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09-05-2011, 02:12 PM   #1
David
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Extraintestinal Manifestations Reported in IBD

The following are a list of Extraintestinal Manifestations that have been reported with Crohn's Disease, Ulcerative Colitis, and other forms of IBD. Some might suggest it's better to let your doctor think about these things so you may want to simply hit back on your browser and stop reading here. I think I contracted 20% of these just listing them. If you're aware of other manifestations, please respond to the thread. My goal is to provide information on each, in time.

Musculoskeletal
Peripheral Arthritis
Granulomatous Arthritis and Synovitis
Rheumatoid Arthritis
Sacroiliitis
Ankylosing Spondylitis
Clubbing
Osteoporosis and Osteomalacia
Rhabdomyolysis
Relapsing Polychondritis

Skin and Mucous Membranes
Oral Ulceration
Cheilitis
Pyostomatitis Vegetans
Erthema Nodosum
Sweet's Syndrome
Metastatic CD
Psoriasis
Epidermolysis Bullosa Acquisita
Perianal Skin Tags
Polyartheritis Nodosa
Cutaneous Vasculitis
Raynaud's Syndrome

Neurologic
Peripheral Neuropathy
Meningitis
Vestibular Dysfunction
Pseudotumour Cerebri
Meniere's Disease

Ocular
Conjunctivitis
Uveitis
Iritis
Episcleritis
Scleritis
Retrobulbar Neuritis
Crohn's Keratopathy

Bronchopulmonary
Chronic Bronchitis with Bronchiectasis
Fibrosing Alveolitis
Pulmonary Vasculitis
Interstitial Lung Disease
Sarcoidosis
Tracheal Obstruction

Cardiac
Pleuropericarditis
Cardiomyopathy
Endocarditis
Myocarditis

Endocrine and Metabolic
Growth failure
Thyroiditis
Osteoporosis

Hematologic
Anemia - Iron Deficiency
Vitamin B12 Deficiency
Anemia of Chronic Disease
Autoimmune Hemolytic Anemia
Hyposplenism
Anticardiolipin Antibody
Takayasu's Arteritis
Wegener's Arteritis

Renal and Genitourinary
Nephrolithiasis
Retroperitoneal Fibrosis
Fistula formation
Glomerulonephritis
Renal Amyloidosis
Dreg-related Nephrotoxicity
Hydronephrosis

Hepatopancreatobiliary
Primary Sclerosing Cholangitis (PSC)
Small Duct PSC
Cholangiocarcinoma
Cholelithiasis
Autoimmune Hepatitis
Primary Biliary Cirrhosis
Pancreatitis
Ampullary CD
Granulomatous Pancreatitis
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Last edited by DustyKat; 10-19-2014 at 01:59 AM.
02-24-2012, 09:48 PM   #2
Susan2
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Every time that my eye is caught by this heading, I read it as "Extraterrestrial Manifestations Reported in IBD" and my crazy, literal, pictorial mind has a field day.

Perhaps that's what's causing the problems in my gut - little green men!
02-24-2012, 10:22 PM   #3
kllyeve
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I had clubbing for awhile but outgrew it when I got married, had kids and then old as I found the music WAY too loud!!
02-24-2012, 11:50 PM   #4
DustyKat
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Ahahahaha, love it guys!

Not sure is this will be of interest to anyone but over time I have read on numerous occasions that EIM's of IBD more frequently affect those that have large bowel involvement. This is one study (abstract) that discusses this relationship...

The records of a series of 700 patients with inflammatory bowel disease, 498 with Crohn's disease and 202 with ulcerative colitis, have been analyzed to determine the relative incidence and characteristic features of their extra-intestinal manifestations. The group with Crohn's disease included 62 with colitis, 223 with ileocolitis, and 213 with regional enteritis. A consideration of the clinical patterns and an understanding of their pathophysiology suggested a subdivision into two main groups: one "colitis related" and one related to the pathophysiology of the small nonspecific third group. Group A, colitis related, comprises joint, skin, mouth, and eye disease. The complications might be immunologically determined, were closely associated with active inflammation, and often responded to medical or surgical treatment of the underlying bowel disease. They occurred in 36% of the entire series of patients: joints were involved in 23%, skin in 15%, and mouth and eye each in 4%. Pyoderma gangrenosum was observed most often in ulcerative colitis and erythema nodosum most often in granulomatous colitis. The incidence of Group A complications was higher in disease involving the colon (42%) than in disease restricted exclusively to the small bowel (23%). There were interrelationships among the various members of Group A, with multiple manifestations occurring in a third of affected patients. Group B, related to small bowel pathophysiology, includes malabsorption, gallstones, kidney stones, and non-calculous hydronephrosis and hydroureter. Disorders in this group were generally related to the severity of the disease in the small bowel and tended to persist even in the absence of active inflammation. In contrast to Group A, this group occurred most frequently in small bowel disease, and least in colonic disease. Malabsorption was virtually confined to the patients with small bowel disease (10% incidence), while gallstones and renal stones were also both more frequent in Crohn's disease (11% and 9% respectively), the latter usually in association with small bowel resection or ileostomy. Group C, found in a small percentage of patients, consists of nonspecific complications, including osteoporosis (3%), liver disease (5%), peptic ulcer (10%), and amyloidosis (1%).

http://ukpmc.ac.uk/abstract/MED/9579...EI00UGJuTIJv.0
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03-01-2012, 07:45 AM   #5
sprout
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I, Myself have Crohn's Disease, and multiply other illnesses, 2 of them being Osteopenia, and Hypothyroidism. Now no dr. has ever mentioned the possiblility of the hypothyroidism being a result or side effect of my CD, but the Osteopenia (the beginning of Osteoprosis) they said was probably due to all the prednisone I was on for so long trying to get my CD under some kind of control. I was on it for 3-4 yrs strait, which sucked. I am also kind of short, 4'9, and they also said CD can cause growth development problems, so...
Anyway good info for us to be more aware of, thank you!! =0)
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Good times!
03-01-2012, 09:53 AM   #6
David
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Sprout, have you had your vitamin D levels checked? If so, when and what was the level?
03-02-2012, 09:04 AM   #7
sprout
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My Vit. D lvls have been checked, though I do not know what the lvls were, my dr. has me on 50,000 UI a week and on Calcium tabs 2x a day, oh and 701mg of Fosamax once a week for the osteopenia.
03-30-2012, 07:19 PM   #8
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this is intersting to read
05-17-2012, 03:01 AM   #9
sid
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Does CD has any link with prostate pain ??
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And a large joint mad family, thus stress cant touch me.
05-17-2012, 05:04 AM   #10
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This is interesting. I had erythema nodosum which I knew was linked to Crohn's but I also had recurring conjunctivitis during this bad flare, which I had no idea about.
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05-17-2012, 02:32 PM   #11
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Does CD has any link with prostate pain ??
Hey sid,

Where is your Crohn's located?

My son had an issue with his urinary system last year and one point the GP was querying Prostatitis. As it was the problem resolved and his PSA was normal so Prostatitis was ruled out but I did research it at the time and I did find at least one study that found there was a link between Ileal Crohn's and Prostatitis and I would imagine it has something to do with the ileum laying close to the prostate gland and coming into contact with it when inflamed. For the life of me I can't find that study again.

If you have pain in this area the other thing to consider may be not Prostatitis specifically but pelvic pain in general caused by the inflamed bowel affecting adjacent structures.

Dusty. xxx
05-18-2012, 06:16 AM   #12
sid
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Hey sid,

Where is your Crohn's located?

My son had an issue with his urinary system last year and one point the GP was querying Prostatitis. As it was the problem resolved and his PSA was normal so Prostatitis was ruled out but I did research it at the time and I did find at least one study that found there was a link between Ileal Crohn's and Prostatitis and I would imagine it has something to do with the ileum laying close to the prostate gland and coming into contact with it when inflamed. For the life of me I can't find that study again.

If you have pain in this area the other thing to consider may be not Prostatitis specifically but pelvic pain in general caused by the inflamed bowel affecting adjacent structures.

Dusty. xxx
its located in ileum. But its very mild and at the moment I am in remission. But sometimes I feel pain in the right side of groin area.(the right of the base of my penis). I am confused as it might be prostate or maybe lymph nodes. BUt no swellings.thus I guess its not the lymph nodes.
05-27-2012, 02:34 PM   #13
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Last edited by Skycruiser; 07-31-2015 at 06:29 AM.
05-27-2012, 02:36 PM   #14
David
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Thanks Brian, I'll do that. Which category do you think they fall under? Neurological?
05-27-2012, 05:28 PM   #15
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Last edited by Skycruiser; 07-31-2015 at 06:28 AM.
05-27-2012, 05:58 PM   #16
David
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Great, I've added them. Thank you again!
07-18-2012, 08:03 PM   #17
LivinglifewithCrohn's
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I have had Uvieitis flare ups and also Arthitis. I just had surgery on June 26th and was hopeful that since I do not have active Crohn's for now, the bad stuff all 14 inches was removed, that my joint pain would not resurface but it has. Trying to understand how the extra manifestations can be active when the Crohn's isn't?
08-22-2012, 06:04 PM   #18
Jennifer
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Wanted to share this image I came across on Extraintestinal Manifestations.

"Crohn’s disease is associated with extraintestinal manifestations that may be more problematic than the bowel disease. Colitic arthritis is a migratory arthritis that affects knees, ankles, hips, wrists, and elbows that may accompany Crohn’s disease (although it is uncommon when Crohn’s is confined to the small intestine). Often, joint pain, swelling, and stiffness parallel the course of the bowel disease. Successful treatment of the bowel disease results in improvement in the arthritic symptoms. Pericholangitis, usually associated with primary sclerosing cholangitis (PSC), is the most common hepatic complication of inflammatory bowel disease. PSC is demonstrable by endoscopic retrograde cholangiopancreatography (ERCP) or hepatic magnetic resonance imaging (MRI). Pericholangitis is characterized by inflammation of the portal tracts with lymphocyte and eosinophil infiltrates. Degenerative changes in the bile ductules are also characteristic. Kidney stones (calcium oxalate stones) are seen in patients with small-intestine Crohn’s disease. Inflammation from the bowel can result in urinary tract complications. Occlusion of the ureters, leading to obstruction and hydronephrosis, usually involves the right ureter in Crohn’s patients. Fistula can form between inflamed bowel and the urinary bladder leading to infection (Figure 8)."
http://www.hopkinsmedicine.org/gastr...ns_disease.pdf
That image and the link itself gives a great overview on Crohn's.
Attached Images
File Type: jpg Crohn's Extraintestinal manifestations.JPG (49.8 KB, 511 views)
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Diagnosis: Crohn's in 1991 at age 9
Surgeries: 1 Small Bowel Resection in 1999; Central IV in 1991-92
Meds for CD: 6MP 50mg
Things I take: Tenormin 25mg (PVCs and Tachycardia), Junel, Tylenol 3, Omeprazole 20mg 2/day, Klonopin 1mg 2/day (anxiety), Restoril 15mg (insomnia), Claritin 20mg
Currently in: REMISSION Thought it was a flare but it's just scar tissue from my resection. Dealing with a stricture. Remission from my resection, 17 years and counting.
10-29-2012, 06:28 AM   #19
DustyKat
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Excellent slide presentation of EIM's:

https://louisville.edu/medschool/gim...s%206-2010.pdf

Dusty.
12-08-2012, 07:35 AM   #20
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I have too many of the problems you have listed, but the rhabdomyolysis is making my life miserable!
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Lialda
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02-27-2013, 11:21 AM   #21
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C-Diff, it whole name is too much, but if you google it you will find it quite overwelming both symptom and prevalency.
03-22-2013, 08:50 AM   #22
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All I can say is, Aren't we all brave? We may not have all this but I'm guessing that many of us are suffering suff without even considering it to be related. I have trouble peeing sometimes and I find that it's nearly always when I'm having a bad time with D, so perhaps dehydation plays a part....
This is a rotten condition and wish there was more ways to get help...
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03-30-2013, 09:41 PM   #23
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Would Thromboembolism be considered an EIM?
03-31-2013, 12:03 AM   #24
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Hi bookchick. Just did a quick search and found that Thromboembolism may be an EIM of Crohn's yet is listed as rare.

"Rarer extra-intestinal manifestations of inflammatory bowel disease include: lung conditions, such as bronchiectasis and bronchitis; hyperhomocysteinemia; pancreatitis; renal stones; and venous thromboembolism." http://www.cks.nhs.uk/crohns_disease...manifestations

"The three organ systems most commonly associated with EIM of Crohn’s disease are musculoskeletal, ocular, and mucocutaneous [6]. More recently described are associations of Crohn’s disease with pulmonary disease, psychological syndromes, osteoporosis, and thromboembolism [7]." http://www.siumed.edu/surgery/clerks...%20of%20CD.pdf

Further reading: http://www.ncbi.nlm.nih.gov/pubmed/6643010
03-31-2013, 02:24 PM   #25
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I had a disastrous leak over the weekend and the number of extra terrestrials had to be seen to be believed. Need a hug...sob!
04-05-2013, 04:13 PM   #26
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David, has anyone reported warts for exampl on the finger?
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06-04-2013, 10:04 AM   #27
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Warts? I am prone to them. Had lots of them on fingers during my late teens/early twenties but not really since. Had the odd one on my face as well, but nobody ever related them to Crohn's.

Going back some 4 years ago, I developped about six large purple red blotches on my legs, primarily on the shins. The doctor I saw on that occasion suggested they were insect bites (despite tmy protests that I NEVER get bitten and these were much bigger than any insect bite I have ever seen) and that my wife should change the bed sheets more often. Well, by the time I had my next Rheumatology appointment a few weeks later they were gone. The doctor there suggested that they were likely Erythema Nodosum and also ran an ACE test. The levels were high and Sarcoidosis was indeed suspected. This was confirmed a few weeks later after I ended up in hospital due hypercalcaemia and kidney impairment.

I can't help thinking though that had the general practitioner bothered to investigate properly and take me seriously, the Erythema Nodosum which is clearly connected with Sarcoidosis might have contributed to a positive diagnosis much sooner and me saved weeks of waiting and suffering.

My Crohns was first identified as affecting the colon (crohn's-colitis) and especially the area near the appendix and close to where the little intestines start, but since I get inexplicably low on Iron, B12 and now, it seems vit D as well, I have been told that the Crohn's is likely affecting the ileum where these are absorbed. This would mean that my Crohn's is in both the large and small intestine. Does this put me in BOTH categories?

One GP told me that it can affect anywhere in the GI tract, which, she said, might also explain my occasional tooth/jaw pains which periodically come and go with no obvious signs of teeth trouble. Anyone else experience this?
06-04-2013, 01:51 PM   #28
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Warts? I am prone to them. Had lots of them on fingers during my late teens/early twenties but not really since. Had the odd one on my face as well, but nobody ever related them to Crohn's.

Going back some 4 years ago, I developped about six large purple red blotches on my legs, primarily on the shins. The doctor I saw on that occasion suggested they were insect bites (despite tmy protests that I NEVER get bitten and these were much bigger than any insect bite I have ever seen) and that my wife should change the bed sheets more often. Well, by the time I had my next Rheumatology appointment a few weeks later they were gone. The doctor there suggested that they were likely Erythema Nodosum and also ran an ACE test. The levels were high and Sarcoidosis was indeed suspected. This was confirmed a few weeks later after I ended up in hospital due hypercalcaemia and kidney impairment.

I can't help thinking though that had the general practitioner bothered to investigate properly and take me seriously, the Erythema Nodosum which is clearly connected with Sarcoidosis might have contributed to a positive diagnosis much sooner and me saved weeks of waiting and suffering.

My Crohns was first identified as affecting the colon (crohn's-colitis) and especially the area near the appendix and close to where the little intestines start, but since I get inexplicably low on Iron, B12 and now, it seems vit D as well, I have been told that the Crohn's is likely affecting the ileum where these are absorbed. This would mean that my Crohn's is in both the large and small intestine. Does this put me in BOTH categories?

One GP told me that it can affect anywhere in the GI tract, which, she said, might also explain my occasional tooth/jaw pains which periodically come and go with no obvious signs of teeth trouble. Anyone else experience this?
Yes, I get the tooth and jaw pain from time to time and it lasts a long time. I use sensitive teeth toothpaste now and is helping. But the jawpain, I always chalked up to my neck. Had no idea crohn's could cause it!
Colitis is just in the colon and crohn's can be anywhere. They just wrote on my report when diagnosed had some colitis too.Because there were 2 ulcers in the colon and the ileum area was inflamed too.
06-04-2013, 02:15 PM   #29
Jennifer
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My Crohns was first identified as affecting the colon (crohn's-colitis) and especially the area near the appendix and close to where the little intestines start, but since I get inexplicably low on Iron, B12 and now, it seems vit D as well, I have been told that the Crohn's is likely affecting the ileum where these are absorbed. This would mean that my Crohn's is in both the large and small intestine. Does this put me in BOTH categories?

One GP told me that it can affect anywhere in the GI tract, which, she said, might also explain my occasional tooth/jaw pains which periodically come and go with no obvious signs of teeth trouble. Anyone else experience this?
Would mean that you basically have Crohn's. Mine also affects me in the ileum and the beginning of the large intestine.

As for the tooth and jaw pain you may have bruxism/teeth grinding which you may be doing in your sleep and not know about it. http://www.mayoclinic.com/health/bruxism/DS00337
06-04-2013, 03:18 PM   #30
DustyKat
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My Crohns was first identified as affecting the colon (crohn's-colitis) and especially the area near the appendix and close to where the little intestines start, but since I get inexplicably low on Iron, B12 and now, it seems vit D as well, I have been told that the Crohn's is likely affecting the ileum where these are absorbed. This would mean that my Crohn's is in both the large and small intestine. Does this put me in BOTH categories?
There are 5 types of Crohn's disease that relate to the area of bowel affected. Crohn's can affect a person anywhere from the mouth to the anus and it is possible to have overlap of types:

The five types of Crohn's disease with their symptoms are:

*Ileocolitis: Ileocolitis is the most common type of Crohn's disease. It affects the small intestine, known as the ileum, and the colon. People who have ileocolitis experience considerable weight loss, diarrhea, and cramping or pain in the middle or lower right part of the abdomen.

*Ileitis: This type of Crohn's disease affects the ileum. Symptoms are the same as those for ileocolitis. In addition, fistulas, or inflammatory abscesses, may form in the lower right section of the abdomen.

*Gastroduodenal Crohn's disease: This form of Crohn's disease involves the stomach and duodenum, which is the first part of the small intestine. People with this type of Crohn's disease suffer nausea, weight loss, and loss of appetite. In addition, if the narrow segments of bowel are obstructed, they experience vomiting.

*Jejunoileitis: This form of the disease affects the jejunum, which is the upper half of the small intestine. It causes areas of inflammation. Symptoms include cramps after meals, the formation of fistulas, diarrhea, and abdominal pain that can become intense.

*Crohn's (granulomatous) colitis: This form of Crohn's disease involves only the colon. Symptoms include skin lesions, joint pains, diarrhea, rectal bleeding, and the formation of ulcers, fistulas, and abscesses around the anus.

There can be overlap between these types of Crohn's disease. Some people have more than one area of the digestive tract affected.

http://www.webmd.com/ibd-crohns-dise...crohns-disease
When you have involvement of the ileum and the large bowel it is ileocolitis which, as stated above, is the most common type of Crohn's.

Have you ever had any studies done of the small bowel?

I would have to wonder too with the involvement of your Crohn's being so close to the ileocaecal valve that there isn't also involvement of the ileum. Your doctor is right to suspect that your B12 issues would point to ileal involvement as the terminal ileum is the only area of the bowel that it is absorbed.

Dusty. xxx
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