Aims: Describe the characteristics of extraintestinal manifestations complicating ulcerative colitis present preoperatively and determine their evolution after surgery. Methods: Between 1976 and 1986, 281 patients with ulcerative colitis exhibiting one or more extraintestinal manifestations (EIM) before either IPAA (n = 147), Brooke ileostomy (n = 71), Kock pouch (n = 48) or ileorectostomy (n = 15) were assessed retrospectively. The clinical evolution of each manifestation was classified as having disappeared, improved, remained unchanged or aggravated postoperatively. An efficacy index was designed to assess the ratio of the number of cases cured or improved over the number of cases unchanged or aggravated. The relationship between EIM and gender, age, duration of disease and the type of surgery was also ascertained. Results: 433 EIM were observed in 281 patients. The most common were arthralgias of the large joints (n = 146), of the sacroiliac joint (n = 59) and the small joints (n = 51). In comparison to patients without EIM having received the same operation during the same period of time, EIM were seen more often in women, younger patients, than those with longer duration of disease and the ileoanal anastomosis group. 60% had only one EIM at a time. Based on the efficacy index, thromboembolic accidents and erythema nodosum were the most commonly cured or improved. Ocular manifestations and primary sclerosing cholangitis were unaffected. The other EIM responded favorably but variably with improvement in two thirds of patients. The presence of a rectal remnant (IRA) or ileal reservoir did not affect the evolution of the EIM. Conclusions: Thromboembolic complications which are life-threatening, erythema nodosum and arthralgia of the small and large joints which impair quality of life, benefited the most from proctocolectomy. Those conditions may be considered preoperatively when making the decision for surgery.

Keywords:
Ulcerative colitis, Extraintestinal manifestations, Proctocolectomy
1.
Orchard TR, Wordsworht BP, Jewell DP: Peripheral arthropathies in inflammatory bowel disease: Their articular distribution and natural history. Gut 1998;42:387–391.
2.
Cangemi JR, Wiesner RH, Beaver SJ, Ludwig J, MacCarty RL, Dozois RR, Zinsmeister AR, LaRusso NF: Effect of proctocolectomy for chronic ulcerative colitis on the natural history of primary sclerosing cholangitis. Gastroenterology 1989;96:790–794.
3.
Lohmuller JL, Pemberton JH, Dozois RR, Ilstrup D, van Heerden J: Pouchitis and extraintestinal manifestations of inflammatory bowel disease after ileal pouch-anal anastomosis. Ann Surg 1990;211:622–627.
4.
Wright V, Watkinson G: The arthritis of ulcerative colitis. Br Med J 1965;ii:670–675.
5.
Greenstein AJ, Janowitz HD, Sachar DB: The extra-intestinal complications of Crohn’s disease and ulcerative colitis: A study of 700 patients. Medicine 1976;55:401–412.
6.
Bargen JA, Barker NW: Extensive arterial and venous thrombosis complicating ulcerative colitis. Arch Intern Med 1936;58:17–31.
7.
Talbot RW, Heppell J, Dozois RR, Beart RW Jr: Vascular complications of inflammatory bowel disease. Mayo Clin Proc 1986;61:140–145.
8.
McEwen C: Arthritis accompanying ulcerative colitis. Clin Orthop 1968;57:9–17.
9.
Palumbo PJ, Ward LE, Sauer WG, Scudamore HH: Musculoskeletal manifestations of inflammatory bowel disease: Ulcerative and granulomatous colitis and ulcerative proctitis. Mayo Clin Proc 1973;48:411–416.
10.
Goudet P, Dozois RR, Kelly KA, Melton LJ III, Ilstrup DM, Phillips SF: Changing referral patterns for surgical treatment of chronic ulcerative colitis. Mayo Clin Proc 1996;71:743–747.
11.
Mir-Madjlessi SH, Taylor JS, Farmer RG: Clinical course and evolution of erythema nodosum and pyoderma gangrenosum in chronic ulcerative colitis: A study of 42 patients. Am J Gastroenterol 1985;80:615–620.
12.
Giroux JM, Ouellet A, Heppell J, Lacroix M: Pyoderma gangrenosum péri-stomale chez un patient atteint de recto-colite ulcéro-hémorragique. Ann Dermatol Vénerol 1987;114:935–939.
13.
Talansky AL, Meyers S, Greenstein AJ, Janowitz HD: Does intestinal resection heal the pyoderma gangrenosum of inflammatory bowel disease? J Clin Gastroenterol 1983;5:207–210.
14.
Cook TJ, Lorincz AL: Pyoderma gangrenosum appearing ten years after colectomy and apparent cure of chronic ulcerative colitis. Arch Dermatol 1962;86:153–55.
15.
Korelitz BI, Coles RS: Uveitis (iritis) associated with ulcerative and granulomatous colitis. Gastroenterology 1967;52:78–82.
16.
Billson FA, De Dombal FT, Watkinson G, Goligher JC: Ocular complications of ulcerative colitis. Gut 1967;8:102–106.
17.
Baiocco PJ, Gorman BD, Korelitz BI: Uveitis occurring after colectomy and ileal-rectal sleeve anastomosis for ulcerative colitis. Dig Dis Sci 1984;29:570–572.
18.
Hightower HC Jr, Broders AC Jr, Haines RC, et al: Chronic ulcerative colitis. II. Complications. Am J Dig Dis 1958;3:861–876.
19.
Spencer JA, Kirsner JB, Mlynaryk P, Reed P, Palmer WL: Immediate and prolonged therapeutic effects of corticotrophin and adrenal steroids in ulcerative colitis: Observations in 340 cases for periods up to ten years. Gastroenterology 1962;42:113–129.
20.
Wright R, Lumsden K, Luntz MH, et al: Abnormalities of the sacro-iliac joints and uveitis in ulcerative colitis. Q J Med 1965;34:229–236.
21.
Andreyev HJ, Kamm MA, Forbes A, Nichols RJ: Joint symptoms after restorative proctocolectomy in ulcerative colitis and familial polyposis coli. J Clin Gastroenterol 1996;23:35–39.
© 2001 S. Karger AG, Basel
2001
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.