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Brain & Heart Neurologic manifestations of IBD

1. Introduction further attention and research. Understanding the full
spectrum of these manifestations, their pathophysiology,
Inflammatory bowel diseases (IBD), such as primarily and effective management strategies is essential for
comprising Crohn’s disease (CD) and ulcerative colitis (UC), improving patient outcomes and quality of life. This review
are chronic inflammatory conditions of the gastrointestinal will explore the spectrum of neurological manifestations
(GI) tract characterized by an inappropriate immune associated with IBD, delving into their epidemiology,
response to intestinal flora. IBD is known to affect about pathophysiology, clinical presentations, and management
1
1.6 million Americans, with approximately 70,000 new challenges.
cases diagnosed each year. While the intestinal symptoms of
IBD are well-documented, the neurological manifestations 1.1. Epidemiology
are less commonly discussed but are increasingly The epidemiology of neurological manifestations in IBD
recognized as significant factors contributing to the overall
disease burden. These neurological complications involve is varied, with reported incidences ranging from 0.25%
2
both the central nervous system (CNS) and the peripheral to 47.5%. This wide range likely reflects differences in
nervous system (PNS), presenting a wide range of clinical study designs, populations, and diagnostic criteria. Lossos
4
challenges that may be directly or indirectly related to the et al. reported neurological involvement in 3% of 638 IBD
patients, whereas in 26% of cases, this complication arose
underlying inflammatory processes of IBD. 2
up to 10 years before the onset of intestinal symptoms, and
The prevalence of neurological manifestations in IBD in all other patients, it emerged up to 12 years after the
is reported to be higher than previously estimated, with onset of IBD. This complication was associated with IBD
recent studies suggesting a range from 0.25% to 47.5% exacerbation in only 10% of cases, and 53% of these patients
of patients experiencing some form of neurological also presented with other extraintestinal manifestations
3
complications. This wide range likely reflects variations and complications. In another study, 67% of patients with
4
in study populations, methodologies, and definitions CD and 53% of patients with UC had neurologic disorders.
5
of neurological involvement. The manifestations can Elsehety and Bertorini reported a 33.2% incidence of
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be broadly categorized into cerebrovascular diseases, neurological and neuropsychiatric manifestations in
peripheral neuropathies, muscle diseases, and other less 253 patients with pathologically confirmed CD. Two
common conditions such as multiple sclerosis (MS) and prospective studies found the prevalence of peripheral
myasthenia gravis (MG). neuropathy to be 13.4% and 8.8%. Asymptomatic
7,8
Cerebrovascular complications are among the focal brain white matter lesions were also found in the
most serious neurological manifestations associated neuroimaging studies using magnetic resonance imaging
with IBD. Patients with IBD are at an increased risk of (MRI) in IBD patients compared to healthy people (43.1%
thromboembolic events, including stroke, particularly vs. 16.0%; relative risk 2.6, 95% confidence interval 1.3
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during periods of active disease. Peripheral neuropathies – 5.3). A recent small study utilizing diffusion tensor
represent another common neurological issue in IBD, imaging and voxel-based morphometry found that IBD
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with a variety of presentations ranging from sensorimotor patients also present with gray matter atrophy. There has
polyneuropathy to mononeuritis multiplex and autonomic been a surge in the interest for neurological complications
neuropathy. The pathophysiology behind these conditions after the introduction of anti-tumor necrosis factor alpha
is complex, involving a combination of immune-mediated (TNFα) and anti-α4 integrin therapy to clinical practice.
damage, nutritional deficiencies, and possibly neurotoxic Although relatively rare, these complications could be
effects triggered by medications commonly used in IBD severe and include cerebrovascular, peripheral, and
treatment, such as metronidazole. 2 central demyelinating events, and progressive multifocal
leukoencephalopathy (PML). Neurological complications
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The management of neurological manifestations in are considered relatively rare but are significant due to
IBD requires a multidisciplinary approach, involving their potential impact on morbidity and quality of life. For
gastroenterologists, neurologists, and other specialists. The instance, peripheral neuropathy is one of the more common
goals of management include controlling the underlying neurological complications, while more severe conditions
IBD activity, treating specific neurological symptoms, and such as cerebrovascular diseases and CNS infections are
adjusting IBD therapies to minimize adverse effects on the less frequent but can be life-threatening. Moreover, the
nervous system. This comprehensive approach is essential presence of neurological signs may exacerbate during the
for improving patient outcomes and quality of life. flare or evolve independently from intestinal manifestation
Therefore, neurological manifestations in IBD without responding to the treatment for the underlying
represent a critical aspect of the disease that requires disease.

Volume 2 Issue 4 (2024) 2 doi: 10.36922/bh.3486