title: Extraintestinal manifestations of inflammatory bowel disease and intestinal tuberculosis: Frequency and relation with disease phenotype.
abstract: BACKGROUND
  Extraintestinal manifestations (EIMs) in inflammatory bowel disease (IBD) including ulcerative colitis (UC) and Crohn's disease (CD), as well as intestinal tuberculosis (ITB) from Asia, are underreported. We, therefore, describe the prevalence of EIMs in Indian IBD and ITB patients and study their relationship with disease extent and severity in IBD.
  
  
  METHODS
  This retrospective single-center study included all IBD and ITB patients evaluated from January 2005 to July 2012. Disease profile and frequencies of arthropathies (peripheral and central) and ocular (episcleritis, iritis/uveitis), oral (aphthous stomatitis), skin (erythema nodosum, pyoderma gangrenosum, psoriasis), hepatobiliary (primary sclerosing cholangitis), and thromboembolic manifestations were analyzed.
  
  
  RESULTS
  Of 1,652 patients (1146 UC, 303 CD, 203 ITB), frequency of any EIM was 33.2 %, 38.3 %, and 14.3 % in UC, CD, and ITB patients, respectively. Thromboembolism was more common among UC patients with pancolitis than proctitis (p < 0.001) and left-sided colitis (p = 0.02). Primary sclerosing cholangitis was seen in 0.4 % UC patients. Steroid-dependent UC patients had higher frequency of any EIM, peripheral arthropathy, or thromboembolism than patients with no or infrequent steroid requirement (p < 0.05). Peripheral arthropathy (p = 0.02), erythema nodosum (p = 0.01), and aphthous stomatitis (p = 0.004) were more common with CD than with UC patients. Patients with colonic CD had higher frequency of peripheral arthropathy, any EIM, and multiple EIMs than ileal or ileocolonic disease (p < 0.05). Relative to ITB, CD patients had higher frequencies of peripheral arthropathy (p < 0.001), aphthous stomatitis (p = 0.01), any EIM (p < 0.001), and multiple EIMs (p < 0.001).
  
  
  CONCLUSIONS
  In Indian IBD and ITB patients, EIMs appear to be related to disease severity in UC and disease location in CD and are significantly more common in CD than in ITB. Overall prevalence of EIMs in these patients is similar to that of the West.
authors: Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India.
authors: Bikramjit
authors: B
authors: Singh
authors: Saurabh
authors: S
authors: Kedia
authors: Gauree
authors: G
authors: Konijeti
authors: Venigalla Pratap
authors: VP
authors: Mouli
authors: Rajan
authors: R
authors: Dhingra
authors: Lalit
authors: L
authors: Kurrey
authors: Saurabh
authors: S
authors: Srivastava
authors: Rajesh
authors: R
authors: Pradhan
authors: Govind
authors: G
authors: Makharia
authors: Vineet
authors: V
authors: Ahuja
mesh_terms: D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D003424:Crohn Disease / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D007194:India / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014385:Tuberculosis, Gastrointestinal / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology