title: Smoking increases the risk of extraintestinal manifestations in Crohn's disease.
abstract: OBJECTIVE
  To demonstrate a high prevalence of extraintestinal manifestations (EIMs) in a prospective population-based cohort of inflammatory bowel disease (IBD) patients at first diagnosis as well as during the early course of the disease.
  
  
  METHODS
  EIMs are common in patients with IBD. Data on the frequency of EIMs have mostly been assessed in patients from tertiary centers; however, data about the prevalence of EIMs at first diagnosis as well as factors influencing their incidence during the early course of disease from prospective population-based cohorts are scarce. We present data of patients of our population-based "Oberpfalz cohort" (Bavaria, Germany) from first diagnosis (up to 3 mo after first diagnosis) as well as during the early course of the disease. Possible risk factors were assessed by calculating the relative risk (RR) as well as using logistic regression analysis.
  
  
  RESULTS
  In total, data of 257 newly diagnosed patients with IBD were evaluated [161 Crohn's disease (CD), 96 ulcerative colitis (UC)]. Median duration of follow-up was 50 mo after first diagnosis. In 63.4% of all patients (n = 163), an EIM was diagnosed at any point during the observation period. At first diagnosis, patients with CD had a significantly increased risk of an EIM [n = 69 (42.9%)] compared with UC patients [n = 21 (21.9%); P < 0.001; RR = 1.96; 95%CI: 1.30-2.98]. Active smoking increased the risk of CD patients developing an EIM during the early course of the disease, but notably not of UC patients (P = 0.046; RR = 1.96; 95%CI: 1.01-3.79). In addition, using logistic regression analysis, the need for IBD-related surgery and a young age at first diagnosis were identified as risk factors for the development of an EIM in CD patients. No association with EIMs was found for the factors sex, localization of the disease and positive family history of IBD. In contrast, no key factors which increased the risk of development of an EIM could be identified in UC patients.
  
  
  CONCLUSIONS
  We found a high prevalence of EIM in this cohort at first diagnosis and during the early course of the disease. In patients with CD, smoking, need for surgery and younger age at first diagnosis were risk factors for the development of an EIM.
authors.affiliation: Claudia Ott, Angela Takses, Florian Obermeier, Elisabeth Schnoy, Martina Müller, Department of Internal Medicine I, University of Regensburg, 93042 Regensburg, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Ott
authors.affiliation: Claudia Ott, Angela Takses, Florian Obermeier, Elisabeth Schnoy, Martina Müller, Department of Internal Medicine I, University of Regensburg, 93042 Regensburg, Germany.
authors.forename: Angela
authors.initials: A
authors.lastname: Takses
authors.affiliation: Claudia Ott, Angela Takses, Florian Obermeier, Elisabeth Schnoy, Martina Müller, Department of Internal Medicine I, University of Regensburg, 93042 Regensburg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Obermeier
authors.affiliation: Claudia Ott, Angela Takses, Florian Obermeier, Elisabeth Schnoy, Martina Müller, Department of Internal Medicine I, University of Regensburg, 93042 Regensburg, Germany.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Schnoy
authors.affiliation: Claudia Ott, Angela Takses, Florian Obermeier, Elisabeth Schnoy, Martina Müller, Department of Internal Medicine I, University of Regensburg, 93042 Regensburg, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Müller
mesh_terms: D000328:Adult; D000367:Age Factors; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000453:epidemiology; D003424:Crohn Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D018450:Disease Progression; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology*; D013997:Time Factors
keywords: Age at onset; Crohn’s disease; Extraintestinal manifestations; Smoking; Surgery; Ulcerative colitis