P603. Prevalence and characteristics of extra-intestinal manifestations in a Greek population of inflammatory bowel disease patients followed-up in tertiary centers
Extra-intestinal manifestation (EIM) diagnosis in inflammatory bowel disease (IBD) patients is often challenging. EIMs' natural history is not adequately elucidated. The aim of the present study was to investigate the prevalence and characteristics of EIMs in a population of IBD patients followed-up in tertiary centers.
Data from 1274 IBD patients (females: 43.6%, Crohn's disease: 52.9%, median [IQR] age at IBD diagnosis: 33.1 [22.9–48.5] and IBD duration until 1st EIM diagnosis: 2.7 [0.3–8.1] years) have been retrospectively retrieved from medical records and registered according to a pre-defined protocol. Prevalence of EIMs as well as the impact of certain demographic and IBD characteristics were studied.
Four hundred fourteen patients exhibited at least one EIM (32.5%, median [IQR] age at 1st EIM diagnosis: 35.0 [23.5–48.0] years, mean number of different EIMs/patient 1.61±0.04). In particular, 313/406 (77.1%) developed at least one arthritic EIM (peripheral arthritis: 164/312 [52.6%], ankylosing spondylitis: 23/312 [7.4%], sacroileitis: 63/312 [20.2%]), 160/408 (39.2%) at least one dermatologic EIM (erythema nodosum: 71/160 [44.4%], pyoderma gangrenosum: 9/160 [5.6%], psoriasis: 36/160 [22.5%], Sweet's syndrome: 2/160 [1.3%], hydradenitis suppurativa: 3/160 [1.9%], aphthous stomatitis: 54/160 [33.8%]), 40/408 (9.8%) at least one ophthalmologic EIM (episcleritis: 8/40 [20%], scleritis: 1/40 [2.5%], anterior uveitis: 27/40 [67.5%], posterior uveitis: 5/40 [12.5%]), 4/408 (1%) PSC, 8/408 (2%) deep vein thrombosis, 20/408 (4.9%) at least one pneumonological EIM (pulmonary embolism: 3/20 [15%] and in non smokers asthma: 14/20 [70%] and bronchiectasis/chronic bronchitis: 3/20 [15%]) and 22/409 (5.4%) an EIM which was characterized as rare by the treating physician. One hundred thirteen out of 405 patients (27.9%) developed an EIM before IBD diagnosis (Crohn's disease: 82.3%, p < 0.0001) and in 124/214 (57.9%) EIM was associated with active IBD. Patients with a prior EIM diagnosis had their IBD diagnosed in an older age (median [IQR] age: 39.9 [27.6–51.9] vs 28.7 [20.9–42.4] years, p < 0.0001). EIMs were more frequent in females (58.2%, p < 0.0001), in Crohn's disease (67.9%, p < 0.0001), in non-smokers (63.8%, p = 0.001) and in patients with a history of a major IBD surgery (p = 0.017), appendectomy (p < 0.0001) and/or tonsilectomy (p < 0.0001).
About one third of IBD patients in our population developed at least one EIM. Of those, more than one fourth had their EIM diagnosed before IBD. EIMs were present more frequently in females, Crohn's disease patients, non-smokers and surgeries related either directly or indirectly with IBD.