Alimentary Tract| Volume 53, ISSUE 2, P196-201, February 2021

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Extraintestinal manifestation of inflammatory bowel disease in Asian patients: A multinational study



      Although inflammatory bowel disease (IBD) incidence has increased over the past two decades in Asia, data on extraintestinal manifestations (EIMs) of IBD in Asian patients are limited. We aimed to evaluate the prevalence and clinical characteristics of EIMs in Asian IBD patients.


      In total, 1,764 patients (1,130 with ulcerative colitis [UC] and 634 with Crohn's disease [CD]) were recruited from 10 tertiary centers in Asia. The medical records of IBD patients were retrospectively reviewed for the presence, clinical characteristics, chronological order, and therapeutic management of EIMs.


      EIMs were reported in 199 (11.3%) patients, of which 17 (1.0%) patients had multiple EIMs. EIMs were more prevalent in CD patients (P = 0.02). Multiple logistic regression analysis revealed that female sex (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.15–3.55), stricture (OR 2.49, 95% CI 1.41–4.39) and female sex (OR 2.57, 95% CI 1.52–4.34), extensive colitis (OR 2.63, 95% CI 1.57–4.41) were associated with EIMs in CD and UC patients respectively. EIMs appeared in 8% of patients before IBD diagnosis; 95% of cases with EIM could be managed via first-line therapy.


      EIM prevalence is lower among Asian IBD patients than among patients from Western countries; however, the risk factors for EIM were similar between both populations.


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        • Ng S.C.
        • Shi H.Y.
        • Hamidi N.
        • et al.
        Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies.
        Lancet. 2018; 390: 2769-2778
        • Hsu Y.C.
        • Wu T.C.
        • Lo Y.C.
        • et al.
        Gastrointestinal complications and extraintestinal manifestations of inflammatory bowel disease in Taiwan: a population-based study.
        J Chin Med Assoc. 2017; 80: 56-62
        • Thoreson R.
        • Cullen J.J.
        Pathophysiology of inflammatory bowel disease: an overview.
        Surg Clin North Am. 2007; 87: 575-585
        • Podolsky D.K
        Inflammatory bowel disease (1).
        N Engl J Med. 1991; 325: 928-937
        • Bernstein C.N.
        • Blanchard J.F.
        • Rawsthorne P.
        • et al.
        The prevalence of extraintestinal diseases in inflammatory bowel disease: a population-based study.
        Am J Gastroenterol. 2001; 96: 1116-1122
        • Mendoza J.L.
        • Lana R.
        • Taxonera C.
        • et al.
        [Extraintestinal manifestations in inflammatory bowel disease: differences between Crohn's disease and ulcerative colitis].
        Med Clin (Barc). 2005; 125: 297-300
        • Ricart E.
        • Panaccione R.
        • Loftus Jr., E.V.
        • et al.
        Autoimmune disorders and extraintestinal manifestations in first-degree familial and sporadic inflammatory bowel disease: a case-control study.
        Inflamm Bowel Dis. 2004; 10: 207-214
        • Yang B.R.
        • Choi N.K.
        • Kim M.S.
        • et al.
        Prevalence of extraintestinal manifestations in Korean inflammatory bowel disease patients.
        PLoS ONE. 2018; 13e0200363
        • Ye L.
        • Cao Q.
        • Cheng J
        Review of inflammatory bowel disease in China.
        ScientificWorldJournal. 2013; 2013296470
        • Garber A.
        • Regueiro M.
        Extraintestinal Manifestations of Inflammatory Bowel Disease: epidemiology, Etiopathogenesis, and Management.
        Curr Gastroenterol Rep. 2019; 21: 31
        • Lennard-Jones J.E.
        Classification of inflammatory bowel disease.
        Scand J Gastroenterol Suppl. 1989; 170 (discussion 16-9): 2-6
        • Vavricka S.R.
        • Schoepfer A.
        • Scharl M.
        • et al.
        Extraintestinal Manifestations of Inflammatory Bowel Disease.
        Inflamm Bowel Dis. 2015; 21: 1982-1992
        • Orchard T.
        Extraintestinal complications of inflammatory bowel disease.
        Curr Gastroenterol Rep. 2003; 5: 512-517
        • Lakatos L.
        • Pandur T.
        • David G.
        • et al.
        Association of extraintestinal manifestations of inflammatory bowel disease in a province of western Hungary with disease phenotype: results of a 25-year follow-up study.
        World J Gastroenterol. 2003; 9: 2300-2307
        • Su C.G.
        • Judge T.A.
        • Lichtenstein G.R
        Extraintestinal manifestations of inflammatory bowel disease.
        Gastroenterol Clin North Am. 2002; 31: 307-327
        • Wang Y.F.
        • Ouyang Q.
        • Hu R.W
        Progression of inflammatory bowel disease in China.
        J Dig Dis. 2010; 11: 76-82
        • Wang Y.F.
        • Zhang H.
        • Ouyang Q
        Clinical manifestations of inflammatory bowel disease: east and West differences.
        J Dig Dis. 2007; 8: 121-127
        • Ng S.C.
        • Tang W.
        • Ching J.Y.
        • et al.
        Incidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn's and colitis epidemiology study.
        Gastroenterology. 2013; 145 (:158–65.e2)
        • Prideaux L.
        • Kamm M.A.
        • De Cruz P.P.
        • et al.
        Inflammatory bowel disease in Asia: a systematic review.
        J Gastroenterol Hepatol. 2012; 27: 1266-1280
        • Ng S.C.
        Epidemiology of inflammatory bowel disease: focus on Asia.
        Best Pract Res Clin Gastroenterol. 2014; 28: 363-372
        • Vavricka S.R.
        • Rogler G.
        • Gantenbein C.
        • et al.
        Chronological Order of Appearance of Extraintestinal Manifestations Relative to the Time of IBD Diagnosis in the Swiss Inflammatory Bowel Disease Cohort.
        Inflamm Bowel Dis. 2015; 21: 1794-1800
        • Karmiris K.
        • Avgerinos A.
        • Tavernaraki A.
        • et al.
        Prevalence and Characteristics of Extra-intestinal Manifestations in a Large Cohort of Greek Patients with Inflammatory Bowel Disease.
        J Crohns Colitis. 2016; 10: 429-436
        • Felice C.
        • Leccese P.
        • Scudeller L.
        • et al.
        Red flags for appropriate referral to the gastroenterologist and the rheumatologist of patients with inflammatory bowel disease and spondyloarthritis.
        Clin Exp Immunol. 2019; 196: 123-138
        • Vavricka S.R.
        • Brun L.
        • Ballabeni P.
        • et al.
        Frequency and risk factors for extraintestinal manifestations in the Swiss inflammatory bowel disease cohort.
        Am J Gastroenterol. 2011; 106: 110-119
        • Veloso F.T.
        • Carvalho J.
        • Magro F
        Immune-related systemic manifestations of inflammatory bowel disease. A prospective study of 792 patients.
        J Clin Gastroenterol. 1996; 23: 29-34
        • Bandyopadhyay D.
        • Bandyopadhyay S.
        • Ghosh P.
        • et al.
        Extraintestinal manifestations in inflammatory bowel disease: prevalence and predictors in Indian patients.
        Indian J Gastroenterol. 2015; 34: 387-394
        • Manguso F.
        • Sanges M.
        • Staiano T.
        • et al.
        Cigarette smoking and appendectomy are risk factors for extraintestinal manifestations in ulcerative colitis.
        Am J Gastroenterol. 2004; 99: 327-334
        • Rankin G.B.
        Extraintestinal and systemic manifestations of inflammatory bowel disease.
        Med Clin North Am. 1990; 74: 39-50
        • Olivieri I.
        • Cantini F.
        • Castiglione F.
        • et al.
        Italian Expert Panel on the management of patients with coexisting spondyloarthritis and inflammatory bowel disease.
        Autoimmun Rev. 2014; 13: 822-830
        • Armuzzi A.
        • Felice C.
        • Lubrano E.
        • et al.
        Multidisciplinary management of patients with coexisting inflammatory bowel disease and spondyloarthritis: a Delphi consensus among Italian experts.
        Dig Liver Dis. 2017; 49: 1298-1305
        • Park Y.E.
        • Cheon J.H.
        • Park J.J.
        • et al.
        Risk factors and clinical courses of concomitant primary sclerosing cholangitis and ulcerative colitis: a Korean multicenter study.
        Int J Colorectal Dis. 2018; 33: 1497-1500
        • Weng M.T.
        • Park S.H.
        • Matsuoka K.
        • et al.
        Incidence and Risk Factor Analysis of Thromboembolic Events in East Asian Patients With Inflammatory Bowel Disease, a Multinational Collaborative Study.
        Inflamm Bowel Dis. 2018; 24: 1791-1800
        • Ling K.L.
        • Ooi C.J.
        • Luman W.
        • et al.
        Clinical characteristics of ulcerative colitis in Singapore, a multiracial city-state.
        J Clin Gastroenterol. 2002; 35: 144-148