Cardiovascular Manifestations in Inflammatory Bowel Disease: A Systematic Review of the Pathogenesis and Management of Pericarditis

Abstract

Inflammatory bowel disease (IBD) is a chronic condition of the bowel that can be further categorized into ulcerative colitis and Crohn's disease. Rarely, this condition can be associated with pericarditis, which can be an extraintestinal manifestation of the disease or drug-induced. This review aims to determine the pathogenesis and management of pericarditis in IBD. In this review, the goal is to elucidate the pathogenesis of pericarditis in IBD and determine if pericarditis is an extraintestinal manifestation of IBD or a complication of current drug therapy used to manage IBD. Additionally, this review intends to explain the first-line management of pericarditis in IBD and explore the role of biologicals in attenuating pericarditis. An electronic search was conducted to identify relevant reports of pericarditis in IBD, and a quality assessment was conducted to identify high-quality articles according to the inclusion criteria. Full-text articles from inception to November 2020 were included, while non-English articles, gray literature, and animal studies were excluded. The majority of studies suggest that pericarditis arises as a complication of drug therapy by 5-aminosalicylic acid derivatives such as sulfasalazine, mesalamine, and balsalazide, and it occurs due to IgE-mediated allergic reactions, direct cardiac toxicity, cell-mediated hypersensitivity reactions, and humoral antibody response to therapy. Drug cessation or the initiation of a corticosteroid regimen seems to be the most effective means of managing pericarditis in IBD due to drug therapy or an extraintestinal manifestation.

Comorbidity of gastroenterological and cardiovascular pathology as a problem of clinical practice

“…Описанные сердечно-сосудистые проявления у пациентов с ВЗК включают перикардит, миокардит, венозную и артериальную тромбоэмболию, аритмии, атриовентрикулярную блокаду, сердечную недостаточность, эндокардит, вальвулопатии и артериит Такаясу [23]. Некоторые из перечисленных заболеваний предположительно имеют общий патогенез с ВЗК, другие могут быть результатом лекарственной терапии ВЗК [24,25]. Частота сердечно-сосудистых проявлений при ВЗК колеблется от 6% до 47% [23].…”

Drug-induced pericarditis

“…20 solve upon therapy discontinuation. A detailed review of this issue was recently published by Patel et al 24 Regarding the newer anti-infl ammatory drugs, pericarditis has been linked to the use of anti-TNF drugs, in particular adalimumab, infl iximab, and etanercept, with the most recent additions being certolizumab and golimumab. 25,26 Pericarditis can develop as early as one to several months of therapy.…”

Extraintestinal Manifestations of Inflammatory Bowel Disease: Unraveling Valvulopathy Connections

“…While the primary focus of IBD management has been on the gastrointestinal manifestations, emerging evidence suggests a potential link between IBD and cardiac manifestations. Cardiovascular complications, including pericarditis, myocarditis, venous and arterial thromboembolism, arrhythmias, and conduction disorders, have been reported in IBD patients at a higher frequency than in the general population [2]. The pathogenesis of these cardiac manifestations is believed to be primarily immune-related.…”