title: Association of extraintestinal manifestations and anaemia with disease outcomes in patients with inflammatory bowel disease.
abstract: OBJECTIVE
  The association between extraintestinal manifestations (EIMs) and disease activity suggest a common pathogenetic link with inflammatory bowel disease (IBD). We report on the association of EIMs and anaemia with long-term disease outcomes, including treatment steps, hospitalization, and surgery in the prospective population-based IBD inception cohort from Veszprem province.
  
  
  METHODS
  Data of 678 incident IBD patients (Crohn's disease/ulcerative colitis(CD/UC): 331/347) diagnosed from 1st January 2000 to 31st December 2012 were analyzed (CD: m/f: 176/155, median age at diagnosis: 28, IQR: 21-40 years, disease duration: 6, IQR: 2-9 years; UC: m/f: 200/147, median age at diagnosis: 36, IQR: 26-50 years, duration: 7, IQR: 4-10 years).
  
  
  RESULTS
  EIMs were present in 30% of the CD and 17.3% of the UC patients. In CD, female gender (p = 0.02) need for steroid (p  < 0.001) and azathioprine (AZA) (p = 0.02), while in UC, young age at onset (p = 0.03), extensive disease (p = 0.003), female gender (p = 0.07), need for steroids (p < 0.001) and AZA (p = 0.004) and need for IBD-related hospitalization (p = 0.01) were associated with the presence of EIMs. Anaemia was present in 56.7% of the CD and 30.2% of the UC patients. In both CD and UC anaemia was associated with age at onset (pCD = 0.001, pUC = 0.04), disease location/extent (pCD = 0.02, pUC < 0.001), steroid and AZA use (for both pCD,UC < 0.001), need for surgery/colectomy (pCD < 0.001, pUC = 0.002) and hospitalization (pCD = 0.004, pUC < 0.001) and in CD, it was associated with anti TNF therapy(p = 0.002).
  
  
  CONCLUSIONS
  The presence of EIMs was associated with disease phenotype in UC and with treatment strategy in both CD and UC. Additionally, anaemia was associated with hospitalization and surgery in both CD and UC, suggesting that EIMs and anaemia may be helpful in stratifying disease severity in IBD.
authors.affiliation: a 1st Department of Medicine , Semmelweis University , Budapest , Hungary ;|b Department of Medicine , Csolnoky Ferenc Province Hospital , Veszprem , Hungary ;
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Vegh
authors.affiliation: a 1st Department of Medicine , Semmelweis University , Budapest , Hungary ;
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Kurti
authors.affiliation: a 1st Department of Medicine , Semmelweis University , Budapest , Hungary ;
authors.forename: Lorant
authors.initials: L
authors.lastname: Gonczi
authors.affiliation: a 1st Department of Medicine , Semmelweis University , Budapest , Hungary ;
authors.forename: Petra Anna
authors.initials: PA
authors.lastname: Golovics
authors.affiliation: a 1st Department of Medicine , Semmelweis University , Budapest , Hungary ;
authors.forename: Barbara Dorottya
authors.initials: BD
authors.lastname: Lovasz
authors.affiliation: b Department of Medicine , Csolnoky Ferenc Province Hospital , Veszprem , Hungary ;
authors.forename: Istvan
authors.initials: I
authors.lastname: Szita
authors.affiliation: c Department of Medicine , Grof Eszterhazy Hospital , Papa , Hungary ;
authors.forename: Mihaly
authors.initials: M
authors.lastname: Balogh
authors.affiliation: b Department of Medicine , Csolnoky Ferenc Province Hospital , Veszprem , Hungary ;
authors.forename: Tunde
authors.initials: T
authors.lastname: Pandur
authors.affiliation: d Department of Medicine, Division of Gastroenterology and Hepatology , University Hospital Zurich , Zurich , Switzerland.
authors.forename: Stephan R
authors.initials: SR
authors.lastname: Vavricka
authors.affiliation: d Department of Medicine, Division of Gastroenterology and Hepatology , University Hospital Zurich , Zurich , Switzerland.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Rogler
authors.affiliation: b Department of Medicine , Csolnoky Ferenc Province Hospital , Veszprem , Hungary ;
authors.forename: Laszlo
authors.initials: L
authors.lastname: Lakatos
authors.affiliation: a 1st Department of Medicine , Semmelweis University , Budapest , Hungary ;
authors.forename: Peter Laszlo
authors.initials: PL
authors.lastname: Lakatos
mesh_terms: D000328:Adult; D000740:Anemia / Q000150:complications; D001379:Azathioprine / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000150:complications; D003424:Crohn Disease / Q000150:complications; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013256:Steroids / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D013256:Steroids; D001379:Azathioprine
keywords: Anaemia; disease outcome; extraintestinal manifestations; inflammatory bowel disease