Loftus EV, et al. Autoimmune disorders and extraintestinal manifestations in first-degree familial and sporadic inflammatory bowel disease: a case-control study. Inflamm Bowel Dis. 2004;10:207–14.
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.
Harbord M, Annese V, Vavricka SR, et al. The first European evidence-based consensus on extra-intestinal manifestations in inflammatory bowel disease. J Crohns Colitis. 2016;10:239–54.
Orchard TR, Chua CN, Ahmad T, Cheng H, Welsh KI, Jewell DP. Uveitis and erythema nodosum in inflammatory bowel disease: clinical features and the role of HLA genes. Gastroenterology. 2002;123:714-8.
Hedin CRH, Vavricka SR, Stagg AJ, et al. The pathogenesis of extraintestinal manifestations: implications for IBD research, diagnosis and therapy. J Crohns Colitis. 2019;13:541–54.
Verbraak FD, Schreinemachers MC, Tiller A, van Deventer SJ, de Smet MD. Prevalence of subclinical anterior uveitis in adult patients with inflammatory bowel disease. Br J Ophthalmol. 2001;85:219-21.
Bandyopadhyay D, Bandyopadhyay S, Ghosh P, et al. Extraintestinal manifestations in inflammatory bowel disease: prevalence and predictors in Indian patients. Indian J Gastroenterol. 2015;34:387–94.
Mendoza JL, Lana R, Taxonera C, Alba C, Izquierdo S, Díaz-Rubio M. Extraintestinal manifestations in inflammatory bowel disease: differences between Crohn's disease and ulcerative colitis. Med Clin (Barc). 2005;125:297-300.
Karmiris K, Avgerinos A, Tavernaraki A, et al. Prevalence and characteristics of extra-intestinal manifestations in a large cohort of Greek patients with inflammatory bowel disease. J Crohns Colitis. 2016;10:429–36.
Algaba A, Guerra I, Ricart E et al. Extraintestinal manifestations in patients with inflammatory bowel disease: study based on the ENEIDA registry. Dig Dis Sci. 2021;66:2014-23.
Kochhar R, Mehta SK, Nagi B, et al. Extraintestinal manifestations in idiopathic ulcerative colitis. Indian J Gastroenterol. 1991;10:88–9.
Pokharna RK, Kabra PK, Sharma R, Kochar DK. Extraintestinal manifestations of idiopathic ulcerative colitis in northwestern India. Indian J Gastroenterol. 2004;23:89–90.
Makharia GK, Ramakrishna BS, Abraham P, et al. Survey of inflammatory bowel diseases in India. Indian J Gastroenterol. 2012;31:299–306.
Amarapurkar AD, Amarapurkar DN, Rathi P, et al. Risk factors for inflammatory bowel disease: A prospective multi-center study. Indian J Gastroenterol. 2018;37:189–95.
Sharma JB, Sharma B, Sharma R, Mahajan SK, Raina R, Sharma P. The profile of inflammatory bowel disease in natives of western Himalayas. Trop Gastroenterol. 2017;38:115–21.
Lennard-Jones JE. Classification of inflammatory bowel disease. Scand J Gastroenterol Suppl.1989;170:2-6.
Silverberg MS, Satsangi J, Ahmad T, et al. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a working party of the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol. 2005;19:5A–36A.
Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med. 1987;317:1625–9.
Alnaqbi KA, Touma Z, Passalent L, et al. Development, sensibility, and reliability of the Toronto Axial Spondyloarthritis Questionnaire in inflammatory bowel disease. J Rheumatol. 2013;40:1726–35.
Edwards FC, Truelove SC. The course and prognosis of ulcerative colitis. Gut. 1964;5:1–15.
Orchard TR, Wordsworth BP, Jewell DP. Peripheral arthropathies in inflammatory bowel disease: their articular distribution and natural history. Gut. 1998;42:387–91.
Philip M, Augustine P, Thomas V, et al. Multi-center prospective survey of inflammatory bowel diseases in Kerala: More than 2000 cases. Indian J Gastroenterol. 2017;36:459–67.
Card TR, Langan SM, Chu TP. Extra-gastrointestinal manifestations of inflammatory bowel disease may be less common than previously reported. Dig Dis Sci. 2016;61:2619–26.
Park SK, Wong Z, Park SH, et al. Extraintestinal manifestation of inflammatory bowel disease in Asian patients: a multinational study. Dig Liver Dis. 2021;53:196–201.
Evans J, Sapsford M, Raine T, et al. AB0719 Prevalence of undiagnosed axial spondyloarthritis in patient with inflammatory bowel disease: a systemic literature review and primary research study. Ann Rheum Dis. 2019;78:1822–3.
Chopra A. Disease burden of rheumatic diseases in India: COPCORD perspective. Indian J Rheumatol. 2015;10:70–7.
Rudwaleit M, van der Heijde D, Landewe R, et al. The development of Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68:777–83.
De Marco G, McGonagle D, Lettieri G, et al. MRI assessment of axial involvement in inflammatory bowel disease related SpA: age at the disease diagnosis, not extent and severity of axial disease relates to HLA-B27. Ann Rheum Dis. 2016;75:331.
Maksymowych WP. The role of imaging in the diagnosis and management of axial spondyloarthritis. Nat Rev Rheumatol. 2019;15:657–72.
de Winter J, de Hooge M, van de Sande M, et al. Magnetic resonance imaging of the sacroiliac joints indicating sacroiliitis according to the assessment of spondyloarthritis international society definition in healthy individuals, runners, and women with postpartum back pain. Arthritis Rheum. 2018;70:1042–8.
Tibdewal P, Bhatt P, Jain A, Gupta D, Bhatia S, Shukla A. Clinical profile and outcome of primary sclerosing cholangitis: A single-centre experience from western India. Indian J Gastroenterol. 2019;38:295-302.
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Rawal, K.K., Shukla, V.P., Chikani, S. et al. Prevalence of extraintestinal manifestations in ulcerative colitis and associated risk factors. Indian J Gastroenterol 40, 477–482 (2021). https://doi.org/10.1007/s12664-021-01181-9
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DOI: https://doi.org/10.1007/s12664-021-01181-9
Keywords
- Aphthous ulcer
- Appendicectomy
- Crohn’s disease
- Inflammatory bowel disease
- Mayo classification
- Primary sclerosing cholangitis
- Spondyloarthritis
- Thrombosis
- Uveitis