Synopsis
Recognise inflammatory, thrombotic, hepatobiliary, nutritional and treatment-related disease beyond the bowel, identify emergencies, and coordinate therapy that respects both intestinal and organ-specific needs.
- Extra-intestinal manifestations can involve joints, eyes, skin, liver, blood, bone, kidneys, lungs and nervous system, and some appear before IBD is diagnosed.
- Peripheral arthritis associated with active colitis may improve when bowel inflammation is controlled, whereas axial spondyloarthritis often follows an independent course and needs rheumatology care.
- A painful photophobic red eye or reduced vision is uveitis until urgently assessed; simple episcleritis is usually less painful and does not impair vision.
Key red flags
A painful photophobic red eye, reduced vision or abnormal pupil needs same-day ophthalmology assessment to prevent irreversible visual damage.
Investigation priorities
Determine whether the extra-intestinal syndrome tracks uncontrolled bowel inflammation.
Management branches
A patient with known or suspected IBD presents with a new joint, eye, skin, liver, neurological or cardiorespiratory syndrome.
- Assess vision, sepsis, joint destruction, thrombosis, biliary obstruction and neurological function first, using emergency specialist pathways when an organ is threatened.
- Relate onset to bowel symptoms, objective IBD activity, recent infection, immunosuppression, corticosteroid changes and newly introduced medicines.
Key medicines
Topical ocular corticosteroidOphthalmologist-directed preparation, frequency and taper after slit-lamp diagnosis of uveitis.
Monoclonal anti-TNF therapyLicensed specialist induction and maintenance regimen chosen for both IBD and extra-intestinal phenotype.