(28-05-12) Neurologic complications in patients with inflammatory bowel disease: Increasing relevance in the era of biologics.

Singh S, Kumar N, Loftus EV Jr, Kane SV.
Source
Division of Gastroenterology and Hepatology, Department of Internal Medicine,
Mayo Clinic, Rochester, Minnesota.
Abstract
Extraintestinal manifestations of inflammatory bowel disease (IBD) can involve
almost every organ system. Neurologic complications are not infrequent in
patients with IBD, but are poorly recognized and underreported.
Pathophysiologically, these may represent immune-mediated phenomenon,
nonimmunologic complications due to micronutrient deficiencies,
thromboembolism, or be medication-induced. Peripheral neuropathy is the most
common neurologic complication of IBD and may be immune-mediated, or caused by
therapy with anti-tumor necrosis factor-alpha (TNF-?) therapy or metronidazole.
Multiple sclerosis occurs with a greater frequency in patients with IBD. Anti-
TNF-? therapy can cause neurologic disease characterized by central
demyelination that mimics multiple sclerosis. Hence, patients with a history of
demyelinating diseases or with symptoms of polyneuropathy should be carefully
evaluated before initiation of anti-TNF-? therapy. Natalizumab has been
associated with fatal progressive multifocal leukoencephalopathy due to
reactivation of JC virus, and occurs with greater frequency in patients with
previous JC virus infection. Stroke secondary to venous or arterial
thromboembolism can be seen in patients with active Crohn's disease. It is
important for gastroenterologists to be aware of the neurologic complications
in patients with IBD. Neurologic symptoms in these patients should be promptly
evaluated. (Inflamm Bowel Dis 2012;).
Copyright ? 2012 Crohn's & Colitis Foundation of America, Inc.

Source: Inflamm Bowel Dis. 2012 May 2. doi: 10.1002/ibd.23011. [Epub ahead of print]

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