M Crohn und Colitis ulcerosa extraintestinal manifestations

My dear patients !

In this article you will read about both of the inflammatory bowel disease, Crohn´s disease and ulcerative colitis. Because the main facts for the extraintestinal manifestations (EIM) are valid for both.

When I ask my patients –  absolutely out of the blue as it seems:

“do you actually have pain in your joints or in your back ?”

Or “did you recognize any skin alterations ?”

Or sometimes “do you have problems with you eyes?”

Or “have you ever had abnormalities in liver function tests ?”

… they look at me …let`s say: at least surprised.

And I can literaly see the thoughts: …?! What`s going on? This appointment is about my ulcerative colitis, right ? My Crohn`s disease. Why on earth is she asking about my eyes ?!

The organs, which can be affected by inflammatory bowel disease have at the first glance nothing to do with the intestine. Neither at second or third glance.

Ok, liver and bile ducts are at least located in the belly. Blood from the intestine goes through the liver, it is an important digestive organ. One might imagine that.

But joints, skin, eyes –  sound`s a bit strange, doesn´t it ?

M Crohn und Colitis ulcerosa Extraintestinale Manifestation

What are Extraintestinal manifestations (EIM)

Let me tell you about the terms here, once again in order that you have heard them and recognize them. We are talking about “extraintestinal manifestations” (EIM). Wich means acivity or appearance of the inflammatory bowel disease outside the intestine.

Joints and bones, liver  or more precisely the bile ducts, skin and eyes are the organs which can also be affected by ulcerative colitis or Crohn`s disease.

Hit ratio is felt …35-45%. Meaning 35-45% of the patients in my consultation hour answer the questions about physical complaints as mentioned above positive.

Felt ?! Wasn`t there something about the approach of good and relevant information on this I.M. INFORMATION MATTERS ? – you might think.

Ok, specific and precise according to literature up to 50% of the patients with Crohn`s disease or ulcerative colitis have extraintestinal manifestations, meaning accompanying illnesses besides inflammation in the intestine. There are quite some differences regarding the frequency of the different manifestations though. Some show a high frequency up to 50%, others are rare – maximum 5%.

And so up to 50% of the patient  have arthritis, up to 30% show alterations of the skin and maximum 7 % have bile duct affection (which turns out to be a liver disaese in the end, I will write about that specifically).

And yes : quite a few patients have more than one IEM (extraintestinal manifestation).

So for most patients it`s arthritis or a pain in the back and that is what I want to focus on the next article. And I will focus on the other EIMs in extra Blog articles as well.

But before I want to write about the big question which is concerning all of you: how on earth does intestinal disease affect other organs like the eyes, which have literaly nothing to do with the intestine ?

What does that mean?

Let me give you just a rough summary, it is as complex as it is interesting. I want to mention it since I do believe that it helps you with the understanding of the disease. And it shows once more: you recognize the intestine, but inflammatory bowel disease is taking place on the level of immune system and immune response.

As the extraintestinal manifestation (EIM) occur, cells of the immune system, which where supposed to create inflammation in the intestine “get lost” in different parts of the body, but still start to cause inflammation since that`s what they are supposed to do. And another mechanisms is that very small molecules from the intestine are entering the circulation and lead to inflammation since the body recognizes it as antigens.

This tendency to develop inflammation in different organs than the intestine in case of IBD inflammatory bowel disease is genetically driven. Also certain genes which significantly influence the immune system seem to come along with certain extraintestinal manifestations.

And that is why the extraintestinal manifestations of IBD always go with inflammation – the same as Crohn`s disease or ulcerative colitis. Inflammation wich is not caused and driven by external factors but rather by immune response respectively a misdirected immune response in the affected organs.

And one could assume now that activity of the extraintestinal manifestations correlate with activity of inflammation in the intestine. Like lots of inflammation in the intestine – lots of inflammation in the joints, the bile ducts, whatever.

And sometimes it turnes out that way.

But some of the illnesses develop independently from the inflammatory bowel disease they are linked to. They can occur and cause symptoms before inflammatory bowel disease has even started.

Or the other way around: even when you have absolutely no active inflammation in the bowel and ulcerative colitis or Crohn`s disease are in complete remission and even when the affected part of the intestine has been removed like it is the case after colectomy in case of ulcerative colitis, the extraintestinal manifestations can show activity and exacerbate.

That`s it so far for the basics. Which are once again helpfull to understand the mechanisms of the disease. But I really want to write about the different extraintestinal manifestations in a more concrete way. 

Next week I will start with the most common EIM: arthritis. You can find it here

So take care everybody !

Best regards,

Dr. Susanne Weyrauch

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