Burden of extraintestinal manifestations and comorbidities in treated and untreated ulcerative colitis and Crohn’s disease: a Latvian nationwide prescription database study 2014–2019

Inflammatory bowel diseases (IBD) are frequently accompanied by extraintestinal manifestations (EIMs) due to systemic autoimmune processes, which are important in the management of IBD patients and their long-term outcomes. The aim of the study was to determine the occurrence of EIMs comorbidities and their burden in IBD patients, based on the Latvian nationwide reimbursed prescription database from 2012 till 2019. Incident Crohn’s disease (CD) and ulcerative colitis (UC) patients between 2014 and 2018 were matched on age and sex with non-treated IBD controls and followed up until 2019. EIMs were selected based on a previously used methodology and grouped into organ systems. The cohort was tested for differences in the timing and occurrence of EIMs, as well as overall cumulating disease burden. The study population included 187 CD and 1137 UC patients. Higher prevalence of EIMs was observed in untreated IBD patients, whereas in the treated IBD patient group prevalence remained numerically similar. Among treated patients, the most common EIMs affected cardiovascular, hepatopancreatobiliary, endocrine, musculoskeletal, respiratory, and the skin and intestinal tract systems, where 28.4–79.9% of IBD patients experienced these EIMs for the first time before their IBD diagnosis. The treated female IBD patients tended to have higher frequency of EIMs compared to male patients. The overall comorbidity burden trend increased with time. The study provides evidence that treated IBD patients have lower risk for EIMs/comorbidities compared to untreated IBD patients.