Extraintestinal Manifestations of Inflammatory Bowel Disease

Abstract

Article first published online 2 July 2015

Oral Pyoderma Gangrenosum: Diagnosis, Treatment and Challenges: A Systematic Review

“…In a recent randomized, observer-blind, parallel group, controlled trial involving 112 patients with cutaneous PG, similar remission rates were reported between groups treated with cyclosporine (4 mg/kg/day) and prednisolone (0.75 mg/kg/day) suggesting that the treatment decision should be based on patient profile and possible adverse effects [55]. Monoclonal antibodies such as Infliximab (anti-TNF-α) and Adalimumab have been suggested as secondary lines of treatment for refractory multifocal disseminated lesions or in cases of multiple organ involvement [13,28,56]. In patients diagnosed with inflammatory bowel disease, Infliximab is often the therapeutic drug of choice [28,57,58].…”

“…Topical clobetasol propionate (Dermovate 0.05%) or Tacrolimus (Protopic 0.1 or 0.03%) can be used as adjuvants to systemic therapy to relieve symptoms [9,23]. Surgical debridement without concomitant medically induced immunosuppression or pre-operative corticosteroids should be avoided as surgery has been demonstrated to exacerbate cutaneous PG [3,36,51,56,60]. Similarly, in oral PG, Yco et al reported that a PG ulcer spread to the adjacent alveolar ridge after a biopsy was undertaken [10].…”

Extra-Intestinal Complications (EIC) and Manifestations (EIM) (Ocular and Pulmonary) among Patients with Crohn's Disease

“…6% to 40% of patients with IBD have one or more extra intestinal manifestation [19]. Up to 15 percent of patients have a cutaneous manifestation of IBD [18]. The incidence of ocular manifestations secondary to IBD is 4% to 10% and it tends to occur more with CD than UC [21,22].…”

“…2 groups of extra intestinal symptoms: extra intestinal manifestations (EIM) and extra intestinal complications. EIM most frequently affect joints (peripheral and axial arthropathies), the skin (erythema nodosum, pyoderma gangrenosum, Sweet's syndrome, aphthous stomatitis), the hepatobiliary tract (primary sclerosing cholangitis [PSC]), and the eye (episcleritis, uveitis) [18]. EI complications are mainly caused by the disease itself that induce malabsorption with consequent micronutrient deficiencies, osteoporosis, peripheral neuropathies, kidney stones, gallstones, and IBD drug-related side effects [18].…”

“…EIM most frequently affect joints (peripheral and axial arthropathies), the skin (erythema nodosum, pyoderma gangrenosum, Sweet's syndrome, aphthous stomatitis), the hepatobiliary tract (primary sclerosing cholangitis [PSC]), and the eye (episcleritis, uveitis) [18]. EI complications are mainly caused by the disease itself that induce malabsorption with consequent micronutrient deficiencies, osteoporosis, peripheral neuropathies, kidney stones, gallstones, and IBD drug-related side effects [18]. The incidence of EIMs reported in both Crohn's disease and Ulcerative colitis is highly variable, ranging from 25% to 40% [19,20].…”