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Wingfield Digby J, King J, Lord R, Smith JA, Marsden P. Chronic cough and inflammatory bowel disease: an under-recognised association? Breathe (Sheff) 2023; 19:220262. [PMID: 37378061 PMCID: PMC10292793 DOI: 10.1183/20734735.0262-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/26/2023] [Indexed: 06/29/2023] Open
Abstract
Respiratory complications of inflammatory bowel disease (IBD) are common and may be under-recognised. Chronic cough may present many years after a colectomy for IBD, is typically productive and can be very responsive to inhaled corticosteroids. https://bit.ly/3DrHNoy.
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Affiliation(s)
- James Wingfield Digby
- The University of Manchester, Faculty of Allergy, Immunology and Respiratory Medicine, Wythenshawe Hospital, Wythenshawe, Manchester, UK
- Manchester University NHS Foundation Trust, North West Lung Centre, Wythenshawe Hospital, Wythenshawe, Manchester, UK
| | - Jenny King
- The University of Manchester, Faculty of Allergy, Immunology and Respiratory Medicine, Wythenshawe Hospital, Wythenshawe, Manchester, UK
- Manchester University NHS Foundation Trust, North West Lung Centre, Wythenshawe Hospital, Wythenshawe, Manchester, UK
| | - Robert Lord
- Manchester University NHS Foundation Trust, North West Lung Centre, Wythenshawe Hospital, Wythenshawe, Manchester, UK
| | - Jaclyn Ann Smith
- The University of Manchester, Faculty of Allergy, Immunology and Respiratory Medicine, Wythenshawe Hospital, Wythenshawe, Manchester, UK
- Manchester University NHS Foundation Trust, North West Lung Centre, Wythenshawe Hospital, Wythenshawe, Manchester, UK
| | - Paul Marsden
- Manchester University NHS Foundation Trust, North West Lung Centre, Wythenshawe Hospital, Wythenshawe, Manchester, UK
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2
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Corriero A, Gadaleta RM, Puntillo F, Inchingolo F, Moschetta A, Brienza N. The central role of the gut in intensive care. Crit Care 2022; 26:379. [PMID: 36476497 PMCID: PMC9730662 DOI: 10.1186/s13054-022-04259-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Critically ill patients undergo early impairment of their gut microbiota (GM) due to routine antibiotic therapies and other environmental factors leading to intestinal dysbiosis. The GM establishes connections with the rest of the human body along several axes representing critical inter-organ crosstalks that, once disrupted, play a major role in the pathophysiology of numerous diseases and their complications. Key players in this communication are GM metabolites such as short-chain fatty acids and bile acids, neurotransmitters, hormones, interleukins, and toxins. Intensivists juggle at the crossroad of multiple connections between the intestine and the rest of the body. Harnessing the GM in ICU could improve the management of several challenges, such as infections, traumatic brain injury, heart failure, kidney injury, and liver dysfunction. The study of molecular pathways affected by the GM in different clinical conditions is still at an early stage, and evidence in critically ill patients is lacking. This review aims to describe dysbiosis in critical illness and provide intensivists with a perspective on the potential as adjuvant strategies (e.g., nutrition, probiotics, prebiotics and synbiotics supplementation, adsorbent charcoal, beta-lactamase, and fecal microbiota transplantation) to modulate the GM in ICU patients and attempt to restore eubiosis.
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Affiliation(s)
- Alberto Corriero
- grid.7644.10000 0001 0120 3326Department of Interdisciplinary Medicine - ICU Section, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Raffaella Maria Gadaleta
- grid.7644.10000 0001 0120 3326Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Filomena Puntillo
- grid.7644.10000 0001 0120 3326Department of Interdisciplinary Medicine - ICU Section, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Francesco Inchingolo
- grid.7644.10000 0001 0120 3326Dental Medicine Section, Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Antonio Moschetta
- grid.7644.10000 0001 0120 3326Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Nicola Brienza
- grid.7644.10000 0001 0120 3326Department of Interdisciplinary Medicine - ICU Section, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
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3
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Okamoto S, Koike K, Sekiya M, Nishino K, Mimori T, Takahashi K. Late relapse of ulcerative colitis presenting as tracheobronchitis: a case report. J Med Case Rep 2022; 16:414. [PMID: 36320034 PMCID: PMC9628047 DOI: 10.1186/s13256-022-03583-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/21/2022] [Indexed: 11/07/2022] Open
Abstract
Background Lung involvement in inflammatory bowel diseases usually follows colitis. However, the time to lung involvement onset varies depending on the case, and pulmonary lesions are usually not parallel to exacerbations of the colitis. Case presentation A 67-year-old Asian woman with a 38-year history of ulcerative colitis presented to our hospital with a complaint of prolonged dry cough for 2 months. The colitis had remained quiescent for > 35 years with low-dose salazosulfapyridine treatment. Chest computed tomography indicated circumferential thickening of the tracheal wall, while bronchoscopy examination revealed widespread erythematous edema and diffuse narrowing of the bronchial lumen. Biopsy of the bronchial mucosa showed submucosal lymphocytic infiltration. She was diagnosed with ulcerative-colitis-related tracheobronchitis and successfully treated with corticosteroids. Conclusions Tracheobronchitis, in our case, occurred despite the longest remission period previously reported. Careful follow-up is necessary for the early recognition and treatment of pulmonary disease in patients with ulcerative colitis, regardless of the disease duration and long-term remission of colitis.
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Affiliation(s)
- Shouichi Okamoto
- grid.258269.20000 0004 1762 2738Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Kengo Koike
- grid.258269.20000 0004 1762 2738Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan ,Department of Respiratory Medicine, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi, Saitama 332-8558 Japan
| | - Mitsuaki Sekiya
- Department of Respiratory Medicine, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi, Saitama 332-8558 Japan
| | - Koichi Nishino
- grid.258269.20000 0004 1762 2738Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan ,Department of Respiratory Medicine, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi, Saitama 332-8558 Japan
| | - Tomoyasu Mimori
- grid.258269.20000 0004 1762 2738Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan ,Department of Respiratory Medicine, Saiseikai Kawaguchi General Hospital, 5-11-5 Nishikawaguchi, Kawaguchi, Saitama 332-8558 Japan
| | - Kazuhisa Takahashi
- grid.258269.20000 0004 1762 2738Division of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
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4
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The Spectrum of Airway Involvement in Inflammatory Bowel Disease. Clin Chest Med 2022; 43:141-155. [DOI: 10.1016/j.ccm.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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5
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Abstract
Bronchiectasis is a heterogenous disease with multiple etiologies and associated comorbidities. As bronchiectasis is a complex disease, it is unsound to think of it as a single disease particularly when the differing etiologies are likely to be driving bronchiectasis through initial divergent molecular pathways, known as endotypes, that phenotypically present as the same disease due to protracted airway inflammation, but revealing potential differing underlying mechanisms that may have disparity of drug responses. Improved understanding of the cellular immune, inflammatory, and microbiological milieu associated with clinical and radiological features of bronchiectasis has resulted in the recognition of important endotypes and phenotypes that will allow for personalized treatments to improve quality of life and outcomes of patients with bronchiectasis. Here we discuss clinical and radiological phenotypes, as well as emerging molecular endotypes that are possible treatable traits in bronchiectasis.
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Affiliation(s)
- Ricardo J José
- Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom.,Centre for Inflammation and Tissue Repair, University College London, London, United Kingdom
| | - Michael R Loebinger
- Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
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6
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Taylor MA, Zhou H, Dansie DM, Short S. Pulmonary Manifestations of Inflammatory Bowel Disease in Children. Cureus 2020; 12:e11369. [PMID: 33304702 PMCID: PMC7721074 DOI: 10.7759/cureus.11369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
The recognition of pulmonary manifestations of inflammatory bowel disease (IBD) is important as these diseases can be confused with infectious etiologies (e.g., tuberculosis or fungal infection) and, as a result, may unnecessarily delay institution of appropriate therapy (e.g., infliximab). Furthermore, they are a source of morbidity that may be overlooked and, like other IBD-related pathologies, are often responsive to treatment with corticosteroids, immunomodulators, or biologic therapies. The purpose of this paper is to describe the cases of six children at a single institution with differing presentations, treatments, and responses to treatment of their IBD-related lung disease to improve recognition of this uncommon process.
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Affiliation(s)
- Mark A Taylor
- Department of Surgery, University of Utah, Salt Lake City, USA
| | - Holly Zhou
- Department of Pathology, University of Utah, Salt Lake City, USA
| | - David M Dansie
- Department of Radiology, Primary Children's Hospital, Salt Lake City, USA
| | - Scott Short
- Department of Surgery, University of Utah, Salt Lake City, USA
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7
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Barfield E, Deshmukh F, Slighton E, Lentine J, Lu Y, Ma X, Christos P, Sockolow R, Loughlin G, Pillai S. Pulmonary Manifestations in Adolescents With Inflammatory Bowel Disease. Clin Pediatr (Phila) 2020; 59:573-579. [PMID: 32146830 PMCID: PMC8359570 DOI: 10.1177/0009922820910821] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objectives. The available literature on pulmonary disease in pediatric inflammatory bowel disease is limited. We evaluated the prevalence of pulmonary manifestations in pediatric inflammatory bowel disease and their association with disease severity. Methods. Patients completed the St. George's Respiratory Questionnaire (SGRQ), a self-reported measure of quality of life in patients with pulmonary disease. Chart review provided demographic information and Pediatric Crohn's Disease Activity Index (PCDAI) and Pediatric Ulcerative Colitis Activity Index scores. Regression models were utilized to evaluate associations between SGRQ score and clinical risk factors. Results. The prevalence of pulmonary manifestations was 9.62% (95% confidence interval = 5.48% to -15.36%). PCDAI scores in Crohn's disease patients with pulmonary symptoms were significantly higher (SGRQ mean = 10.71 ± 10.94) than in patients without such symptoms. SGRQ score was also higher in patients with indeterminate colitis (8.64, 95% confidence interval = 0.72-16.57, P = .03), when compared with Crohn's disease. Conclusions. Additional investigations including pulmonary function tests and imaging could provide further insight into this issue.
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Affiliation(s)
- Elaine Barfield
- Division of Pediatric Gastroenterology and Nutrition, New York-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Farah Deshmukh
- Division of Pediatric Gastroenterology and Nutrition, New York-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Elisabeth Slighton
- Division of Pediatric Gastroenterology and Nutrition, New York-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Jennifer Lentine
- Division of Pediatric Gastroenterology and Nutrition, New York-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Yao Lu
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY
| | - Xiaoyue Ma
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY
| | - Paul Christos
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY
| | - Robbyn Sockolow
- Division of Pediatric Gastroenterology and Nutrition, New York-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Gerald Loughlin
- Division of Pediatric Pulmonology, New York-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Sophia Pillai
- Division of Pediatrics and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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8
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Danve A. Thoracic Manifestations of Ankylosing Spondylitis, Inflammatory Bowel Disease, and Relapsing Polychondritis. Clin Chest Med 2019; 40:599-608. [PMID: 31376894 DOI: 10.1016/j.ccm.2019.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Ankylosing spondylitis, inflammatory bowel disease (IBD), and relapsing polychondritis are immune-mediated inflammatory diseases with variable involvement of lungs, heart and the chest wall. Ankylosing spondylitis is associated with anterior chest wall pain, restrictive lung disease, obstructive sleep apnea, apical fibrosis, spontaneous pneumothorax, abnormalities of cardiac valves and conduction system, and aortitis. Patients with IBD can develop necrobiotic lung nodules that can be misdiagnosed as malignancy or infection. Relapsing polychondritis involves large airways in at least half of the patients. Relapsing polychondritis can mimic asthma in some patients. Medications used to treat these inflammatory conditions can cause pulmonary complications such as infections, pneumonitis, and rarely serositis.
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Affiliation(s)
- Abhijeet Danve
- Section of Rheumatology, Department of Medicine, Yale School of Medicine, 300 Cedar Street, TACS-525, New Haven, CT 06520-8031, USA.
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9
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Chiu K, Wright JL. Large and Small Airway Disease Related to Inflammatory Bowel Disease. Arch Pathol Lab Med 2017; 141:470-473. [PMID: 28234576 DOI: 10.5858/arpa.2016-0188-rs] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although airway disease associated with inflammatory bowel disease is uncommon, its involvement may have severe clinical consequences. This article reviews the breadth of pathologic processes that can be expected in the various sizes of airways, and provides a differential diagnosis from other airway diseases that can be found in association with inflammatory bowel disease. It also makes suggestions as to how airway disease can be best differentiated by using appropriate special stains.
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Affiliation(s)
| | - Joanne Lynne Wright
- From the Department of Pathology, St Paul's Hospital, Vancouver, British Columbia, Canada
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10
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Boyton RJ, Altmann DM. Bronchiectasis: Current Concepts in Pathogenesis, Immunology, and Microbiology. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2016; 11:523-54. [PMID: 26980162 DOI: 10.1146/annurev-pathol-012615-044344] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Bronchiectasis is a disorder of persistent lung inflammation and recurrent infection, defined by a common pathological end point: irreversible bronchial dilatation arrived at through diverse etiologies. This suggests an interplay between immunogenetic susceptibility, immune dysregulation, bacterial infection, and lung damage. The damaged epithelium impairs mucus removal and facilitates bacterial infection with increased cough, sputum production, and airflow obstruction. Lung infection is caused by respiratory bacterial and fungal pathogens, including Pseudomonas aeruginosa, Haemophilus, Aspergillus fumigatus, and nontuberculous mycobacteria. Recent studies have highlighted the relationship between the lung microbiota and microbial-pathogen niches. Disease may result from environments favoring interleukin-17-driven neutrophilia. Bronchiectasis may present in autoimmune disease, as well as conditions of immune dysregulation, such as combined variable immune deficiency, transporter associated with antigen processing-deficiency syndrome, and hyperimmunoglobulin E syndrome. Differences in prevalence across geography and ethnicity implicate an etiological mix of genetics and environment underpinning susceptibility.
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Affiliation(s)
- Rosemary J Boyton
- Lung Immunology Group, Department of Medicine, Imperial College London, London W12 0NN, United Kingdom; .,Department of Respiratory Medicine, Royal Brompton & Harefield NHS Foundation Trust, London SW3 6NP, United Kingdom
| | - Daniel M Altmann
- Division of Immunology and Inflammation, Department of Medicine, Imperial College London, London W12 0NN, United Kingdom
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11
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Rodriguez-Roisin R, Bartolome SD, Huchon G, Krowka MJ. Inflammatory bowel diseases, chronic liver diseases and the lung. Eur Respir J 2016; 47:638-50. [PMID: 26797027 DOI: 10.1183/13993003.00647-2015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 11/12/2015] [Indexed: 12/12/2022]
Abstract
This review is devoted to the distinct associations of inflammatory bowel diseases (IBD) and chronic liver disorders with chronic airway diseases, namely chronic obstructive pulmonary disease and bronchial asthma, and other chronic respiratory disorders in the adult population. While there is strong evidence for the association of chronic airway diseases with IBD, the data are much weaker for the interplay between lung and liver multimorbidities. The association of IBD, encompassing Crohn's disease and ulcerative colitis, with pulmonary disorders is underlined by their heterogeneous respiratory manifestations and impact on chronic airway diseases. The potential relationship between the two most prevalent liver-induced pulmonary vascular entities, i.e. portopulmonary hypertension and hepatopulmonary syndrome, and also between liver disease and other chronic respiratory diseases is also approached. Abnormal lung function tests in liver diseases are described and the role of increased serum bilirubin levels on chronic respiratory problems are considered.
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Affiliation(s)
- Roberto Rodriguez-Roisin
- Servei de Pneumologia (Institut del Tòrax), Hospital Clínic, Institut Biomédic August Pi i Sunyer (IDIBAPS), Ciber Enfermedades Respiratorias (CIBERES), Universitat de Barcelona, Barcelona, Spain
| | - Sonja D Bartolome
- Pulmonary and Critical Care Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Gérard Huchon
- Service de Pneumologie, Université Paris 5, Paris, France
| | - Michael J Krowka
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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12
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Majewski S, Piotrowski W. Pulmonary manifestations of inflammatory bowel disease. Arch Med Sci 2015; 11:1179-88. [PMID: 26788078 PMCID: PMC4697051 DOI: 10.5114/aoms.2015.56343] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 01/03/2014] [Indexed: 02/07/2023] Open
Abstract
Bronchopulmonary signs and symptoms are examples of variable extraintestinal manifestations of the inflammatory bowel diseases (IBD). These complications of Crohn's disease (CD) and ulcerative colitis (UC) seem to be underrecognized by both pulmonary physicians and gastroenterologists. The objective of the present review was to gather and summarize information on this particular matter, on the basis of available up-to-date literature. Tracheobronchial involvement is the most prevalent respiratory presentation, whereas IBD-related interstitial lung disease is less frequent. Latent and asymptomatic pulmonary involvement is not unusual. Differential diagnosis should always consider infections (mainly tuberculosis) and drug-induced lung pathology. The common link between intestinal disease and lung pathology is unknown, but many hypotheses have been proposed. It is speculated that environmental pollution, common immunological mechanisms and predisposing genetic factors may play a role.
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Affiliation(s)
- Sebastian Majewski
- Department of Pneumology and Allergy, Medical University of Lodz, Lodz, Poland
| | - Wojciech Piotrowski
- Department of Pneumology and Allergy, Medical University of Lodz, Lodz, Poland
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13
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Papanikolaou I, Kagouridis K, Papiris SA. Patterns of airway involvement in inflammatory bowel diseases. World J Gastrointest Pathophysiol 2014; 5:560-569. [PMID: 25400999 PMCID: PMC4231520 DOI: 10.4291/wjgp.v5.i4.560] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 08/03/2014] [Accepted: 09/10/2014] [Indexed: 02/06/2023] Open
Abstract
Extraintestinal manifestations occur commonly in inflammatory bowel diseases (IBD). Pulmonary manifestations (PM) of IBD may be divided in airway disorders, interstitial lung disorders, serositis, pulmonary vasculitis, necrobiotic nodules, drug-induced lung disease, thromboembolic lung disease and enteropulmonary fistulas. Pulmonary involvement may often be asymptomatic and detected solely on the basis of abnormal screening tests. The common embryonic origin of the intestine and the lungs from the primitive foregut, the co-existence of mucosa associated lymphoid tissue in both organs, autoimmunity, smoking and bacterial translocation from the colon to the lungs may all be involved in the pathogenesis of PM in IBD. PM are mainly detected by pulmonary function tests and high-resolution computed tomography. This review will focus on the involvement of the airways in the context of IBD, especially stenoses of the large airways, tracheobronchitis, bronchiectasis, bronchitis, mucoid impaction, bronchial granulomas, bronchiolitis, bronchiolitis obliterans syndrome and the co-existence of IBD with asthma, chronic obstructive pulmonary disease, sarcoidosis and a1-antitrypsin deficiency.
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14
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Ji XQ, Wang LX, Lu DG. Pulmonary manifestations of inflammatory bowel disease. World J Gastroenterol 2014; 20:13501-13511. [PMID: 25309080 PMCID: PMC4188901 DOI: 10.3748/wjg.v20.i37.13501] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/04/2014] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Abstract
Extraintestinal manifestations of inflammatory bowel disease (IBD) are a systemic illness that may affect up to half of all patients. Among the extraintestinal manifestations of IBD, those involving the lungs are relatively rare and often overlooked. However, there is a wide array of such manifestations, spanning from airway disease to lung parenchymal disease, thromboembolic disease, pleural disease, enteric-pulmonary fistulas, pulmonary function test abnormalities, and adverse drug reactions. The spectrum of IBD manifestations in the chest is broad, and the manifestations may mimic other diseases. Although infrequent, physicians dealing with IBD must be aware of these conditions, which are sometimes life-threatening, to avoid further health impairment of the patients and to alleviate their symptoms by prompt recognition and treatment. Knowledge of these manifestations in conjunction with pertinent clinical data is essential for establishing the correct diagnosis and treatment. The treatment of IBD-related respiratory disorders depends on the specific pattern of involvement, and in most patients, steroids are required in the initial management. Corticosteroids, both systemic and aerosolized, are the mainstay therapeutic approach, while antibiotics must also be administered in the case of infectious and suppurative processes, whose sequelae sometimes require surgical intervention.
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15
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Lu DG, Ji XQ, Liu X, Li HJ, Zhang CQ. Pulmonary manifestations of Crohn’s disease. World J Gastroenterol 2014; 20:133-141. [PMID: 24415866 PMCID: PMC3886002 DOI: 10.3748/wjg.v20.i1.133] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 11/09/2013] [Accepted: 12/06/2013] [Indexed: 02/06/2023] Open
Abstract
Crohn’s disease (CD) is a systemic illness with a constellation of extraintestinal manifestations affecting various organs. Of these extraintestinal manifestations of CD, those involving the lung are relatively rare. However, there is a wide array of lung manifestations, ranging from subclinical alterations, airway diseases and lung parenchymal diseases to pleural diseases and drug-related diseases. The most frequent manifestation is bronchial inflammation and suppuration with or without bronchiectasis. Bronchoalveolar lavage findings show an increased percentage of neutrophils. Drug-related pulmonary abnormalities include disorders which are directly induced by sulfasalazine, mesalamine and methotrexate, and opportunistic lung infections due to immunosuppressive treatment. In most patients, the development of pulmonary disease parallels that of intestinal disease activity. Although infrequent, clinicians dealing with CD must be aware of these, sometimes life-threatening, conditions to avoid further impairment of health status and to alleviate patient symptoms by prompt recognition and treatment. The treatment of CD-related respiratory disorders depends on the specific pattern of involvement, and in most patients, steroids are required in the initial management.
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16
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Boyton RJ, Reynolds CJ, Quigley KJ, Altmann DM. Immune mechanisms and the impact of the disrupted lung microbiome in chronic bacterial lung infection and bronchiectasis. Clin Exp Immunol 2013; 171:117-23. [PMID: 23286938 DOI: 10.1111/cei.12003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2012] [Indexed: 12/27/2022] Open
Abstract
Recent studies analysing immunogenetics and immune mechanisms controlling susceptibility to chronic bacterial infection in bronchiectasis implicate dysregulated immunity in conjunction with chronic bacterial infection. Bronchiectasis is a structural pathological end-point with many causes and disease associations. In about half of cases it is termed idiopathic, because it is of unknown aetiology. Bronchiectasis is proposed to result from a 'vicious cycle' of chronic bacterial infection and dysregulated inflammation. Paradoxically, both immune deficiency and excess immunity, either in the form of autoimmunity or excessive inflammatory activation, can predispose to disease. It appears to be a part of the spectrum of inflammatory, autoimmune and atopic conditions that have increased in prevalence through the 20th century, attributed variously to the hygiene hypothesis or the 'missing microbiota'. Immunogenetic studies showing a strong association with human leucocyte antigen (HLA)-Cw*03 and HLA-C group 1 homozygosity and combinational analysis of HLA-C and killer immunoglobulin-like receptors (KIR) genes suggests a shift towards activation of natural killer (NK) cells leading to lung damage. The association with HLA-DR1, DQ5 implicates a role for CD4 T cells, possibly operating through influence on susceptibility to specific pathogens. We hypothesize that disruption of the lung microbial ecosystem, by infection, inflammation and/or antibiotic therapy, creates a disturbed, simplified, microbial community ('disrupted microbiota') with downstream consequences for immune function. These events, acting with excessive NK cell activation, create a highly inflammatory lung environment that, in turn, permits the further establishment and maintenance of chronic infection dominated by microbial pathogens. This review discusses the implication of these concepts for the development of therapeutic interventions.
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Affiliation(s)
- R J Boyton
- Lung Immunology Group, Section of Infectious Diseases and Immunity, Hammersmith Campus, Department of Medicine, Centre for Respiratory Infection, Imperial College London, UK.
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17
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Tillie-Leblond I, Crestani B, Perez T, Nunes H. [The distal airways in systemic disease]. Rev Mal Respir 2012; 29:1254-63. [PMID: 23228682 DOI: 10.1016/j.rmr.2012.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 08/07/2012] [Indexed: 01/06/2023]
Abstract
The association of inflammatory involvement of the distal airways or bronchiolitis and systemic diseases is essentially observed in Sjögren's syndrome, rheumatoid arthritis and chronic inflammatory bowel disease. Bronchiolitis may be mainly cellular in nature, often involving lympho-monocytic cells, and sometimes associated with lymphoid follicles, as in Sjögren's syndrome. It may also, particularly in rheumatoid arthritis, be constrictive, with peribronchiolar fibrosis. This type is associated with a worse prognosis, with possible progression to chronic respiratory insufficiency. The diagnosis of bronchiolitis should be suspected in any atypical form of asthma, or recurrent "bronchitis", and it is essential to look for extrarespiratory symptoms and auto-antibodies to establish the diagnose of systemic disease. The CT appearances coupled with the evaluation of pulmonary function parameters usually lead to the diagnosis. In severe and/or rapidly progressive cases treatment-combining corticosteroids with immunosuppressive drugs may be prescribed, but often with disappointing results. In these cases, lung transplantation should be considered in young patients.
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Affiliation(s)
- I Tillie-Leblond
- Service de Pneumologie et D'immuno-Allergologie, Hôpital Calmette, Institut Pasteur de Lille, Université de Lille II et CHRU, France.
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The immune response and its therapeutic modulation in bronchiectasis. Pulm Med 2012; 2012:280528. [PMID: 23094149 PMCID: PMC3474275 DOI: 10.1155/2012/280528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 09/04/2012] [Indexed: 12/22/2022] Open
Abstract
Bronchiectasis (BC) is a chronic pulmonary disease with tremendous morbidity and significant mortality. As pathogen infection has been advocated as a triggering insult in the development of BC, a central role for the immune response in this process seems obvious. Inflammatory cells are present in both the airways as well as the lung parenchyma, and multiple mediators of immune cells including proteases and cytokines or their humoral products are increased locally or in the periphery. Interestingly, a defect in the immune system or suppression of immune response during conditions such as immunodeficiency may well predispose one to the devastating effects of BC. Thus, the outcome of an active immune response as detrimental or protective in the pathogenesis of BC may be dependent on the state of the patient's immunity, the severity of infection, and the magnitude of immune response. Here we reassess the function of the innate and acquired immunity in BC, the major sites of immune response, and the nature of the bioactive mediators. Furthermore, the potential link(s) between an ongoing immune response and structural alterations accompanying the disease and the success of therapies that can modulate the nature and extent of immune response in BC are elaborated upon.
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Gut G, Sivan Y. Respiratory Involvement in Children with Inflammatory Bowel Disease. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2011; 24:197-206. [DOI: 10.1089/ped.2011.0086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Guy Gut
- Department of Pediatric Pulmonology, Critical Care and Sleep Medicine, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yakov Sivan
- Department of Pediatric Pulmonology, Critical Care and Sleep Medicine, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Respiratory involvement in inflammatory bowel diseases. Multidiscip Respir Med 2010; 5:173-82. [PMID: 22958334 PMCID: PMC3463044 DOI: 10.1186/2049-6958-5-3-173] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 04/15/2010] [Indexed: 12/21/2022] Open
Abstract
Inflammatory bowel diseases (IBD) include ulcerative colitis (UC) and Crohn's disease (CD) and are due to a dysregulation of the antimicrobial defense normally provided by the intestinal mucosa. This inflammatory process may extend outside the bowel to many organs and also to the respiratory tract. The respiratory involvement in IBD may be completely asymptomatic and detected only at lung function assessment, or it may present as bronchial disease or lung parenchymal alterations. Corticosteroids, both systemic and aerosolized, are the mainstay of the therapeutical approach, while antibiotics must be also administered in the case of infectious and suppurative processes, whose sequels sometimes require surgical intervention. The relatively high incidence of bronchopulmonary complications in IBD suggests the need for a careful investigation of these patients in order to detect a possible respiratory involvement, even when they are asymptomatic.
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Bachmann O, Länger F, Rademacher J. [Pulmonary manifestations of inflammatory bowel disease]. Internist (Berl) 2010; 51 Suppl 1:264-8. [PMID: 20107759 DOI: 10.1007/s00108-009-2504-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pulmonary disease is a rare complication of inflammatory bowel disease. Airway inflammation, interstitial lung disease and several other manifestations have been described, and typical symptoms are productive cough, chest pain, and progressive dyspnea. Due to the frequency of preceding pulmonary disease and the common temporal dissociation regarding intestinal disease, pulmonary manifestations of inflammatory bowel disease are at high risk of being overlooked. If suspected, early work-up including CT scan and bronchoscopy should be initiated, since the natural course often involves rapidly progressive lung damage. The best therapeutic results have been obtained with topic and systemic steroids, while classic immunosuppressants are commonly not efficacious. Several case reports describe a beneficial effect of infliximab.
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Affiliation(s)
- O Bachmann
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Deutschland.
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Tzanakis NE, Tsiligianni IG, Siafakas NM. Pulmonary involvement and allergic disorders in inflammatory bowel disease. World J Gastroenterol 2010; 16:299-305. [PMID: 20082474 PMCID: PMC2807949 DOI: 10.3748/wjg.v16.i3.299] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) has been associated with either clinical or subclinical airway and parenchymal lung involvement and interstitial lung complications. Several studies have reported that atopy has a high prevalence in IBD patients. Overlapping allergic disorders seem to be present in both the respiratory and gastrointestinal systems. The purpose of this review is to update clinicians on recent available literature and to discuss the need for a highly suspicious approach by clinicians.
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Moon E, Gillespie CT, Vachani A. Pulmonary complications of inflammatory bowel disease: focus on management issues. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2009. [DOI: 10.1016/j.tgie.2009.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Raj AA, Birring SS, Green R, Grant A, de Caestecker J, Pavord ID. Prevalence of inflammatory bowel disease in patients with airways disease. Respir Med 2008; 102:780-5. [PMID: 18321696 DOI: 10.1016/j.rmed.2007.08.014] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2007] [Revised: 08/28/2007] [Accepted: 08/30/2007] [Indexed: 12/12/2022]
Abstract
BACKGROUND Case reports and case series have suggested an association between inflammatory bowel disease (IBD) and airways disease, but there are no data demonstrating a higher prevalence of IBD among patients with airways disease. Furthermore, no consistent radiological, pulmonary or pathological abnormalities have been demonstrated in patients with both conditions. AIMS To determine the prevalence of IBD among patients with airways disease and to evaluate clinical and pathophysiological features. METHODS A retrospective analysis of outpatients with airways disease over a 10-year period. RESULTS IBD was four times more prevalent among patients with airways disease compared with published local IBD prevalence [Odds Ratio 4.26, 95% CI 1.48, 11.71, p=0.006; Crohn's disease OR 5.96, 95% CI 1.94, 18.31, p=0.002 and ulcerative colitis OR 4.21, 95% CI 1.71, 10.41, p=0.001]. IBD was more frequent in all types of airways disease except asthma; the association was particularly strong for conditions associated with productive cough. All except 1 patient had established IBD before the onset of respiratory symptoms. There were no obvious radiological differences between ulcerative colitis and Crohn's disease cases. There was a trend for a higher lymphocyte count (despite a tendency to lower blood lymphocyte count) but lower sputum neutrophil count in patients with Crohn's disease compared with ulcerative colitis. There were no significant differences in physiological measurements of pulmonary function between the two types of IBD. CONCLUSION Our findings support an association between airways disease and inflammatory bowel disease, particularly non-asthmatic airways disease with productive cough.
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Affiliation(s)
- A A Raj
- Department of Respiratory Medicine, Institute for Lung Health, Glenfield Hospital, Leicester, LE3 9PQ, UK.
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Aspiration, Bronchial Obstruction, Bronchiectasis, and Related Disorders. DAIL AND HAMMAR’S PULMONARY PATHOLOGY 2008. [PMCID: PMC7121473 DOI: 10.1007/978-0-387-68792-6_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The conducting airways play a pivotal role in the spectrum of pulmonary pathology, not only as conduits for injurious agents to enter the lung, but also as an anatomic compartment that is affected by a diverse array of primary or secondary bronchocentric diseases. This chapter discusses aspiration and bronchial obstruction in detail, with emphasis on the aspiration of toxic, infective, or particulate matter. Lung abscess, a frequent complication of obstruction or aspiration, is also reviewed. Both aspiration and lung abscess are reconsidered within the context of pulmonary infectious disease mainly in Chapter 8 on bacterial infections, and to some extent in the chapters on mycobacterial (Chapter 9), fungal (Chapter 10), and parasitic diseases (Chapter 14).
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Abstract
BACKGROUND A growing number of case reports suggest that pulmonary disease occurs in association with inflammatory bowel disease (IBD) more frequently than previously recognized. Screening studies have also identified pulmonary abnormalities in a significant proportion of IBD patients. METHODS A focused literature review of respiratory abnormalities in IBD patients and 55 English-language case series documenting 171 instances of respiratory pathology in 155 patients with known IBD. RESULTS Screening studies using respiratory symptoms, high-resolution CT, and pulmonary function testing support a high prevalence of respiratory abnormalities among patients with IBD. Case reports and series document a spectrum of respiratory system involvement that spans from larynx to pleura, with bronchiectasis as the single most common disorder. IBD patients have a threefold risk of venous thromboembolism, and recent investigations have also revealed possible ties between IBD and other diseases involving the respiratory system, including sarcoidosis, asthma, and alpha(1)-antitrypsin deficiency. CONCLUSION Respiratory symptoms and diagnosed respiratory system disorders are more common among patients with IBD than generally appreciated. The spectrum of respiratory disorders occurring among patients with IBD is very broad. Diseases of the large airways are the most common form of involvement, with bronchiectasis being the most frequently reported form of IBD-associated lung disease.
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Affiliation(s)
- Hugh Black
- Department of Internal Medicine, University of California at Davis School of Medicine, Sacramento, CA 95817, USA
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Jain R, Scheurich D, Lindberg GM, Girod CE. Bronchorrhoea complicating inflammatory bowel disease. Thorax 2006; 61:1014. [PMID: 17071842 PMCID: PMC2121181 DOI: 10.1136/thx.2005.057554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- R Jain
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX 75390-9034, USA
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Abstract
Respiratory involvement in ulcerative colitis is exceptional. Respiratory symptoms may develop during the disease course, particularly after colectomy, but can also occur prior to colitis. Chronic bronchitis and bronchial dilatation are the main respiratory manifestations. We report the case of a 43-year-old woman with an uneventful history who presented bronchiectasia which was the inaugural manifestation ulcerative colitis.
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Alcázar Navarrete B, Quiles Ruiz-Rico N, González Vargas F, Cabrera Torres L. [Bronchiectasis following colectomy in a patient with ulcerative colitis and factor V Leiden mutation]. Arch Bronconeumol 2005; 41:230-2. [PMID: 15826533 DOI: 10.1016/s1579-2129(06)60428-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
For some years it has been known that lung disease may be present in patients with inflammatory bowel disease (IBD). Diseases of the central airway, bronchi, and lung parenchyma are among the most common forms of lung involvement in IBD patients. Bronchiectasis is frequent and almost always appears after the onset of disease and in close association with inflammatory activity. However, reports of the appearance of bronchiectasis following colectomy for an exacerbation of IBD have been rare. We present the case of a 36-year-old man with severe ulcerative colitis who, following a total colectomy, developed bilateral bronchiectasis 12 months after surgery and for whom both preoperative and postoperative computed tomography scans were available.
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Affiliation(s)
- B Alcázar Navarrete
- Servicio de Neumología, Hospital Universitario Virgen de las Nieves, Granada, España.
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Alcázar Navarrete B, Quiles Ruiz- Rico N, González Vargas F, Cabrera Torres L. Bronquiectasias tras colectomía en paciente con colitis ulcerosa y mutación del factor V Leiden. Arch Bronconeumol 2005. [DOI: 10.1157/13073173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Songür N, Songür Y, Tüzün M, Doğan I, Tüzün D, Ensari A, Hekimoglu B. Pulmonary function tests and high-resolution CT in the detection of pulmonary involvement in inflammatory bowel disease. J Clin Gastroenterol 2003; 37:292-8. [PMID: 14506385 DOI: 10.1097/00004836-200310000-00006] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
GOALS To assess the pulmonary involvement detected by pulmonary function tests (PFT) and high-resolution computed tomography (HRCT) in inflammatory bowel disease (IBD) patients and to investigate the relationship of the pulmonary abnormalities with respiratory symptoms and bowel disease activity. METHODS 23 patients with ulcerative colitis, 13 patients with Crohn disease and 14 control subjects took part in this prospective, controlled study. In all patients, detailed clinical information was obtained and extent and activity of the bowel disease were established. Each patient underwent PFT and HRCT scanning. RESULTS A pulmonary function abnormality was present in 21 of 36 patients. In IBD patients, DLCO were significantly lower, but RV/TLC was significantly higher than those of controls. HRCT revealed air trapping, fibrosis, emphysema, bronchiectasis and alveolitis in 19 patients. One-third of the patients with PFT abnormality, and 42% of the patients with HRCT abnormality were respiratory symptom free. Approximately 80% of the patients with pulmonary involvement had active bowel disease. CONCLUSIONS Pulmonary involvement is common in patients with IBD. A high degree of suspicion is necessary to detect the pulmonary abnormality in IBD, because considerably large proportions of the symptom free patients have abnormal findings on HRCT and PFT.
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Affiliation(s)
- Necla Songür
- Division of Chest Disease, Cancer Research and Education Hospital, Ankara, Turkey.
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Abstract
Extraintestinal manifestations of both Crohn's disease and ulcerative colitis (UC) have been well described, although pulmonary findings are often overlooked. We summarize the experience of more than 400 cases of pulmonary manifestations of inflammatory bowel disease (IBD). These manifestations will be categorized by disease mechanism into drug-induced disease, anatomic disease, over-lap syndromes, autoimmune disease, physiologic consequences of IBD, pulmonary function test abnormalities, and nonspecific lung disease. We intend to provide the clinician with a practical working update on the spectrum of pulmonary dysfunction associated with IBD.
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Affiliation(s)
- Ian Storch
- Department of Medicine, North Shore-Long Island Jewish Health Care System, Manhasset, New York, USA.
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Koek GH, Verleden GM, Evenepoel P, Rutgeerts P. Activity related increase of exhaled nitric oxide in Crohn's disease and ulcerative colitis: a manifestation of systemic involvement? Respir Med 2002; 96:530-5. [PMID: 12194639 DOI: 10.1053/rmed.2002.1312] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Nitric oxide (NO) is an important mediator of inflammation in several pathological conditions. Patients with lung diseases, like asthma, have higher levels of exhaled NO (eNO) in active disease in comparison with healthy volunteers. Aspirated colonic gas in patients with ulcerative colitis (UC) showed more than 100 times higher levels of NO in comparison with normal subjects. Crohn's disease (CD) and UC are associated with a variety of systemic manifestations, although lung diseases as an extra-intestinal expression of inflammatory bowel disease (IBD) are not well investigated. In some studies, clinical and subclinical pulmonary abnormalities are described in active IBD as well as in the stable situation. The aim of the present study is to evaluate whether eNO is increased in patients with active IBD and to investigate whether there exists a correlation between (1) the eNO levels and the disease activity, and (2) the spirometry and the disease activity in a subgroup of patients. In 31 patients with CD (mean age 36.8 +/- 12.9 years) and 24 patients with UC (mean age 38.0 +/- 14.7 years) the Crohn's Disease Activity Index (CDAI) and Colitis Activity Index (CAI) were measured, respectively. Exhaled NO was measured with a chemiluminescence analyzer, according to standardized criteria. In a subgroup of CD patients, spirometry was also performed according to standardized criteria. The mean CDAI in CD patients was 192.4 +/- 94.3 and their mean eNO value was 13.5 +/- 4.6 ppb. For UC the mean CAI was 6.2 +/- 4.8 and the mean eNO value was 15.8 +/- 6.2 ppb. In a matched control group of 27 healthy, non-smoking volunteers (mean age of 33.7 +/- 13.2 years) the eNO was 10.2 +/- 2.5 ppb (P < 0.05 compared to CD and P < 0.01 compared to UC). There was a disease-activity-related increase of the eNO level in patients with IBD. For patients with UC the correlation coefficient (r = 0.63, P < 0.001) was more pronounced than for CD (r = 0.39, P < 0.05). In 17 patients with CD, spirometry was available at the time of the eNO measurement. We found a significant negative correlation between the CDAI and the FEV1 and FVC in these patients (r = -0.559, P = 0.02 and r = -0.634, P = 0.006, respectively). We conclude that eNO is increased in active IBD and correlates with the activity of the disease; furthermore, we found a negative correlation between spirometry and disease activity in patients with CD. These observations strengthen the arguments that IBD is a systemic disease. Further research is needed to try to explain the significance of an increased eNO in IBD.
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Affiliation(s)
- G H Koek
- Department of Gastroenterology, University Hospital Gasthuisberg, Leuven, Belgium
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Herrlinger KR, Noftz MK, Dalhoff K, Ludwig D, Stange EF, Fellermann K. Alterations in pulmonary function in inflammatory bowel disease are frequent and persist during remission. Am J Gastroenterol 2002; 97:377-81. [PMID: 11866276 DOI: 10.1111/j.1572-0241.2002.05473.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Information on the occurrence and frequency of pulmonary involvement in patients with inflammatory bowel disease (IBD) is inconsistent. The aim of this prospective study was to determine the frequency and type of pulmonary dysfunction in patients with IBD. METHODS Sixty-six patients with IBD (35 with Crohn's disease [CD] and 31 with ulcerative colitis [UC]) and 30 control patients were investigated with respect to the following pulmonary function tests: forced expiratory volume in 1 s (FEV1), inspiratory vital capacity (IVC), Tiffeneau value (FEV1/IVC), and lung CO transfer capacity (D(LCO)). Disease activity in IBD patients was assessed by the CD activity index for CD and the Truelove index for UC, respectively. Smoking habits and medication were documented in every patient. RESULTS Fourteen of 36 CD patients (39%) and 14 of 31 UC patients (45%) but only one of the controls exhibited at least one pathological (<80% of predicted value) pulmonary function test. In both CD and UC lung function tests were significantly decreased in comparison to the control group. This could be shown for FEV1 (-14% of predicted value in CD and -17% in UC, p < 0.01), IVC (-10% in CD and -12% in UC, p < 0.05), and DLCO (-20% in CD and -31% in UC, p < 0.01) without significant differences between both disease entities. The impairment of pulmonary function tests was more pronounced in patients with active disease than in those with inactive disease (FEV1, 81.4% vs 93.4% predicted, p < 0.02; IVC, 84.4% vs 93.7%, p < 0.05; DLCO, 80.4% vs 95.8%, ns). CONCLUSIONS IBD patients show significantly decreased lung function tests in comparison to healthy controls. The impairment in active disease exceeded that during remission.
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Affiliation(s)
- K R Herrlinger
- Department of Internal Medicine I, Medical University of Luebeck, Germany
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Affiliation(s)
- T V Colby
- Department of Laboratory Medicine and Pathology, Mayo Clinic Scottsdale, Arizona 85259, USA
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Affiliation(s)
- M Cohen
- Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston, SC
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