The First European Evidence-based Consensus on Extra-intestinal Manifestations in Inflammatory Bowel Disease

This is the first European Crohn’s and Colitis Organisation ECCO consensus guideline that addresses extra-intestinal manifestations EIMs in inflammatory bowel disease IBD. It has been drafted by 21 ECCO members from 13 European countries. Although this is the first ECCO consensus guideline that primarily addresses EIMs, it is partly derived from, updates, and replaces previous ECCO consensus advice on EIMs, contained within the consensus guidelines for Crohn’s disease1 CD and ulcerative colitis2 UC. The strategy to define consensus was similar to that previously described in other ECCO consensus guidelines available at www.ecco-ibd.eu. Briefly, topics were selected by the ECCO guidelines committee GuiCom. ECCO members were selected to form working groups. Provisional ECCO Statements and supporting text were written following a comprehensive literature review, then refined following two voting rounds which included national representative participation by ECCO’s 35 member countries. The level of evidence was graded according to the Oxford Centre for Evidence-based Medicine www.cebm.net. The ECCO Statements were finalised by the authors at a meeting in Vienna in October 2014 and represent consensus with agreement of at least 80% of participants. Complete consensus 100% agreement was reached for most statements. The supporting text was then finalised under the direction of each working group leader VA, SV, FC, MH before being integrated by the two consensus leaders MH, FC. This consensus guideline is pictorially represented within the freely available ECCO e-Guide http://www.e-guide.ecco-ibd.eu/. Up to 50% of patients with inflammatory bowel disease IBD experience at least one extra-intestinal manifestation EIM, which can present before IBD is diagnosed.34,5,6 EIMs adversely impact upon patients’ quality of life and some, such as primary sclerosing cholangitis PSC or venous thromboembolism VTE, can be life-threatening. The probability of developing EIMs increases with disease duration and in patients who already have one EIM.7 …