Characteristics and evolution of extraintestinal manifestations associatedwith ulcerative colitis after proctocolectomy

Aims: Describe the characteristics of extraintestinal manifestations compli cating ulcerative colitis present preoperatively and determine their evolut ion after surgery. Methods: Between 1976 and 1986, 281 patients with ulcera tive colitis exhibiting one or more extraintestinal manifestations (EIM) be fore either IPAA(n = 147), Brooke ileostomy (n = 71), Kock pouch (n = 48) o r ileorectostomy (n = 15) were assessed retrospectively. The clinical evolu tion of each manifestation was classified as having disappeared, improved, remained unchanged or aggravated postoperatively. An efficacy index was des igned 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 ascertain ed. Results: 433 EIM were observed in 281 patients. The most common were ar thralgias of the large joints (n = 146), of the sacroiliac joint (n = 59) a nd 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 m ore often in women, younger patients, than those with longer duration of di sease and the ileoanal anastomosis group. 60% had only one EIM at a time. B ased on the efficacy index, thromboembolic accidents and erythema nodosum w ere the most commonly cured or improved. Ocular manifestations and primary sclerosing cholangitis were unaffected. The other EIM responded favorably b ut variably with improvement in two thirds of patients. The presence of a r ectal 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. Copy right (C) 2001 S. Karger AG, Basel.