The medical term ‘inflammatory bowel disease’ is fairly common. But most people are not familiar with the ‘extra-intestinal manifestations (EIMS)’ of IBD.

A recent article in the AGA Journals Blog sets out a comprehensive review of the connection between IBD and EIMs. Almost half the patients who have IBD also have EIMs.

About IBD and EIMs

According to the NCBI, IBD is defined as abdominal pain with altered bowel habits. IBD is spreading throughout the world and is on the rise in developing countries. IBD symptoms are not confined to the gastrointestinal tract. They affect skin, joints, eyes, lungs, liver, and pancreas. Unfortunately, available treatments for inflammation of the intestines do not treat EIMs effectively.

Inflammation is also responsible for EIMs developing in areas other than the GI tract. Researchers are of the opinion that EIMs may be caused by the same genetic factors that are responsible for gut inflammation. EIM’s symptoms surface independently in patients who have Crohn’s disease or ulcerative colitis.

EIMs involve the musculoskeletal system composed of muscles, bones, tendons, soft tissues, and ligaments. They work in a synergy that supports the body’s weight and motion.

Eighteen percent of IBD patients have:

• Exocrine pancreatic insufficiency (EPI) – a condition that prevents proper digestion of food. The condition may result from nonpancreatic or pancreatic causes.
• Pancreatic duct abnormalities such as pancreas divisum, a common anomaly of the pancreatic duct that is present at birth.
• Hyperamylasemia is an excess of the pancreatic enzyme amylase. Daily intake of carbohydrates depends on amylase to begin to digest starches.

Gastroenterology: A Review by Gerhard Rogler et al.

Readers may find the October issue of Gastroenterology of interest. Rogler and his team analyze the prevalence of various forms of EIMs. A small number of patients who have IBD may also develop several EIMs.

Rogler and his team also analyze the environmental and genetic factors leading to IBD and EIMs together with the immune system and changes in the intestinal microbiomes.

According to their review, fifty-six percent of IBD patients experience musculoskeletal disorders such as carpal tunnel syndrome, tendinitis, rheumatoid arthritis, osteoarthritis, bone fractures, and fibromyalgia. Skin disorders often develop.

Treatment options are reviewed such as drugs with anti-inflammatory properties. A COX2 inhibitor, celecoxib, has been judged to be safe for patients whose ulcerative colitis is inactive.

IBD patients are at risk for myocardial infarction and a three-fold increased risk of venous thromboembolic events. Patients who are hospitalized with severe colitis present the highest level of risk.

Rogler and team report that over fifty percent of IBD patients experience pain in different areas of the body for up to five years. Their review emphasizes that it is necessary to differentiate whether the pain is associated with an intestinal disease or is separate and apart from IBD or EIMs. This is necessary to provide appropriate treatment.

The review suggests that treatment involves pain medication, psychiatry, physical therapy, and cognitive-behavioral therapy.