Abstract Background Inflammatory Bowel Disease (IBD) is increasingly recognized as a systemic disorder, given its high prevalence of extra-intestinal manifestations (EIM) affecting various organs. The frequency of these manifestations varies depending on factors such as geographical region, IBD subtype, disease location, disease duration, and the timeliness of diagnosis, yet data on this topic remain limited in Latin America. This study aimed to assess the prevalence of the primary EIMs in IBD patients in Colombia, as well as to examine differences between Crohn's disease (CD) and ulcerative colitis (UC). Methods Prospective observational descriptive multicenter study in adult and pediatric patients with IBD of the Colombian IBD Foundation, with suspicious of EIM and after confirmed with by a multidisciplinary group in Colombia. Results A total of 266 out of 482 (55.1%) patients with inflammatory bowel disease (IBD) were suspected of having extra-intestinal manifestations (EIM) by their gastroenterologists, of which 197 (74.1%) were confirmed upon evaluation by a multidisciplinary team, resulting in an EIM prevalence of 40.9%, with a predominance of female patients (67.5%). Of the cohort, 95% were adults and 5% were pediatric patients, with 134/197 (68%) diagnosed with ulcerative colitis (UC) and 63/197 (32%) with Crohn's disease (CD), 49.2% of whom required biologic therapy. In UC patients, extensive colitis (E3) was the most common disease extension, while ileo-colonic (L3) involvement predominated in CD. The most frequent types of EIM were articular (36%), followed by cutaneous (34.5%) and ocular (24.9%) manifestations. The hospitalization rate due to IBD was 72.5%, with EIM present in 37.5% of UC patients and 52.5% of CD patients (Figure 1). Hepatobiliary manifestations (odds ratio [OR] = 1.931; 95% confidence interval [CI] 0.4311-13.66, p=0.44) were more common in UC compared to CD, whereas articular (OR=2.277; 95% CI 1.228-4.22), cutaneous (OR=1.027; 95% CI 0.5474-1.925), oral (OR=2.017; 95% CI 0.8727-4.661), and ocular (OR=2.683; 95% CI 1.374-5.23) manifestations were more frequent in CD (Figure 1). In terms of the number of EIMs, 71.5% of UC patients had one, 16% had two, and 12.5% had three or more, while in CD, 50.7% had one, 27% had two, and 22.2% had three or more. A higher prevalence of EIM was observed in the central region of the country (Figure 2). Conclusion The prevalence of EIM in this Colombian cohort was high (40,9%), predominating the CD, female, extensive disease and higher requirement for biologicals.