Ocular Affection as an Extraintestinal Manifestation in Cases of Inflammatory Bowel Disease at the Kafrelsheikh Governorate

Abstract Introduction The manifestations of inflammatory bowel disease (IBD) are not restricted to the gastrointestinal tract. Musculoskeletal conditions are considered the most common extraintestinal manifestations, followed by mucocutaneous and ocular diseases. Many general practitioners are unaware of the variety and severity of the ocular affection in IBD patients. Objective To assess the prevalence of extraintestinal manifestations in IBD patients at Kafrelsheikh governorate, and to evaluate the different ocular manifestations and their relationship to the severity of the disease. Methods A cross-sectional study evaluating 120 patients treated at the Kafrelsheikh University Hospital. The diagnosis of IBD was made between December 2018 and December 2019 through clinical, endoscopic and histopathological examinations. All patients were assessed for any extraintestinal manifestation or evidence of ocular affection through slit-lamp examinations, tonometry, visual acuity, and indirect ophthalmoscopy. Results The mean age of the sample was 35.5 ± 13.3 years. In total, 52 (43.3%) patients were male and 68 (56.7%) were female. Ocular manifestations represent ∼ 22.5% of extraintestinal manifestations. The most common ocular findings were conjunctivitis (25.8%) and anterior uveitis (10.8%), followed by scleritis (9.2%) and cataract (8.3%). Other extraintestinal manifestations were observed in 41 (34.1%) 29 (29.9%) of ulcerative colitis cases, and 12 (52%) of Crohn disease cases. There was no statistically significant difference in the presence of ocular involvement in relation to the two types of IBD included in the Montreal classification. Conclusion Ocular manifestations in cases of IBD are common and usually nonspecific in presentation. The severity of the IBD does not reflect the severity of the ocular affection.

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The burden and management of anemia in Greek patients with inflammatory bowel disease: a retrospective, multicenter, observational study

BMC Gastroenterology ◽

10.1186/s12876-021-01826-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kalliopi Foteinogiannopoulou ◽

Konstantinos Karmiris ◽

Georgios Axiaris ◽

Magdalini Velegraki ◽

Antonios Gklavas ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Clinical Laboratory ◽

Real Life ◽

Extraintestinal Manifestations ◽

Extraintestinal Manifestation ◽

Multicenter Observational Study ◽

Treatment Data ◽

Inflammatory Bowel ◽

Anemia Treatment

Abstract Background Anemia is a common extraintestinal manifestation of Inflammatory Bowel Disease (IBD) affecting negatively the patients’ quality of life. The aim of this study was to determine the frequency and real-life management of anemia in IBD patients in Greece. Methods This study was conducted in 17 Greek IBD referral centers. Demographic, clinical, laboratory, IBD and anemia treatment data were collected and analyzed retrospectively. Results A total of 1394 IBD patients [560 ulcerative colitis (UC), 834 Crohn’s disease (CD)] were enrolled. Anemia at any time was reported in 687 (49.3%) patients of whom 413 (29.6%) had episodic and 274 (19.7%) had recurrent/persistent anemia. Anemia was diagnosed before IBD in 45 (6.5%), along with IBD in 269 (39.2%) and after IBD in 373 (54.3%) patients. In the multivariate analysis the presence of extraintestinal manifestations (p = 0.0008), IBD duration (p = 0.026), IBD related surgeries and hospitalizations (p = 0.026 and p = 0.004 accordingly) were risk factors of recurrent/persistent anemia. Serum ferritin was measured in 839 (60.2%) IBD patients. Among anemic patients, 535 (77.9%) received treatment. Iron supplementation was administered in 485 (90.6%) patients, oral in 142 (29.3%) and intravenous in 393 (81%). Conclusions The frequency of anemia in IBD patients, followed at Greek referral centers, is approximately 50%. Development of recurrent/persistent anemia may be observed in 20% of cases and is independently associated with the presence of extraintestinal manifestations, IBD duration, IBD related surgeries and hospitalizations. Anemia treatment is administered in up to $$4/5$$ 4 / 5 of anemia IBD patients with the majority of them receiving iron intravenously.

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Two Cases of Pericarditis Associated with Inflammatory Bowel Disease

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2018.28 ◽

2005 ◽

Vol 48 (1) ◽

pp. 43-44 ◽

Cited By ~ 2

Author(s):

Bilge Tunc ◽

Levent Filik ◽

Aysel Ulker ◽

Erkan Parlak

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Cardiac Disease ◽

Bowel Disease ◽

The Other ◽

Intestinal Disease ◽

Extraintestinal Manifestations ◽

Extraintestinal Manifestation ◽

Inflammatory Bowel ◽

Cardiac Manifestations

Extraintestinal manifestations are common complications of inflammatory bowel disease (IBD) whereas the association of cardiac disease with IBD is rarely reported. Cardiac manifestations may be diagnosed before, concomitantly or after the diagnosis of the specific type of inflammatory bowel disease. Pericarditis and myocarditis are potentially serious complications. This extraintestinal manifestation developed in one patient concomitantly with onset of intestinal disease. One patient had ulcerative colitis (UC), while other had Crohn’s disease (CD). Indomethacin was effective in one and the other patient required prednisone in addition. Chest symptoms in patients with inflammatory bowel disease should be evaluated to exclude myopericardial disease.

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1433 Are Ocular Manifestations Predictive Of Ocular Inflammation In Inflammatory Bowel Disease? A Large Cross-sectional Survey

SciVee ◽

10.4016/40429.01 ◽

2012 ◽

Author(s):

Veronique Cloché

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Ocular Inflammation ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Ocular Manifestations ◽

Inflammatory Bowel

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Risk of Vaccine-Preventable Infections in Swiss Adults with Inflammatory Bowel Disease

Digestion ◽

10.1159/000516111 ◽

2021 ◽

pp. 1-9

Author(s):

Laure F. Pittet ◽

Charlotte M. Verolet ◽

Pierre Michetti ◽

Elsa Gaillard ◽

Marc Girardin ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Bowel Disease ◽

Immunosuppressive Treatment ◽

Cross Sectional Study ◽

Cross Sectional ◽

Varicella Zoster ◽

Significant Difference ◽

Inflammatory Bowel

Background: Patients with inflammatory bowel disease (IBD) have a higher risk of infection and are frequently not up to date with their immunizations. Objectives: This study aims to review vaccination status and evaluate whether age, disease type, or treatment regimen could predict the absence of seroprotection against selected vaccine-preventable infection in adults with IBD. Methods: Cross-sectional study using questionnaire, immunization records review, and assessment of tetanus-specific, varicella-specific, and measles-specific immunoglobulin G concentrations. ClinicalTrials.gov: NCT01908283. Results: Among the 306 adults assessed (median age 42.7 years old, 70% with Crohn’s disease, 78% receiving immunosuppressive treatment), only 33% had an immunization record available. Absence of seroprotection against tetanus (6%) was associated with increasing age and absence of booster dose; absence of seroprotection against varicella (1%) or measles (3%) was exclusively observed in younger patients with Crohn’s disease. There was no statistically significant difference in immunoglobulin concentrations among treatment groups. Although vaccinations are strongly recommended in IBD patients, the frequencies of participants with at least 1 dose of vaccine recorded were low for nearly all antigens: tetanus 94%, diphtheria 87%, pertussis 54%, poliovirus 22%, measles-mumps-rubella 47%, varicella-zoster 0%, Streptococcus pneumoniae 5%, Neisseria meningitidis 12%, hepatitis A 41%, hepatitis B 48%, human papillomavirus 5%, and tick-borne encephalitis 6%. Conclusions: Although many guidelines recommend the vaccination of IBD patients, disease prevention through immunization is still often overlooked, including in Switzerland, increasing their risk of vaccine-preventable diseases. Serological testing should be standardized to monitor patients’ protection during follow-up as immunity may wane faster in this population.

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P203 Sexual Dysfunction in Chronic Inflammatory Bowel Disease: Myth or Reality?

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjab076.329 ◽

2021 ◽

Vol 15 (Supplement_1) ◽

pp. S266-S266

Author(s):

A Hassine ◽

A Hammami ◽

W Ben Ameur ◽

W Dahmani ◽

N Elleuch ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Sexual Dysfunction ◽

Disease Activity ◽

Bowel Disease ◽

Severe Disease ◽

Chronic Inflammatory Bowel Disease ◽

Cross Sectional ◽

Significant Difference ◽

Inflammatory Bowel ◽

Chronic Inflammatory Bowel

Abstract Background Sexual dysfunction is often associated with impaired body image and quality of life in patients. However, little data exists on sexual dysfunction (SD) in patients with Chronic Inflammatory Bowel Disease (IBD). The aim of this study was to assess the prevalence and risk factors for sexual dysfunction in patients with IBD. Methods This is a cross-sectional study of all patients followed for IBD. Sexual function was assessed by the Female Sexual Index Function (FSIF) for women and the International Index of Erectile Function (IIEF) for men. Sexual dysfunction was confirmed when the total FSIF score was less than 26, or the IIEF score less than 26. Crohn’s disease (CD) activity was assessed by the Harvey-Bradshaw index (HBI), and that of ulcerative colitis (UC), by the clinical Mayo scores. Results We collected 100 patients, with a mean age of 42.18 ± 15.71 and a sex ratio (M / F) = 1.5. Sixty eight patients had CD and 32 patients had UC. Ano-perineal manifestations were present in 38.2% of cases. Severe disease activity was noted in 14 patients (20.6%) with CD and 10 patients (31.3%) with UC. Twelve patients had proctitis. 38% of patients had surgical treatment: 18.75% for patients with UC and 47.05% for those with CD. Total colectomy was performed in 12% of cases. At the time of the study, 20% of patients were on systemic corticosteroid therapy, 22% on Azathioprine, 4% on Salazopyrine, 8% on 5-ASA and 46% on Anti-TNFα. Sexual dysfunction was reported by 42.9% of women: 57.14% (UC) vs 38.46% (CD) (p = 0.042). On the other hand, sexual dysfunction was reported by 27.6% of men: 22.2% of men with UC and 28.57% with CD, with no statistically significant difference (p = 0.78). A significant association was found between sexual dysfunction and the degree of disease activity (p <0.001 for CD, p = 0.003 for UC), as well as pancolitic involvement in women with UC (p = 0.002). However, the presence of anoperineal manifestations, rectal involvement and history of surgery were not significantly associated with the frequency of sexual disturbances. Conclusion Our study showed a high prevalence of sexual dysfunction in patients with IBD. Training gastroenterologists in the management of sexual dysfunction would make it possible to satisfy patient expectations.

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Serum trough levels of infliximab are not associated with peripheral arthralgia activity in patients with inflammatory bowel disease

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2021-000788 ◽

2021 ◽

Vol 8 (1) ◽

pp. e000788

Author(s):

Shaina Sekhri ◽

Bharat Rao ◽

Akanksha Mohananey ◽

Poonam Beniwal-Patel ◽

Alexandra Bruss ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Therapeutic Drug ◽

Extraintestinal Manifestation ◽

Cross Sectional ◽

Patient Reported ◽

Serum Trough ◽

Inflammatory Bowel ◽

Trough Levels ◽

Serum Trough Levels

BackgroundInfliximab is an efficacious therapy for inflammatory bowel disease and may play a role in management of some extraintestinal manifestations. While higher trough levels of infliximab are associated with higher rates of disease remission, the association between trough levels of infliximab and arthralgia activity characterised as an extraintestinal manifestation has yet to be defined.ObjectiveWe aimed to assess the association between serum trough levels of infliximab and peripheral arthralgia activity in patients with inflammatory bowel disease.DesignIn this cross-sectional study, we identified patients with inflammatory bowel disease on infliximab therapy with known history of arthralgias attributed to an extraintestinal manifestation. Collected variables included disease phenotype, medications (such as thiopurines or methotrexate), Harvey Bradshaw Index, partial Mayo score, C reactive protein, trough levels of infliximab and anti-infliximab antibodies. The primary outcome was active patient-reported arthralgia.ResultsOut of 267 patients included, 65 (24.4%) had active arthralgias at the time the trough level of infliximab was measured. No significant differences in trough levels were seen between those patients with and without arthralgias. Patients on combination therapy with methotrexate or thiopurines or those with detectable anti-infliximab antibodies were not more likely to have inactive arthralgias (OR 0.99, 95% CI 0.57 to 1.74, p=0.99 and OR 1.94, 95% CI 0.9 to 4.1, p=0.09, respectively).ConclusionsThis study suggests that although therapeutic drug monitoring of infliximab can have a role in the management of Crohn’s disease and ulcerative colitis, it does not seem to be useful in managing arthralgias associated with inflammatory bowel disease.

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IMMUNIZATION STATUS OF PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201900000-26 ◽

2019 ◽

Vol 56 (2) ◽

pp. 124-130 ◽

Cited By ~ 2

Author(s):

Karin Lye auf der STRASSE ◽

Carmen Mayanna JAMUR ◽

Janaina MARQUES ◽

Mirian Su Mi KIM ◽

Ricardo Rasmussen PETTERLE ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Hepatitis B ◽

Influenza Vaccine ◽

Bowel Disease ◽

Demographic Data ◽

Biological Agents ◽

University Hospital ◽

Cross Sectional ◽

Immunization Status ◽

Inflammatory Bowel

ABSTRACT BACKGROUND: Treatment for inflammatory bowel disease (IBD) includes a variety of immunosuppressants and biological agents, which increase the risk of infections due to altered cellular and humoral immunity. Prevention of these infections can be done through vaccination, however, patients with IBD are usually under-immunized. OBJECTIVE: Analyze the immunization status of patients with IBD and confront it with the current recommendations to verify if the immunization guidelines are being followed correctly. METHODS: Analytical cross-sectional study including 239 IBD patients being regularly followed in the Gastroenterology Service from Hospital de Clínicas da Universidade Federal do Paraná, which were subjected to a survey about their relevant demographic data and immunization status. RESULTS: The amount of patients that declared being unaware of their immunization status is high - between 34.3% (Tdap) and 52% (meningococcal) - excepting IIV, hepatitis B and HPV. The vaccines with the largest rates of patients declaring to have taken it are inactivated influenza vaccine (72.4%), BCG (55.3%), hepatitis B (48.3%), measles, mumps and rubella vaccine (43.8%) and DTaP (43%). The vaccines with the lowest rates of patients declaring to have taken it are Haemophilus influenza type b (0.8%), herpes zoster (2.1%) and HPV (3.4%). Patients that are being treated or have been treated with biological therapy have the largest immunization coverage for inactivated influenza vaccine (81%) and PPSV23 (25.9%), also they have the largest awareness rates for those vaccines. CONCLUSION: Although being a specialized service linked to a university hospital, vaccination coverage and patients’ awareness rates proved to be below the desirable level. Vaccination and recovery of the immunization history is recommended immediately after the diagnosis of IBD, regardless of the use of biological agents. Those findings support the need of implementing hospital guidelines and constantly verifying its application by the multidisciplinary team in specialized services in IBD.

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Ocular Manifestations of Inflammatory Bowel Disease

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa359 ◽

2021 ◽

Author(s):

Janaki Shah ◽

Aaditya Shah ◽

Lynn Hassman ◽

Alexandra Gutierrez

Keyword(s):

Internal Medicine ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Intestinal Inflammation ◽

Extraintestinal Manifestations ◽

Review Of The Literature ◽

Ocular Manifestations ◽

Ocular Symptoms ◽

Inflammatory Bowel ◽

Ocular Morbidity

Abstract Inflammatory bowel disease (IBD) is characterized by intestinal inflammation; however, it is also known to have extraintestinal manifestations. Ocular manifestations of IBD include keratopathy, episcleritis, scleritis, and uveitis and are among the most common extraintestinal manifestations. These diseases can lead to significant ocular morbidity if unrecognized and left untreated. A review of the literature was performed on PubMed and is summarized and critically appraised in this article with the aim being to describe the varying ocular manifestations of IBD and outlining their treatments. Ultimately, a framework is provided to investigate ocular symptoms in patients with IBD. An ocular review of systems is also provided as a tool to equip gastroenterologists and internal medicine physicians to be able to recognize and triage ocular complaints appropriately.

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Prevalence of axial spondyloarthritis in patients with inflammatory bowel disease using cross-sectional imaging: a systematic literature review

Therapeutic Advances in Musculoskeletal Disease ◽

10.1177/1759720x21996973 ◽

2021 ◽

Vol 13 ◽

pp. 1759720X2199697

Author(s):

Jobie Evans ◽

Mark Sapsford ◽

Scott McDonald ◽

Kenneth Poole ◽

Tim Raine ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Axial Spondyloarthritis ◽

Inflammatory Back Pain ◽

Sample Sizes ◽

Cross Sectional ◽

Significant Difference ◽

Cross Sectional Imaging ◽

Inflammatory Bowel ◽

Sectional Imaging

Background: Patients with inflammatory bowel disease (IBD) have an excess burden of axial spondyloarthritis (axSpA), which, if left untreated, may significantly impact on clinical outcomes. We aimed to estimate the prevalence of axSpA, including previously undiagnosed cases, in IBD patients from studies involving cross-sectional imaging and identify the IBD features potentially associated with axSpA. Methods: PubMed, Embase and Cochrane databases were searched systematically between 1990 and 2018. Article reference lists and key conference abstract lists from 2012 to 2018 were also reviewed. All abstracts were reviewed by two authors to determine eligibility for inclusion. The study inclusion criteria were (a) adults aged 18 years or above, (b) a clinical diagnosis of IBD and (c) reporting identification of sacroiliitis using cross-sectional imaging. Results: A total of 20 observational studies were identified: 12 used CT, 6 used MR and 2 utilised both computed tomography (CT) and magnetic resonance (MR) imaging. Sample sizes ranged from 25 to 1247 (a total of 4096 patients); 31 studies were considered to have low selection bias, 13 included two or more radiology readers, and 3 included rheumatological assessments. The prevalence of sacroiliitis, the most commonly reported axSpA feature, ranged from 2.2% to 68.0% with a pooled prevalence of 21.0% [95% confidence interval (CI) 17–26%]. Associated IBD features include increasing IBD duration, increasing age, male sex, IBD location, inflammatory back pain and peripheral arthritis. No significant difference in the prevalence of sacroiliitis between Crohn’s disease and ulcerative colitis was identified. Study limitations include variability in the individual study sample sizes and patient demographics. Conclusion: This review highlights the need for larger, well-designed studies using more sensitive imaging modalities and multivariable modelling to better estimate the prevalence of axSpA in IBD. An improved knowledge of the IBD phenotype(s) associated with axSpA and use of cross-sectional imaging intended for IBD assessment to screen for axSpA may help clinicians identify those patients most at risk.

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