Extraintestinal manifestations of pediatric inflammatory bowel disease in Saudi Arabia.

Abstract

I refer to the interesting study by Alreheili et al.[1] published in this Journal. It is well‐known that inflammatory bowel disease (IBD) is associated with a variety of extraintestinal manifestations (EIMs) that could produce greater morbidity than the underlying intestinal disease and might even be the initial presentation of IBD. The authors mentioned that during the 10‐year study period (2001–2011) in a single‐center in the Kingdom of Saudi Arabia (KSA), EIMs were reported in 21 (31.8%) of 66 patients.[1] These included osteoporosis/osteopenia (n = 11), peripheral joint inflammation (n = 9), primary sclerosing cholangitis (n = 5), erythema nodosum (n = 2), sacroiliitis (n = 2), ankylosing spondylitis (n = 2), pyoderma gangrenosum (n = 1), and uveitis/episcleritis (n = 1).[1] Interestingly, this reported prevalence of EIMs appeared higher than that previously reported in KSA. For instance, Hasosah et al.[2] reported that during the 7‐year study period (2005–2012) in a single center, only one child (8%) with skin involvement (pyoderma gangrenosum) was observed among 12 pediatric IBD patients. AlSaleem et al.[3] noted that during the 9‐year study period (2003–2012) involving 188 pediatric IBD patients from 15 medical centers from different regions in KSA, EIMs were reported in only 6 (4%) patients, namely arthritis (n = 3) and skin rash (n = 3). I presume that the differences in the reported prevalence and pattern of EIMs in the study by Alreheili et al.[1] and that reported in other Saudi studies[2,3] could be plausibly explained by a number of factors.