Prevalence, timing and risk factors of extraintestinal manifestations in inflammatory bowel disease: a retrospective cohort study from a German tertiary referral center.
- 1Department of Medicine 1, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
- 2Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
- 3Department of Medicine 3 - Rheumatology and Immunology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Abstract
Background
Extraintestinal manifestations (EIMs) are a frequent and clinically significant feature of inflammatory bowel disease (IBD), contributing to morbidity and impaired quality of life.Objectives
To investigate the prevalence, spectrum, timing, and risk factors of EIMs in a large cohort of patients with IBD.Methods
In this retrospective cohort study, adult patients with ulcerative colitis (UC) or Crohn's disease (CD) followed at a German tertiary referral center were included. Electronic medical records were reviewed to identify specialist-confirmed EIMs, their timing relative to IBD diagnosis, and associated demographic and disease-related factors.Results
A total of 817 patients with IBD (527 CD, 290 UC) were included, with a median disease duration of 11 years (IQR 6-19). EIMs were identified in 227 patients (27.8%), with rheumatologic (17.4%) and cutaneous (8.9%) manifestations being the most frequent. Most patients had one EIM (70%), while 30% developed multiple manifestations. Female sex (OR 2.88; 95% CI 2.08-4.02, P < .001), longer IBD duration (OR 1.02 per year; 95% CI 1.01-1.04, P = .002), and CD (OR 1.57; 95% CI 1.08-2.29, P = .018) were independently associated with EIM development. EIMs occurred before or concurrently with IBD diagnosis in 20.7% of affected patients. Kaplan-Meier analysis demonstrated a continuous increase in the cumulative probability of developing EIMs over time, reaching approximately 27% at 15 years of follow-up.Conclusion
EIMs affect more than one quarter of patients with IBD and may precede or coincide with intestinal disease onset. Female sex and CD appear to be independent risk factors. These findings highlight the importance of early recognition and long-term surveillance of EIMs in patients with IBD.
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BibTeX
@article{fousekis2026prevalence,
title = {{Prevalence, timing and risk factors of extraintestinal manifestations in inflammatory bowel disease: a retrospective cohort study from a German tertiary referral center.}},
author = {Fotios Fousekis and Panagiotis Garantziotis and André Jefremow and Christina Bergmann and Maria Gabriella Raimondo and Andreas Ramming and Georg Schett and Markus F Neurath and Raja Atreya},
journal = {Crohn's \& colitis 360},
year = {2026},
month = sep,
doi = {10.1093/crocol/otag100},
url = {https://europepmc.org/article/MED/42836101},
note = {CC BY},
}
RIS
TY - JOUR
TI - Prevalence, timing and risk factors of extraintestinal manifestations in inflammatory bowel disease: a retrospective cohort study from a German tertiary referral center.
AU - Fotios Fousekis
AU - Panagiotis Garantziotis
AU - André Jefremow
AU - Christina Bergmann
AU - Maria Gabriella Raimondo
AU - Andreas Ramming
AU - Georg Schett
AU - Markus F Neurath
AU - Raja Atreya
PY - 2026
DA - 2026/09/02
JO - Crohn's & colitis 360
DO - 10.1093/crocol/otag100
UR - https://europepmc.org/article/MED/42836101
AB - Background Extraintestinal manifestations (EIMs) are a frequent and clinically significant feature of inflammatory bowel disease (IBD), contributing to morbidity and impaired quality of life.Objectives To investigate the prevalence, spectrum, timing, and risk factors of EIMs in a large cohort of patients with IBD.Methods In this retrospective cohort study, adult patients with ulcerative colitis (UC) or Crohn's disease (CD) followed at a German tertiary referral center were included. Electronic medical records were reviewed to identify specialist-confirmed EIMs, their timing relative to IBD diagnosis, and associated demographic and disease-related factors.Results A total of 817 patients with IBD (527 CD, 290 UC) were included, with a median disease duration of 11 years (IQR 6-19). EIMs were identified in 227 patients (27.8%), with rheumatologic (17.4%) and cutaneous (8.9%) manifestations being the most frequent. Most patients had one EIM (70%), while 30% developed multiple manifestations. Female sex (OR 2.88; 95% CI 2.08-4.02, P < .001), longer IBD duration (OR 1.02 per year; 95% CI 1.01-1.04, P = .002), and CD (OR 1.57; 95% CI 1.08-2.29, P = .018) were independently associated with EIM development. EIMs occurred before or concurrently with IBD diagnosis in 20.7% of affected patients. Kaplan-Meier analysis demonstrated a continuous increase in the cumulative probability of developing EIMs over time, reaching approximately 27% at 15 years of follow-up.Conclusion EIMs affect more than one quarter of patients with IBD and may precede or coincide with intestinal disease onset. Female sex and CD appear to be independent risk factors. These findings highlight the importance of early recognition and long-term surveillance of EIMs in patients with IBD.
SN - 2631-827X
ER -