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What are the most common extraintestinal complications of IBD?

What are the most common extraintestinal complications of IBD?

Updated on
November 12, 2023
Medical reviewer
Medically reviewed by
Brittany Rogers, MS, RDN
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Written by
Romanwell Dietitians

What are extraintestinal manifestations (complications) of IBD?

Extraintestinal manifestations (EIMs) of IBD are complications that occur outside of your gastrointestinal tract. IBD can affect nearly any organ in the body including your joints and bones, eyes, liver, skin, kidneys, lungs, heart, and cardiovascular system.

Some EIMs of IBD can be treated using the same medications used to treat inflammation in your intestines, while others must be treated with different medications.

The severity of EIMs can range from mild to severe, and some, such as primary sclerosing cholangitis, have serious long term implications.  

How common are extraintestinal manifestations of IBD?

Research studies estimate that 25-40% of people with IBD may experience an extraintestinal manifestation of their disease.ď‚Ž EIMs may occur before or after your initial diagnosis, with one study estimating that 26% of people experience their first EIM before IBD is diagnosed.ď‚Ž

EIMs can occur together with active disease (when inflammation is present) or when your IBD is in remission. 

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Extraintestinal manifestations of Crohn’s disease

Extraintestinal manifestations are more common in people with Crohn’s disease (35% of cases) than people with ulcerative colitis (27% of cases). The most common EIMs seen in people with Crohn’s disease include complications of the:

  • Bones and joints - Axial arthritis (inflammation primarily of the spine) may occur in up to 5% of cases while peripheral arthritis (inflammation of the joints in the arms and legs) may occur in up to 17% of people with Crohn’s disease.ď‚Ž
  • Eyes - Uveitis, or inflammation of the eyes, may occur in up to 3% of people with Crohn’s disease.ď‚Ž
  • Skin - Erythema nodosum (painful bumps under the skin) may occur in up to 3% of cases while pyoderma gangrenosum (large, painful sores on the skin) may occur in up to 1% of people with Crohn’s disease.ď‚Ž
  • Mouth - Oral ulcers may occur in up to 50% of people with Crohn’s disease.ď‚Ž

Extraintestinal manifestations of Ulcerative colitis

The most common EIMs seen in people with ulcerative colitis include complications of the:

  • Bones and joints - Axial arthritis (inflammation primarily of the spine) may occur in up to 4% of cases while peripheral arthritis (inflammation of the joints in the arms and legs) may occur in up to 11% of people with ulcerative colitis.ď‚Ž
  • Eyes - Uveitis, or inflammation of the eyes, may occur in up to 2% of people with ulcerative colitis.ď‚Ž
  • Skin - Erythema nodosum (painful bumps under the skin) may occur in up to 1% of cases while pyoderma gangrenosum (large, painful sores on the skin) may occur in up to 1% of people with ulcerative colitis.ď‚Ž
  • Liver - Primary sclerosing cholangitis may occur in up to 5% of people with ulcerative colitis.ď‚Ž

Treatment of extraintestinal manifestations of IBD

It’s important to always let your doctor know if you’re experiencing any symptoms that could be related to your IBD. Your doctor will be able to prescribe an appropriate treatment plan to address your symptoms and any extraintestinal manifestations of your IBD.

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References

  1. Levine JS, Burakoff R. Extraintestinal manifestations of inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2011 Apr;7(4):235-41. PMID: 21857821; PMCID: PMC3127025.
  2. Vavricka SR, Rogler G, Gantenbein C, Spoerri M, Prinz Vavricka M, Navarini AA, French LE, Safroneeva E, Fournier N, Straumann A, Froehlich F, Fried M, Michetti P, Seibold F, Lakatos PL, Peyrin-Biroulet L, Schoepfer AM. Chronological Order of Appearance of Extraintestinal Manifestations Relative to the Time of IBD Diagnosis in the Swiss Inflammatory Bowel Disease Cohort. Inflamm Bowel Dis. 2015 Aug;21(8):1794-800. doi: 10.1097/MIB.0000000000000429. PMID: 26020601.
  3. Kilic Y, Kamal S, Jaffar F, Sriranganathan D, Quraishi MN, Segal JP. Prevalence of Extraintestinal Manifestations in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. Inflamm Bowel Dis. 2023 Apr 12:izad061. doi: 10.1093/ibd/izad061. Epub ahead of print. PMID: 37042969.
  4. Rogler G, Singh A, Kavanaugh A, Rubin DT. Extraintestinal Manifestations of Inflammatory Bowel Disease: Current Concepts, Treatment, and Implications for Disease Management. Gastroenterology. 2021 Oct;161(4):1118-1132. doi: 10.1053/j.gastro.2021.07.042. Epub 2021 Aug 3. PMID: 34358489; PMCID: PMC8564770.

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