Incidence, Characteristics, Clinical Course, and Risk Factors of Ulcerative Colitis-related Lung Diseases

Prevalence of bronchiectasis in inflammatory bowel disease: a systematic review and meta-analysis

Objective

The aim of this study was to conduct a systematic review and meta-analysis of the incidence of inflammatory bowel disease-associated bronchiectasis (IBD-BE) and to explore the possible risk factors for IBD-BE, which could help to understand the pulmonary involvement in patients with IBD and to determine the global incidence of the disease.

Methods

We searched PubMed and EMBASE databases to identify information on the prevalence of IBD-BE among IBD patients in the published literature. Information was extracted on study design, country, year, IBD-BE testing method, IBD characteristics, number of IBD-BE cases and total number of IBD patients, and factors associated with IBD-BE. We conducted meta-analyses using random-effects or fixed-effects models to estimate the prevalence of IBD-BE among IBD patients.

Results

Out of a total of 682 studies, we identified 16 studies that reported prevalence. These studies used a heterogeneous approach to identify IBD-BE. In these 16 studies, there were 92,191 patients with IBD, of whom 372 cases of IBD-BE were identified. The results of the meta-analysis showed that the overall prevalence of IBD-BE in IBD derived from the use of a random effects model was 5.0% (95% CI 2.0-12.0%). In contrast, the prevalence of IBD-BE in studies using high-resolution chest computed tomography (HRCT) imaging was 12% (95% CI 4-39%) using a random-effects model. When only retrospective studies with sample sizes greater than 100 (n = 6) were considered, the prevalence was 1% (95% CI 0-1%). However, when only retrospective studies with sample sizes less than 100 were included (n = 4), the prevalence was 29% (95% CI 6-100%); in prospective studies (n = 6), the combined prevalence was 11% (95% CI 4-29%). we performed a subgroup analysis of the differences in the incidence of IBD-BE between the different studies, each of which we subgrouped by type of study, type of disease, duration of disease, and diagnostic modality, and the results showed no significance. Future studies should standardize methods to identify IBD-BE cases and investigate the natural history and clinical course given the relatively high prevalence among IBD.

Conclusion

In this systematic review and meta-analysis, the prevalence of IBD-BE was 12% among studies with HRCT imaging, suggesting that bronchiectasis may be an underestimated common extraintestinal manifestation of IBD. Asymptomatic patients with IBD-BE may present with abnormalities on HRCT or pulmonary function tests. Future studies should standardize methods to identify IBD-BE cases and investigate the natural history and clinical course given the relatively high prevalence among IBD.

A rare pulmonary manifestation of Crohn's disease: Acute fibrinous and organizing pneumonia presenting as multifocal nodules

Acute Fibrinous and Organizing Pneumonia (AFOP) is a rare pulmonary disease, and it has not been recorded in literature as a pulmonary manifestation of Crohn's disease. A 22-year-old individual with an extensive history of Crohn's disease presented to the hospital initially for hematochezia and diarrhea. Computed tomography of her abdomen and pelvis showed multiple pulmonary nodules bilaterally. The patient did not report cough, sputum production, or dyspnea. Autoimmune and infectious workup were overall unremarkable. A CT-guided percutaneous biopsy of a peripheral lung nodule was performed showing features consistent with AFOP. The patient was ultimately treated with a long taper of prednisone and Ustekinumab for Crohn's disease. Follow-up CT-chest showed interval reduction and improvement in lung nodules, which correlated with better control of the patient's Crohn's disease. Pulmonary manifestations of IBD are varied, including pleural disease, bronchiectasis, and organizing pneumonia. Bronchiolitis obliterans organizing pneumonia has been described more frequently in patients with ulcerative colitis compared to Crohn's. Pulmonary nodules are a rare manifestation of IBD and often tend to be granulomatous or necrobiotic. AFOP is a rare entity with no previously reported association with IBD. Secondary AFOP can be caused by autoimmune diseases, drug reactions, infections, or radiation. Treatment of AFOP is usually immunosuppression by glucocorticoids.

Pulmonary manifestation of inflammatory bowel disease: Two case reports

Pulmonary involvement associated with inflammatory bowel disease (IBD) are a rare extraintestinal manifestation (EIM) of inflammatory bowel disease (IBD), we herein presented two cases. Case 1: 53-year-old man with Crohn's disease treated with mesalazine and azathioprine. Pulmonary nodular shadows were incidentally detected on chest imaging, and revealed granulomas through transbronchial lung biopsy. Case 2: 68-year-old man with ulcerative colitis treated with mesalazine. He presented with fever and respiratory symptoms, and chest imaging showed multiple nodular infiltrates. He was diagnosed with organizing pneumonia by lung biopsy. Both cases were diagnosed to have pulmonary involvement associated with inflammatory bowel disease (IBD) according to multidisciplinary examination including positron emission tomography-computed tomography (FDG-PET) and pathological test. Pulmonary manifestations with IBD may not always require discontinuation of drugs or additional use of steroids or immunosuppressants.