ECCO guidelines on extraintestinal manifestations in inflammatory bowel disease

Abstract

This is the second European Crohn’s and Colitis Organisation [ECCO] evidence-based consensus on extraintestinal manifestations [EIMs] of inflammatory bowel disease [IBD] and anaemia. Up to 50% of patients with IBD will develop at least one EIM, which may impact each body system ; hence they are a source of considerable morbidity, or even mortality in the case of primary sclerosing cholangitis [PSC] or venous thromboembolic events [VTE]. Broadly, EIMs can be categorized as classical, arising from inflammatory pathology at distant sites, the consequences of systemic inflammation and treatment, or wider associations. The underlying pathophysiology of extraintestinal inflammation is not fully understood. Potential driving forces include extension of the immune-mediated response from the inflamed gut to other organs, with shifts in leukocyte trafficking, changes to the intestinal microbiota, and underlying predisposing genetic factors. The systemic consequences of IBD lead to broader associations, including VTEs and anaemia. Whether these are strictly EIMs is of debate, but they are included within this guideline as they incur a considerable health burden to patients with IBD.