This document discusses extra-intestinal manifestations (EIMs) that can occur in patients with inflammatory bowel disease (IBD). It notes that EIMs can affect various organs like joints, skin, eyes, and less commonly the liver, lungs and pancreas. EIMs can occur before or after IBD diagnosis and sometimes require specific treatments separate from treating intestinal inflammation. Successful treatment of intestinal inflammation does not always resolve EIMs. The document emphasizes that EIMs contribute significantly to IBD disease burden and integrated multidisciplinary care is needed to properly address EIMs and improve patients' quality of life.

1. Kurdistan Board GEH/GIT Surgery J Club 2021
Supervised by Professor Dr. Mohamed Alshekhani.

2. Introduction:
 IBDs are systemic diseases that manifest not only in the gut& GIT, but also
in the extraintestinal organs in many patients.
 The QOL for patients with IBD substantially affected by these EIMs.
 Knowledge of their prevalence, pathophysiology& clin presentation needed
to adapt therapeutic options to cover all aspects of IBD.
 EIMs occur in up to 24% of IBD before the onset of intestinal symptoms&
need to be recognized to initiate appropriate diagnostic procedures.
 EIMs mostly affect joints,skin,eyes, less others; liver, lung, pancreas.
 Successful trt of int inflammation is not always sufficient to treat EIMs.
 Peripheral arthritis, oral aphthous ulcers, episcleritis, erythema nodosum
associated with active intestinal inflammation&improve on standard trt of
the intestinal inflammation.
 Anterior uveitis,AS&PSC usually occur independent of disease flares.

3. Introduction:
 EIMs occur with varying frequency, depending on the affected organ.
 EIMs can occur before or after the diagnosis of IBD.
 They can substantially impact QOL, sometimes more so than int disease.
 Frequently, EIMs require specific treatments or at least need to be
considered when deciding on the treatment of the intestinal inflammation.
 EIMs can occur together with flares of the underlying IBD& respond to
the treatment of the int inflammation or independent of the IBD activity.
 EIMs should be differentiated from extraintestinal complications of IBD.
 EI complications are direct or indirect sequela of int inflammation.
 EIMs defined as “an inflammatory pathology in a patient with IBD located
outside the gut and for which the pathogenesis is either dependent on
extension/translocation of immune responses from the intestine, or is an
independent inflammatory event perpetuated by IBD or that shares a
common environmental or genetic predisposition with IBD.”
 EIMs are common in both UC&CD.

4.  Introduction:
 In both CD/ UC, EIMs most commonly involve the musculoskeletal system
(eg, peripheral/ axial arthritis& enthesitis), skin (eg,PG,EN, Sweet
syndrome& aphthous stomatitis),hepatobiliary tract (PSC)& eyes
(episcleritis, anterior uveitis& iritis),but, almost any organ can be affected.
 These manifestations might not be clinically obvious or easy to detect.
 For example, an acute or chronic pancreatitis associated with IBD (not
wmedication, as azathioprine) is rare.
 However, asymptomatic exocrine insufficiency, pancreatic duct
abns&hyperamylasaemia are seen in up to 18%&antibodies against
exocrine pancreatic tissue (PAbs)found in up to 29% CD, but not with UC.
 Other conditions,as pneumonitis or PSC can persist in patients with UC,
even after proctocolectomy.
 EIMs in IBD represent a challenge for the treating health care providers.
 MD integrated management plans can improve patient outcomes&QOL.

12. Conclusion:
 EIMs in patients with IBD contribute significantly to the burden of
disease.
 Specific anti-inflammatory and symptomatic treatments/ therapies in a
multidisciplinary team approach are necessary to address EIMs
adequately& improve the quality of life of our patients.
 In the absence of specific therapeutic biomarkers for EIMs, considerations
of co-existing EIMs in patients with IBD can inform treatment selection&
decisions