Frequency and risk factors for extraintestinal manifestations in the Swiss inflammatory bowel disease cohort.
OBJECTIVE
Data on the frequency of extraintestinal manifestations (EIMs) in Crohn's disease (CD) and ulcerative colitis (UC) and analyses of their risk factors are scarce. We evaluated their prevalence and risk factors in a large nationwide cohort of inflammatory bowel disease (IBD) patients.


METHODS
IBD patients from an adult clinical cohort in Switzerland (Swiss IBD cohort study) were prospectively included. Data from validated physician enrolment questionnaires were analyzed.


RESULTS
A total of 950 patients were included, 580 (61%) with CD (mean age 41 years) and 370 (39%) with UC (mean age 42 years). Of these, 249 (43%) of CD and 113 (31%) of UC patients had one to five EIMs. The following EIMs were found: arthritis (CD 33%, UC 21%), aphthous stomatitis (CD 10%, UC 4%), uveitis (CD 6%, UC 4%), erythema nodosum (CD 6%, UC 3%), ankylosing spondylitis (CD 6%, UC 2%), psoriasis (CD 2%, UC 1%), pyoderma gangrenosum (CD and UC each 2%), and primary sclerosing cholangitis (CD 1%, UC 4%). Multiple logistic regression identified the following risk factors for ongoing EIM in CD: active disease (odds ratio (OR)=1.95, 95% confidence interval (CI)=1.17-3.23, P=0.01), and positive IBD family history (OR=1.77, 95% CI=1.07-2.92, P=0.025). No risk factors were identified in UC patients.


CONCLUSIONS
EIMs are a frequent problem in CD and UC patients. Active disease and positive IBD family history are associated with ongoing EIM in CD patients. Identification of EIM prevalence and associated risk factors may result in increased awareness for this problem and thereby facilitating their diagnosis and therapeutic management.
Vavricka
Stephan R
SR
Division of Gastroenterology, Department of Internal Medicine, University Hospital, Zurich, Switzerland. stephan.vavricka@usz.ch
Brun
Lionel
L
Ballabeni
Pierluigi
P
Pittet
Valérie
V
Prinz Vavricka
Bettina Mareike
BM
Zeitz
Jonas
J
Rogler
Gerhard
G
Schoepfer
Alain M
AM
D000328:Adult; D017677:Age Distribution; D017668:Age of Onset; D001168:Arthritis / Q000175:diagnosis / Q000453:epidemiology; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000453:epidemiology*; D016001:Confidence Intervals; D003424:Crohn Disease / Q000175:diagnosis* / Q000453:epidemiology*; D004893:Erythema Nodosum / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000453:epidemiology; D008107:Liver Diseases / Q000175:diagnosis / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D011565:Psoriasis / Q000175:diagnosis / Q000453:epidemiology; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013167:Spondylitis, Ankylosing / Q000175:diagnosis / Q000453:epidemiology; D013557:Switzerland / Q000453:epidemiology; D014605:Uveitis / Q000175:diagnosis / Q000453:epidemiology