P209 Extraintestinal manifestations are a prognostic factor in patients with inflammatory bowel disease
P. Sousa*, D. Martins, J. Pinho, R. Araújo, E. Cancela, A. Castanheira, P. Ministro, A. Silva
Centro Hospitalar Tondela-Viseu, Gastroenterology, Viseu, Portugal
Extraintestinal manifestations (EIM) are a common feature in inflammatory bowel disease (IBD) and may occur before or after IBD diagnosis. The aim of this study was to evaluate the frequency, type and chronology of EIM in ulcerative colitis (UC) and Cohn’s disease, predictive factors of occurrence of EIM and clinical course of IBD in patients with EIM.
IBD patients with a definitive diagnosis of CD or UC followed in our institution were included. Patients with suspected EIM still waiting a definitive diagnosis were excluded. Demographic data, type and chronology of EIM, influence of EIM on change of treatment, and clinical course of IBD, as evaluated by need of surgery, corticosteroids, and immunosuppressants, were collected.
In total, 463 patients with IBD were analysed: 246 with UC and 217 with CD, with a mean age of 46 years and a mean follow-up of 8.8 years. Further, 138 EIM were identified in 109 patients (24% of the total population), with a mean of 1.3 EIM per patient. Moreover, 74 patients (68%) had arthropathy, 24 (22%) had aphtous stomatitis, 24 (22%) had cutaneous manifestations (erythema nodosum and pyoderma gangrenosum), 11 (10%) had hepatobiliary manifestations (such as autoimmune hepatitis and primary sclerosing cholangitis), 2 (2%) had ophthalmological manifestations, and 3 (3%) cardiopulmonary manifestations. In 73% of the cases, the EIM was diagnosed after the IBD; in 11% of the cases before and in 16%, there was a concomitant diagnosis of IBD and EIM. CD diagnosis (p = 0.017), female gender (p < 0.001), and positive anti-Saccharomyces cerevisiae antibody (ASCA) serology (p = 0.015) were associated with the development of EIM. Patients with EIM were more likely to have had received corticosteroids (p < 0.001), to be corticoresresistant or corticodependent (p = 0.005), and to be immunosuppressed with immunomodulators and/or anti-tumour necrosis factor (TNF) agents (p < 0.001). In 28% of the cases, there was a need to step-up the treatment because of the EIM itself. The EIM was also responsible for the need of corticosteroids in 54% of cases and the need of hospitalisation in 15% of cases. There was no mortality associated with EIM.
In this population, articular manifestations were the most common EIM. The majority of EIM was diagnosed after the underlying IBD, but all physicians should be aware of the possibility of these manifestations being the presenting feature of IBD. We identified a sub-group of patients associated with a higher prevalence of EIM, namely female patients with CD and positive anti-Saccharomyces cerevisiae antibody (ASCA) serology. IBD patients with EIM were more frequently corticoresistant/dependent and had a greater need of immunosuppressants and corticosteroids, which suggests EIM as a prognostic factor in IBD.