Open AccessAssessment of extraintestinal manifestations in inflammatory bowel diseases: A systematic review and a proposed guide for clinical trials
Author(s) -
Guillo Lucas,
D’Amico Ferdinando,
Serrero Mélanie,
Angioi Karine,
Loeuille Damien,
Costanzo Antonio,
Danese Silvio,
PeyrinBiroulet Laurent
Publication year - 2020
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640620950093
Subject(s) - medicine , inflammatory bowel disease , primary sclerosing cholangitis , disease , inflammatory bowel diseases , systematic review , clinical trial , medline , political science , law
Background and aims Extraintestinal manifestations are common in inflammatory bowel disease patients, although there are few data available on their diagnosis, management and follow‐up. We systematically reviewed the literature evidence to evaluate tools and investigations used for the diagnosis and for the assessment of the treatment response in inflammatory bowel disease patients with extraintestinal manifestations. Methods We searched in PubMed, Embase and Web of Science from January 1999–December 2019 for all interventional and non‐interventional studies published in English assessing diagnostic tools and investigations used in inflammatory bowel disease patients with extraintestinal manifestations. Results Forty‐five studies (16 interventional and 29 non‐interventional) were included in our systematic review, enrolling 7994 inflammatory bowel disease patients. The diagnostic assessment of extraintestinal manifestations was performed by dedicated specialists in a percentage of cases ranging from 60–100% depending on the specific condition. The clinical examination was the most frequent diagnostic strategy, accounting for 35 studies (77.8%). In patients with primary sclerosing cholangitis or rheumatological symptoms, biochemical and imaging tests were also performed. Anti‐TNF agents were the most used biological drugs for the treatment of extraintestinal manifestations (20 studies, 44.4%), and the treatment response varied from 59.1% in axial spondyloarthritis to 88.9% in ocular manifestations. No benefit was detected in primary sclerosing cholangitis patients after treatment with biologics. Conclusions In the clinical management of inflammatory bowel disease patients with extraintestinal manifestations the collaboration of dedicated specialists for diagnostic investigations and follow‐up is key to ensure the best of care approach. However, international guidelines are needed to homogenise and standardise the assessment of extraintestinal manifestations.