Stroke and idiopathic inflammatory bowel diseases

Created 16/02/2023, last revision 24/06/2023

  • idiopathic inflammatory bowel diseases (IBDs) are chronic, medically incurable inflammatory disorders of the gastrointestinal (GI) tract with unknown etiopathogenesis. In general, idiopathic IBDs include these forms:
    • ulcerative colitis (UC) – transmural segmental involvement
    • Crohn’s disease (CD) – superficial inflammation without T-cell activation, humoral mechanisms predominate
    • IBD-unclassified (IBD-U)
  • the incidence and prevalence of IBD are increasing around the world
  • IBDs are associated with an increased risk of thromboembolic events (including stroke)  (Sun, 2023)
    • meta‐analysis indicates that IBD was associated with an increased risk of stroke (OR/RR = 1.21, 95% CI 1.08 to 1.34, I 2 = 83.6%, p < .001)  (Chen, 2021)
    • the study also showed that CD was more relevant to the risk of stroke than UC
    • increased risk of stroke is probably related to inflammatory mechanisms (elevated CRP), as it is also associated with other systemic diseases such as psoriasis, systemic sclerosis, and systemic lupus erythematosus (SLE)
  • diagnosis is based on the following:
    • clinical presentation
    • endoscopic and radiologic findings
    • histology
Crohn disease

Etiopathogenesis of complications

  • systemic inflammation with the production of cytokines and free oxygen radicals
  • the exact etiology of IBD remains unclear; epidemiologic data suggest that multiple risk factors are associated with IBD, including diet, smoking, and genetic factors
  • probable mechanisms increasing the risk of stroke and other CV diseases include:

Clinical presentation

Extraintestinal non-thrombotic symptoms

  • non-neurological
    • arthritis
    • sclerosing cholangitis
    • gluten-sensitive enteropathy
  • neurological
    • peripheral neuropathies
    • myelopathy
    • myasthenia gravis

Extraintestinal thrombotic symptoms

  • deep vein thrombosis and/or pulmonary embolism (VTE)
    • venous thrombosis of atypical localization (mesenteric, etc.)
  • stroke and cerebral venous sinus thrombosis (CVST)
    • mostly due to hypercoagulable state
    • vasculitis is rare


Acute stroke management

Stroke prevention

  • the mainstay of prevention is the compensation for the inflammatory disease + treatment of traditional vascular risk factors
  • low-dose anticoagulation or antiplatelet therapy reduces the risk of thromboembolism but increases the risk of bleeding
  • start vitamin supplementation in case of hyperhomocysteinemia → see here

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Stroke and idiopathic inflammatory bowel diseases (IBDs)