International Journal of Innovative Research in Medical Science (IJIRMS) Volume 08, Issue 03, March 2023, https://doi.org/10.23958/ijirms/vol08-i03/1644 www.ijirms.in 107 Original article Skin Biopsies in Gastrointestinal Diseases: A Single Centre Experience from North India Nadia Shirazi *1 , Rashmi Jindal 2 , Sohaib Ahmad 3 1 Professor Department of Pathology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, Uttarakhand, India. 2 Professor Department of Dermatology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University; Jolly Grant, Dehradun, Uttarakhand, India. 3 Professor Department of General Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, Uttarakhand, India. *Corresponding Author: Dr. Nadia Shirazi; shirazinadia@gmail.com Received 22 February 2023; Accepted 15 March 2023; Published 18 March 2023 Abstract Skin manifestations have always been alarming to the patient and often warrant complete clinical evaluation. A thorough understanding of relationship between gastrointestinal (GI) disorders and skin diseases can alert the clinician to an underlying occult GI disorder. The aim of the study was to review the cutaneous changes in patients with co-existent, often masked GI diseases and to observe the underlying pathophysiology of such lesions. This was a retrospective, record based observational study. The archived histopathology reports & medical records of patients over a period of 5 years were searched and all patients who underwent skin biopsy with co-existent GI diseases were included. Out of a total of 218 patients of GI diseases who had dermatological manifestations, only 44 were biopsied. Pruritis (n=175), koilonychia (n=52) and erythematous rash (n=35) were the most common clinical features. Psoriasis (n=4), vasculitis (n=4), Dermatitis Herpetiformis (n=3) and pyoderma gangrenosum (n=5) were often seen associated with benign GI diseases like Inflammatory Bowel Diseases, Chronic Liver Disease, Malabsorption syndrome etc. Sweets syndrome (n=2) and cutaneous metastatic nodules (n=3) were associated with underlying malignancy particularly of gall bladder and pancreas. Keywords: skin biopsy, gastrointestinal disorders, cutaneous manifestations, benign, malignant. Introduction Skin is the largest organ of the human body and reflects the state of functioning of our organs [1] . There are numerous disorders in the gastrointestinal tract (Inflammatory Bowel Disease (IBD), celiac disease, gastritis, pancreatitis etc.) as well as chronic liver diseases which can cause cutaneous manifestations [2] . The proposed pathophysiology suggests there is a loss of equilibrium between host defense and tolerance, leading to overactivity of some immune pathways. There may also be an underlying genetic linkage responsible for the cutaneous disease. The immune dysregulation results in a lymphocyte mediated destructive process [3] . Both Dermatologists and Gastroenterologists should be aware of the cutaneous manifestations as these may be the first alarm of underlying liver or gastrointestinal (GI) disease and may even be more debilitating than the underlying disease itself. Dermatological manifestations can increase the risk of developing other extra- intestinal manifestations as well, all of which increase morbidity and mortality in GI disease. Hence early diagnosis and appropriate therapeutic intervention is warranted in such cases [4] . These findings will also help other family members who may need appropriate screening tests and genetic counseling [5] . The present study lays stress on cutaneous manifestations in various gastro-intestinal and hepatobiliary diseases in patients attending a tertiary referral centre of North India. The aim of this study is to document the spectrum of cutaneous lesions in patients of gastro-intestinal diseases and to observe the clinical presentation and histopathological diagnosis of all patients in the study group. Material and Methods This was a retrospective medical record based observational study carried out in the Department of Pathology during January 2016 and January 2021 (5 years). All biopsied patients attending Dermatology OPD who were having a co-existent gastrointestinal disorder (like gastritis, diarrhoea, Jaundice, loose stools etc.) in the study duration were studied whereas patients who had co-existent primary skin disease elsewhere were excluded. The hospital records of all the patients fulfilling the inclusion criteria were analyzed and their clinical features, and demographic details were compiled. Histopathological findings of skin biopsy were tabulated. Results A total of 218 patients of various GI disorders attended the Medicine/Gastroenterology/Dermatology OPD with co-existent