Extraintestinal manifestations in inflammatory bowel disease

Abstract

Introduction: Inflammatory bowel diseases (IBD) - ulcerative colitis (UC) and Crohn’s disease (CD), have chronic progression evolution with frequent extraintestinal manifestations and increasing incidence in East Europe, inclusive in Moldova. The aim of the study was to investigate the frequency and spectrum of extraintestinal pathology Associated with IBD in Moldova – the region with very high incidence of liver and articular disorders. 88 The 6th International Medical Congress for Students and Young Doctors Materials and methods: The study was open prospective and included 126 patients with IBD (56% female, age of 18-67 years) who were treated in Republican Clinical Hospital in 2015. Diagnosis of ulcerative colitis or Crohn’s disease was confirmed endoscopically and histologically. The following methods were used to diagnose extraintestinal manifestation: clinical, ultrasonography, X-ray, biochemical tests, immunological markers etc. Discussion results: 114 (90,5%) patients were diagnosed with UC, 11 (8,7%) with CD and 1 (0,8%) with IBD type unclassified (IBDU). The most frequent extraintestinal manifestation was liver pathology, diagnosed in 30 (23,8%) patients. The spectrum of diseases was broad and included: chronic viral hepatitis B and C – 12 (9,5%), liver steatosis – 9 (7,1%), nonspecific reactive hepatitis - 5 (4,0%), drug induced hepatitis 2 (1,6%), primary sclerosing cholangitis – 1 (0,8%) and primary biliary cirrhosis 1 (0,8%). Arthropathy was diagnosed in 18 (14,3%) patients. Peripheral arthropathy was more frequent than central arthropathy: peritheral oligoartritis – 5 (4,0%), poliartritis 7 (5,6%) in comparison with sacroiliitis – 5 (4,0%) and ankylosing spondylitis – 1 (0,8%). Skin and mucosal affectations were observed in 6 (4,8%) patients: aphthous stomatitis – 3 (2,4%), pyoderma gangrenosum – 1 (0,8%), nodular erythema – 1 (0,8%), and Sweet syndrome – 1 (0,8%). Ocular affectation was diagnosed in 4 (3,2%) cases. Extraintestinal manifestations were more frequent in association than as mono extraintestinal disorder – 22 (17,5%) and 12 (9,5%) patients respectively, and the common associations were liver-articular, skin-articular. It was not revealed significant interrelation between activity/ extention/localization of IBD and severity of extraintestinal manifestation. Exception have made nonspecific reactive hepatitis, peritheral oligoartritis, and pyoderma gangrenosum which was characteristic for a severe debut of IBD. Conclusion: An essential number of IBD patients have Associated extraintestinal pathology (27%). Liver diseases were diagnosed more often and skin and ocular lesions less frequent in comparison with literature data.