Reviews in Basic and Clinical Gastroenterology and HepatologyExtraintestinal Manifestations of Inflammatory Bowel Disease: Current Concepts, Treatment, and Implications for Disease Management
Section snippets
Epidemiology, Frequency, and Chronology of Extraintestinal Manifestations in Inflammatory Bowel Disease
The prevalence and incidence of EIMs are dependent on the types of EIMs included in definitions, as outlined. More stringent definitions of EIMs, as suggested by the European Crohn’s and Colitis Organization’s working group on EIM, will result in lower estimates of prevalence: “An inflammatory pathology in a patient with IBD that is located outside the gut and for which the pathogenesis is either dependent on extension/translocation of immune responses from the intestine, or is an independent
Pathophysiology of Extraintestinal Manifestations in Inflammatory Bowel Disease
It has been assumed that the factors relevant for the pathogenesis of EIMs are similar or the same as for the intestinal inflammation.5 Genetic risk factors seem to play a role, as several are shared between IBD and various EIMs. Furthermore, environmental factors appear to play a role. The innate and adaptive immune system certainly plays an important role in the initiation and perpetuation of organ inflammation. In addition, the interaction with components of the microbiota can be important.
Summary
EIMs in patients with IBD contribute significantly to the burden of disease. Specific anti-inflammatory and symptomatic treatments and therapies in a multidisciplinary team approach are necessary to address EIMs adequately and improve the quality of life of our patients. In the absence of specific therapeutic biomarkers for EIMs, considerations of co-existing EIMs in patients with IBD can inform treatment selection and decisions.
Acknowledgments
All of the authors contributed equally to the conceptualization, writing, editing, and review of final draft of this manuscript.
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Conflicts of interest Gerhard Rogler has consulted for Abbvie, ARENA, Augurix, Biogen, BMS, Boehringer, Calypso, Celgene, FALK, Ferring, Fisher, Genetech, Gilead, Janssen, MSD, Novartis, Pfizer, Phadia, Roche, UCB, Takeda, Tillots, Vifor, Vital Solutions, and Zeller; has received speaker's honoraria from Astra Zeneca, Abbvie, BMS, FALK, Janssen, MSD, Pfizer, Phadia, Takeda, Tillots, UCB, Vifor, and Zeller; has received educational grants and research grants from Abbvie, Ardeypharm, Augurix, Calypso, FALK, Flamentera, MSD, Novartis, Pfizer, Roche, Takeda, Tillots, UCB, and Zeller; and is co-founder of PharmaBiome. Abha Singh receives grant support from Pfizer and Novartis. Arthur Kavanaugh has consulted for Abbvie, Pfizer, Amgen, BMS, Eli Lilly, Novartis, and UCB. David T. Rubin serves as a consultant for Abbvie, Altrubio, Allergan, Inc, Arena Pharmaceuticals, Aslan Pharmaceuticals, Athos Therapeutics, Bellatrix Pharmaceuticals, Boehringer Ingelheim, Ltd, Bristol-Myers Squibb, Celgene Corp/Syneos, Connect BioPharma, GalenPharma/Atlantica, Genentech/Roche, Glycominds, InDex Pharmaceuticals, Ironwood Pharmaceuticals, Iterative Scopes, Janssen Pharmaceuticals, Lilly, Materia Prima, Pfizer, Prometheus Biosciences, Reistone, Takeda, and Techlab, Inc; and receives grant support from Takeda.