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Cardiovascular Manifestations in Inflammatory Bowel Disease: A Systematic Review of the Pathogenesis and Management

Ravi S Patel1, Sai Rohit Reddy1, Adiona Llukmani1

  • 1Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.

Cureus
|April 22, 2021
PubMed

Insights

Pericarditis in inflammatory bowel disease (IBD) is often a drug complication, not an IBD manifestation. Management involves stopping offending medications or using corticosteroids.

Area of Science:

  • Gastroenterology
  • Cardiology
  • Immunology

Background:

  • Inflammatory bowel disease (IBD), encompassing ulcerative colitis and Crohn's disease, is a chronic gastrointestinal disorder.
  • Pericarditis, inflammation of the heart's outer lining, is a rare but serious complication associated with IBD.
  • The exact cause of pericarditis in IBD patients remains debated: extraintestinal manifestation or drug-induced.

Purpose of the Study:

  • To elucidate the pathogenesis of pericarditis in IBD patients.
  • To determine if pericarditis is an extraintestinal manifestation or a drug-induced complication.
  • To outline the management strategies for pericarditis in IBD, including the role of biologics.

Main Methods:

  • Systematic electronic search for relevant reports on pericarditis in IBD.
  • Quality assessment of identified articles based on predefined inclusion criteria.
  • Inclusion of full-text articles published in English from inception to November 2020.

Main Results:

  • The majority of evidence suggests pericarditis in IBD is a complication of 5-aminosalicylic acid derivatives (e.g., sulfasalazine, mesalamine).
  • Mechanisms include IgE-mediated reactions, direct cardiac toxicity, cell-mediated hypersensitivity, and humoral antibody responses.
  • Pericarditis is rarely considered a direct extraintestinal manifestation of IBD itself.

Conclusions:

  • Pericarditis in IBD is predominantly linked to adverse drug reactions rather than being a direct disease manifestation.
  • Drug cessation or corticosteroid therapy are effective first-line treatments for drug-induced pericarditis in IBD.
  • Further research may clarify the role of biologics in preventing or managing pericarditis in this patient population.

Keywords:
crohn’s diseaseextraintestinal manifestationsinflammatory bowel diseasepericarditisulcerative colitis

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