Extra-intestinal Manifestations of Inflammatory Bowel Disease

Crohn's disease manifesting in the head and neck

Crohn's disease may present to the head and neck surgeon with symptoms and signs attributed to the disease. Many clinical presentations, both specific and non-specific, have been recorded in the oral cavity, nose and larynx. Some of these clinical manifestations have been found to be consistent with Crohn's disease, but most have been attributed to Crohn's disease without histologic confirmation of the presence of non-caseating granulomas, which is pathognomonic of Crohn's disease. Lesions, when present without an associated diagnosis of Crohn's disease, should be ascribed the diagnosis of orofacial granulomatosis, until a diagnosis of intestinal Crohn's disease has been confirmed.

Lack of support for a common etiology in Johne's disease of animals and Crohn's disease in humans

The superficial similarity of Johne's disease to Crohn's disease led to the hypothesis that, like the former. Crohn's disease was caused by Mycobacterium paratuberculosis. Detailed pathologic comparisons, however, reveal little similarity between these two entities, including the lack of important extraintestinal manifestations. Attempts to recover M. paratuberculosis by culture have only rarely succeeded and the significance of spheroplasts that appear more frequently on culture is seriously in question. Five immunocytochemistry studies have failed to find mycobacterial antigens in diseased tissues and the five most recent polymerase chain reaction (PCR) attempts to find genomic evidence of M. paratuberculosis were uniformly negative. Numerous serologic studies failed to demonstrate antibody to M. paratuberculosis and attempts to show cell-mediated immunity were also unrewarding. Inoculation of numerous experimental animals with Crohn's disease tissue has failed to induce Johne's disease, and inoculation of various animal species with M. paratuberculosis has equally failed to result in Crohn's disease. Controlled studies of the treatment of Crohn's disease with antimycobacterial agents have generally resulted in no improvement, and most studies that have shown a positive response are either uncontrolled or include broad-spectrum antibiotics that may be acting on pathogens other than mycobacteria. Finally, although Johne's disease is common in farm animals, and infected animals shed M. paratuberculosis in large numbers, no record of zoonotic transmission has been recorded.

Hepatobiliary manifestations of inflammatory bowel disease

Several hepatobiliary disorders may be associated with inflammatory bowel disease (IBD). These various disease states can be diagnosed before, concomitant with, or after the diagnosis of IBD is made. This article describes these disorders, clinical features, evaluation, and possible treatment.

Extraintestinal and systemic manifestations of inflammatory bowel disease

Extraintestinal and systemic manifestations occur commonly in patients with inflammatory bowel disease, specifically ulcerative colitis and Crohn's disease, and affect most all organ systems of the body. The occurrence of such widespread manifestations strongly suggests that these disorders are systemic in nature and may have a common mechanism. Extraintestinal manifestations may be incidental findings that cause no symptoms, but more commonly complicate the management of the underlying inflammatory bowel disease, being a source of considerable morbidity and mortality. Some extraintestinal manifestations not only correlate with a specific disease state but also with the location, extent, and degree of activity and disease. Most extraintestinal manifestations found in patients with inflammatory bowel disease involving the small intestine appear to correlate with some underlying pathophysiologic mechanism.

Periosteal new bone formation and disseminated granulomatosis in a patient with Crohn's disease

In a 20-year-old man, a proliferative periosteal new bone growth developed over the left forearm. Crohn's disease had been diagnosed the year before. Bone biopsy demonstrated granuloma formation. Biopsy specimens of skin lesions demonstrated granulomas as well. Bowel studies indicated active small intestinal inflammation with fistula formation. Despite the superficial resemblance to hypertrophic osteoarthropathy, it is believed that this case represents Crohn's disease with disseminated granulomatosis involving skin and periosteum.

Nasal mucosal involvement in ulcerative colitis

A patient with ulcerative colitis, sclerosing cholangitis, and mouth ulceration, developed an unusual lesion involving the nasal mucosa. This was thought to represent another extra-intestinal manifestation of inflammatory bowel disease.