Gastroparesis induced by glucagon-like peptide-1 receptor agonists: A systematic review of clinical features, diagnosis, management, and outcomes.

Crohn’s disease (CD) is a chronic inflammatory condition of the gastrointestinal tract, characterized by its potential to cause progressive bowel damage and disability (). The prevalence of CD is increasing, with approximately one million individuals affected in the United States alone (). Due to its relapsing systemic inflammatory nature, patients with CD frequently report extraintestinal manifestations (EIMs) (). Compared with patients with ulcerative colitis (UC), those with CD exhibit a higher prevalence of EIMs, ranging from 6% to 47%; these manifestations significantly impact morbidity and quality of life (; ). In CD, EIMs commonly involve the musculoskeletal system (e.g., peripheral and axial arthritis, enthesitis), skin (e.g., pyoderma gangrenosum (PG), erythema nodosum (EN), Sweet syndrome, aphthous stomatitis), hepatobiliary tract (e.g., primary sclerosing cholangitis (PSC)), and eyes (e.g., episcleritis, anterior uveitis, iritis) (). However, nearly any system, including hematological, cardiovascular, respiratory, and central nervous systems, can be involved (). EIMs are generally considered to occur either in parallel with intestinal disease activity or as independent phenomena unrelated to intestinal inflammation (). Notably, approximately 25.8% of patients develop EIMs prior to the onset of inflammatory bowel disease (IBD), and the presence of a single EIM is reported to increase the likelihood of developing additional EIMs (; ). The pathophysiological mechanisms underlying EIMs remain incompletely elucidated. Potential contributing factors may include the extension of immune-mediated responses from the inflamed gastrointestinal tract to other organ systems, alterations in leukocyte trafficking, modifications of the intestinal microbiota, and inherent genetic predisposition (; ; ). A cohort study observed that tumor necrosis factor (TNF) antagonists were generally effective for psoriasis, aphthous stomatitis, uveitis, and peripheral arthritis (). For patients with CD and EIMs, TNF antagonists are commonly preferred by gastroenterologists, and the ECCO guidelines recommend the use of TNF antagonists for CD patients with several EIMs (). However, prolonged use of TNF antagonists is associated with an increased risk of infections, loss of response, and treatment failure. Exploring diverse biologic therapies for treating EIMs in CD offers patients a wider range of therapeutic options ().