Report on the Update of the Guideline on Extraintestinal Manifestations in IBD
Torsten Kucharzik, GuiCom Chair
Up to 50% of patients with IBD suffer from extraintestinal manifestations (EIMs), which may impact every body system. EIMs are a source of considerable morbidity, and even mortality in the case of primary sclerosing cholangitis or venous thromboembolic events. Broadly, EIMs can be categorised as those resulting from inflammatory pathology at distant sites, the consequences of IBD and treatment, or wider associations. The underlying pathophysiology of extraintestinal inflammation is not fully understood. The systemic consequences of IBD lead to broader associations, including venous thromboembolic events and anaemia. Whether these are strictly EIMs is debated, but they result in great health burdens for our patients.
The current update of the EIM guideline was created according to ECCO’s standardised methodology. A panel of 20 gastroenterologists was selected by the ECCO Guidelines Committee from a competitive pool of applicants. Two GuiCom Members, Hannah Gordon and Torsten Kucharzik, were selected as project coordinators. Participating experts were split into four working groups, and a leader was selected for each. Topics were determined by the project coordinators and WG leaders and divided between the four groups. Subjects of this guideline include haematological disease (including anaemia), cardiovascular and respiratory disease, hepatobiliary manifestations, bone, joint and skin disease, CNS and ocular manifestations, fatigue and endocrine manifestations. ECCO recognises the need for a multidisciplinary approach when managing EIMs in IBD. Accordingly, we invited experts from other disciplines, including dermatology, rheumatology, vascular medicine, hepatology and ophthalmology.
For each topic, a clinically relevant question was formulated and used to define a Population, Intervention, and Comparator(s) of interest (PICO). These informed a systematic literature search, performed by a professional librarian using PubMed/Medline, Embase and the Cochrane Central databases. Abstracts from each literature search were screened by two participants. Full texts of potentially relevant abstracts were retrieved and evaluated in full by both authors, who reached agreement on which papers were most relevant in informing the answer to the clinical question. Recommendations and statements underwent two rounds of voting. Final recommendations were discussed and approved during a virtual consensus conference in autumn 2022. The collaboration in this multidisciplinary guideline was extremely effective and fruitful and resulted in a comprehensive manuscript that includes 37 statements and recommendations and a wide variety of clinically useful figures and tables.