Inflammatory bowel disease: complications and extraintestinal manifestations

Inflammatory bowel disease (IBD) is a disorder driven by immune dysregulation, characterized by a relapsing-remitting pattern which is punctuated by flares associated with abdominal pain and bloody diarrhea. Management in general is guided by potent immunosuppressive regimens, often with equally potent associated toxicities. Treatment of refractory disease has been revolutionized by biologic therapies. Surgery remains an important part of the overall treatment plan, especially in patients presenting with acute mechanical complications and for prophylactic total colectomy in certain patients at high risk for colorectal cancer (CRC). IBD is associated with a host of intestinal disease-related complications such as intestinal stricture and fistula formation, small bowel obstruction, toxic megacolon, CRC and malnutrition. In addition to these complications there exist a myriad of extraintestinal manifestations that affect almost every organ system, such as primary sclerosing cholangitis, ankylosing spondylitis, pyoderma gangrenosum and uveitis.