Correspondence Address:
Prof. Mahmood Dhahir Al-Mendalawi
Department of Paediatrics, Al-Kindy College of Medicine, University of Baghdad, P. O. Box 55302, Baghdad Post Office, Baghdad
Iraq

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Dear Editor,

I refer to the interesting study by Mohamed Abdelsalam et al.[1] published in April–June 2020 issue of the Libyan Journal of Medical Sciences. They reported extra intestinal manifestation (EIM) in 55.7% of Libyan patients with inflammatory bowel disease (IBD).[1] Its worthy to mention that it is still not obvious whether EIM is the aftermath of a shared genetic background resulting in disturbed functional immune responses to environmental stimuli or a direct consequence of the inflammatory process in the intestinal tract.[2] Worldwide, around one-third of IBD patients are affected by EIM.[3] The prevalence of EIM reported by Mohamed Abdelsalam et al.[1] was worryingly higher than that reported worldwide.[3] I presume that the following three factors could plausibly contribute to that difference in EIM prevalence.

First, there is a link between IBD severity and the risk to have EIM where sever disease is significantly associated with increased risk of EIM.[4]

Second, the duration of the IBD could influence EIM development. In general, after 10 years of IBD development, age at disease onset is not anymore correlated with disease behavior. Nevertheless, there is still a small difference in the evolution of EIM and complications.[5]

Third, the potential impacts of various environmental and genetic determinants related to Libyian population as well as unknown factors in aggravating the occurrence of EIM ought to be taken into consideration.

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Conflicts of interest

There are no conflicts of interest.

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