Decision-Making in Diagnosis and Management of Extraintestinal Manifestations of Inflammatory Bowel Disease

Nicholas V. Costrini*

Decision-Making in Diagnosis and Management of Extraintestinal Manifestations of Inflammatory.

EIMs are classified in restricted or universal patterns based upon
an immunologically-informed or a disciplined interpretation of the
term “extraintestinal.”

The European Crohn’s and Colitis Organization
(ECCO, 7) defines the EIMs of IBD (in this communication labeled as “true”
EIMs) as follows: “An inflammatory pathology in a patient with IBD that is 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.”
ECCO invokes the “mechanistic” definition of EIMs while admitting
that most of the immunologic mechanisms proposed have yet to be proven.
That notwithstanding,

the EIMs of the skin, eye, bone, and hepatobiliary target  are accepted
as those which are immunologically mediated as defined above, i.e., translocation of the
immune response. ECCO and most clinicians recognize that IBD
carries with it risks of non-inflammatory Extraintestinal disorders
that are secondary to the intestinal disease itself, secondary to the
treatment of intestinal disease, or by observation seem to occur
more often in association with IBD but through as yet very much
undefined mechanisms. These add to the particularly clinically relevant,
and more inclusive EIM classification scheme but
offer the IBD clinician a daunting check list of Extraintestinal dis

Gastro Open J. 2021; 5(1): 4-12. doi: 10.17140/GOJ-5-133