Extra-intestinal manifestations in inflammatory bowel disease: a comparative review of pediatric and adult-onset disease

Introduction: Inflammatory Bowel Diseases (IBD) are chronic immune-mediated disorders diagnosed in both adult and pediatric populations. In recent years, there has been a significant global increase in pediatric-onset IBD, not only in Western countries but also in newly industrialized regions. Age of onset plays a crucial role in disease behavior and prognosis, with pediatric onset often associated with a more extensive and aggressive disease. As a systemic inflammatory condition, IBD can involve multiple organ systems beyond the gastrointestinal tract, thus resulting in extraintestinal manifestations (EIMs) of variable severity. These manifestations (musculoskeletal, dermatological, oral, ocular, and hepatobiliary) may significantly impact patients’ quality of life, sometimes even more than intestinal symptoms. To support this review, a PubMed search was conducted using the terms inflammatory bowel disease, Crohn’s disease, ulcerative colitis, pediatric inflammatory bowel disease, extraintestinal manifestations, focusing on the most relevant papers with no time restrictions. Areas covered: This review aims to provide a comprehensive revision and comparison of the presentation, course, and management of EIMs in pediatric- versus adult-onset IBD. Expert opinion: A deeper understanding of EIMs in different age groups is essential for timely diagnosis and holistic care, ultimately improving the overall quality of clinical management of patients with IBD.