Is There a Way to Break the Glass Ceiling in the Diagnosis and Treatment of Extraintestinal Manifestations (EIMs) in the Course of Inflammatory Bowel Diseases? A Comprehensive Review of Diagnosis, Pathophysiology, and Treatment of EIM.

Inflammatory bowel diseases (IBDs), particularly Crohn's disease (CD) and ulcerative colitis (UC), are chronic disorders that affect not only the gastrointestinal tract but also other organ systems through extraintestinal manifestations (EIMs). It is estimated that EIM may occur in up to half of all patients, with at least two different EIM present in 20% of cases and preceding the diagnosis of IBD by approximately five months in 26% of cases. The most frequently reported manifestations include dermal lesions, spondyloarthropathy, and hepatobiliary disorders, although ocular involvement is also observed, significantly impairing patients' daily functioning. Given the profound impact on quality of life (QoL) and the associated diagnostic challenges, this article provides an overview of the epidemiology, pathophysiological mechanisms, and current diagnostic and therapeutic strategies for EIM. Special emphasis is placed on the importance of early recognition and coordinated, multidisciplinary care involving gastroenterology, rheumatology, dermatology, ophthalmology, and other specialties. The roles of genetic, immunological, and environmental factors in the development of these complications are also discussed, along with recent therapeutic advances, including biologics and small molecules. Future directions highlight the need for multicenter studies aimed at improving both prophylactic and therapeutic strategies. This comprehensive narrative review aims to summarize current evidence on the epidemiology, pathophysiology, diagnosis, and treatment of extraintestinal manifestations in IBD, with particular emphasis on their early recognition, multidisciplinary management, and clinical implications. We also discuss emerging therapeutic strategies, screening and referral approaches, and areas requiring further research.