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Cavalli CAM, Gabbiadini R, Dal Buono A, Quadarella A, De Marco A, Repici A, Bezzio C, Simonetta E, Aliberti S, Armuzzi A. Lung Involvement in Inflammatory Bowel Diseases: Shared Pathways and Unwanted Connections. J Clin Med 2023; 12:6419. [PMID: 37835065 PMCID: PMC10573999 DOI: 10.3390/jcm12196419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/01/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
Inflammatory bowel diseases (IBDs) are chronic, relapsing inflammatory disorders of the gastrointestinal tract, frequently associated with extraintestinal manifestations (EIMs) that can severely affect IBD patients' quality of life, sometimes even becoming life-threatening. Respiratory diseases have always been considered a rare and subsequently neglected extraintestinal manifestations of IBD. However, increasing evidence has demonstrated that respiratory involvement is frequent in IBD patients, even in the absence of respiratory symptoms. Airway inflammation is the most common milieu of IBD-related involvement, with bronchiectasis being the most common manifestation. Furthermore, significant differences in prevalence and types of involvement are present between Crohn's disease and ulcerative colitis. The same embryological origin of respiratory and gastrointestinal tissue, in addition to exposure to common antigens and cytokine networks, may all play a potential role in the respiratory involvement. Furthermore, other causes such as drug-related toxicity and infections must always be considered. This article aims at reviewing the current evidence on the association between IBD and respiratory diseases. The purpose is to raise awareness of respiratory manifestation among IBD specialists and emphasize the need for identifying respiratory diseases in early stages to promptly treat these conditions, avoid worsening morbidity, and prevent lung damage.
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Affiliation(s)
- Carolina Aliai Micol Cavalli
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.A.M.C.); (R.G.); (A.D.B.); (A.Q.); (A.D.M.); (C.B.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (A.R.); (S.A.)
| | - Roberto Gabbiadini
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.A.M.C.); (R.G.); (A.D.B.); (A.Q.); (A.D.M.); (C.B.)
| | - Arianna Dal Buono
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.A.M.C.); (R.G.); (A.D.B.); (A.Q.); (A.D.M.); (C.B.)
| | - Alessandro Quadarella
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.A.M.C.); (R.G.); (A.D.B.); (A.Q.); (A.D.M.); (C.B.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (A.R.); (S.A.)
| | - Alessandro De Marco
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.A.M.C.); (R.G.); (A.D.B.); (A.Q.); (A.D.M.); (C.B.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (A.R.); (S.A.)
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (A.R.); (S.A.)
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Cristina Bezzio
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.A.M.C.); (R.G.); (A.D.B.); (A.Q.); (A.D.M.); (C.B.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (A.R.); (S.A.)
| | - Edoardo Simonetta
- Respiratory Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (A.R.); (S.A.)
- Respiratory Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Alessandro Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.A.M.C.); (R.G.); (A.D.B.); (A.Q.); (A.D.M.); (C.B.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (A.R.); (S.A.)
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Valentin S, Renel B, Manneville F, Caron B, Choukour M, Guillaumot A, Chaouat A, Poussel M, Chateau T, Peyrin-Biroulet C, Achit H, Peyrin-Biroulet L, Chabot F. Prevalence of and Factors Associated with Respiratory Symptoms Among Patients with Inflammatory Bowel Disease: A Prospective Study. Inflamm Bowel Dis 2023; 29:207-216. [PMID: 35394504 DOI: 10.1093/ibd/izac062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND No large, prospective study has investigated respiratory symptoms in patients with inflammatory bowel diseases. We aimed to describe the prevalence of and factors associated with respiratory symptoms in patients with inflammatory bowel disease. METHODS In an observational, prospective, cross-sectional study, we evaluated the frequency of respiratory symptoms using a validated self-reporting questionnaire from February 2019 to February 2021 during routine follow-up outpatient visits of patients with inflammatory bowel disease followed in the Gastroenterology Department of the Nancy University Hospital. In case of a positive questionnaire, patients were systematically offered a consultation with a pulmonologist in order to investigate a potential underlying respiratory disease. RESULTS There were 325 patients included, and 180 patients had a positive questionnaire (144 with Crohn's disease). Of the included patients, 165 (50.8%) presented with respiratory symptoms, with dyspnea being the most frequent symptom (102 patients). There were 102 patients (56.7%) who benefited from a consultation in the pulmonology department: 43 (42.2%) were diagnosed with a respiratory disease, mainly asthma (n = 13) or chronic obstructive pulmonary disease (n = 10). Fourteen patients (13.7%) had obstructive sleep apnea. A body mass index increase, being a smoker or ex-smoker, and having articular extra-intestinal manifestations were independently associated with a higher prevalence of respiratory symptoms. CONCLUSIONS Half of patients with inflammatory bowel disease reported respiratory symptoms in our study. Patients with inflammatory bowel disease should be systematically screened, as pulmonary disease is frequently present in this population, with specific attention being given to smokers or ex-smokers and patients with extra-articular intestinal manifestations.
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Affiliation(s)
- Simon Valentin
- Université de Lorraine, Centre Hospitalier Régional Universitaire (CHRU) Nancy, Pôle des Spécialités Médicales/Département de Pneumologie, Nancy, France.,Université de Lorraine, Faculté de Médecine de Nancy, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Médicale de Recherche (UMR)_S1116, Vandœuvre-Lès-Nancy, France
| | - Brian Renel
- Université de Lorraine, Centre Hospitalier Régional Universitaire (CHRU) Nancy, Pôle des Spécialités Médicales/Département de Pneumologie, Nancy, France
| | - Florian Manneville
- Centre Hospitalier Régional Universitaire (CHRU)-Nancy, Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Lorraine, Centre d'Investigation Cinique (CIC) Épidémiologie Clinique, Nancy, France
| | - Bénédicte Caron
- Nancy University Hospital, Department of Gastroenterology, Nancy, France.,Centre Hospitalier Régional Universitaire (CHRU) Nancy, Délégation à la Recherche Clinique et à l'Innovation, Plateforme Maladies Inflammatoires Chroniques de l'Intestin (MICI), Vandoeuvre-Lès-Nancy, France
| | - Myriam Choukour
- Centre Hospitalier Régional Universitaire (CHRU) Nancy, Délégation à la Recherche Clinique et à l'Innovation, Plateforme Maladies Inflammatoires Chroniques de l'Intestin (MICI), Vandoeuvre-Lès-Nancy, France
| | - Anne Guillaumot
- Université de Lorraine, Centre Hospitalier Régional Universitaire (CHRU) Nancy, Pôle des Spécialités Médicales/Département de Pneumologie, Nancy, France
| | - Ari Chaouat
- Université de Lorraine, Centre Hospitalier Régional Universitaire (CHRU) Nancy, Pôle des Spécialités Médicales/Département de Pneumologie, Nancy, France.,Université de Lorraine, Faculté de Médecine de Nancy, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Médicale de Recherche (UMR)_S1116, Vandœuvre-Lès-Nancy, France
| | - Mathias Poussel
- Centre Hospitalier Régional Universitaire (CHRU)-Nancy, Department of Pulmonary Function Testing, University Center of Sports Medicine and Adapted Physical Activity, Nancy, France.,Université de Lorraine, Développement, Adaptation et Handicap (DevAH), Nancy, France
| | - Thomas Chateau
- Nancy University Hospital, Department of Gastroenterology, Nancy, France
| | - Carina Peyrin-Biroulet
- Université de Lorraine, Centre Hospitalier Régional Universitaire (CHRU) Nancy, Pôle des Spécialités Médicales/Département de Pneumologie, Nancy, France
| | - Hamza Achit
- Centre Hospitalier Régional Universitaire (CHRU)-Nancy, Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Lorraine, Centre d'Investigation Cinique (CIC) Épidémiologie Clinique, Nancy, France
| | - Laurent Peyrin-Biroulet
- Nancy University Hospital, Department of Gastroenterology, Nancy, France.,Université de Lorraine, Inserm, Nutrition-Genetics and Environmental Risk Exposure (NGERE), Nancy, France
| | - François Chabot
- Université de Lorraine, Centre Hospitalier Régional Universitaire (CHRU) Nancy, Pôle des Spécialités Médicales/Département de Pneumologie, Nancy, France.,Université de Lorraine, Faculté de Médecine de Nancy, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité Médicale de Recherche (UMR)_S1116, Vandœuvre-Lès-Nancy, France
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Gastrointestinal consequences of lipopolysaccharide-induced lung inflammation. Inflamm Res 2023; 72:57-74. [PMID: 36322182 PMCID: PMC9628607 DOI: 10.1007/s00011-022-01657-0] [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: 01/11/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Respiratory inflammation is the body's response to lung infection, trauma or hypersensitivity and is often accompanied by comorbidities, including gastrointestinal (GI) symptoms. Why respiratory inflammation is accompanied by GI dysfunction remains unclear. Here, we investigate the effect of lipopolysaccharide (LPS)-induced lung inflammation on intestinal barrier integrity, tight-junctions, enteric neurons and inflammatory marker expression. METHODS Female C57bl/6 mice (6-8 weeks) were intratracheally administered LPS (5 µg) or sterile saline, and assessed after either 24 or 72 h. Total and differential cell counts in bronchoalveolar lavage fluid (BALF) were used to evaluate lung inflammation. Intestinal barrier integrity was assessed via cross sectional immunohistochemistry of tight junction markers claudin-1, claudin-4 and EpCAM. Changes in the enteric nervous system (ENS) and inflammation in the intestine were quantified immunohistochemically using neuronal markers Hu + and nNOS, glial markers GFAP and S100β and pan leukocyte marker CD45. RESULTS Intratracheal LPS significantly increased the number of neutrophils in BALF at 24 and 72 h. These changes were associated with an increase in CD45 + cells in the ileal mucosa at 24 and 72 h, increased goblet cell expression at 24 h, and increased expression of EpCAM at 72 h. LPS had no effect on the expression of GFAP, S100β, nor the number of Hu + neurons or proportion of nNOS neurons in the myenteric plexus. CONCLUSIONS Intratracheal LPS administration induces inflammation in the ileum that is associated with enhanced expression of EpCAM, decreased claudin-4 expression and increased goblet cell density, these changes may contribute to systemic inflammation that is known to accompany many inflammatory diseases of the lung.
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Georgakopoulou VE, Tarantinos K, Papalexis P, Spandidos DA, Damaskos C, Gkoufa A, Chlapoutakis S, Sklapani P, Trakas N, Mermigkis D. Role of pulmonary function testing in inflammatory bowel diseases (Review). MEDICINE INTERNATIONAL 2022; 2:25. [PMID: 36699508 PMCID: PMC9829212 DOI: 10.3892/mi.2022.50] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/01/2022] [Indexed: 01/28/2023]
Abstract
Inflammatory bowel disease (IBD) is a term used to describe chronic inflammatory entities of the gastrointestinal system with an unclear etiology. Extra-intestinal manifestations beyond the involvement of the gastrointestinal tract can also occur. Several studies have investigated the alterations of pulmonary function tests (PFTs) in patients with IBD. To the best of our knowledge, the present review article is the first to summarize all the types of PFTs that have been performed in patients with IBD. Contradictory data exist regarding the association of PFT alterations with disease activity. PFT abnormalities can develop in individuals with IBD who have no clear clinical signs or radiological evidence, suggesting that PFTs may be useful in detecting latent respiratory involvement. The most prevalent finding in the PFTs of adults and children with IBD is an impairment in the diffusing capacity for carbon monoxide, although evidence on the other tests, particularly spirometric values, and their connection with disease activity is inconsistent.
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Affiliation(s)
| | | | - Petros Papalexis
- Unit of Endocrinology, First Department of Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece,Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece,Correspondence to: Dr Petros Papalexis, Department of Biomedical Sciences, University of West Attica, 28 Agiou Spyridonos Street, 12243 Athens, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Christos Damaskos
- Renal Transplantation Unit, Laiko General Hospital, 11527 Athens, Greece,N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Aikaterini Gkoufa
- First Department of Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | | | - Pagona Sklapani
- Department of Cytology, Mitera Hospital, 15123 Athens, Greece
| | - Nikolaos Trakas
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
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Schmid F, Chao CM, Däbritz J. Pathophysiological Concepts and Management of Pulmonary Manifestation of Pediatric Inflammatory Bowel Disease. Int J Mol Sci 2022; 23:7287. [PMID: 35806292 PMCID: PMC9266732 DOI: 10.3390/ijms23137287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023] Open
Abstract
Pulmonary manifestation (PM) of inflammatory bowel disease (IBD) in children is a rare condition. The exact pathogenesis is still unclear, but several explanatory concepts were postulated and several case reports in children were published. We performed a systematic Medline search between April 1976 and April 2022. Different pathophysiological concepts were identified, including the shared embryological origin, "miss-homing" of intestinal based neutrophils and T lymphocytes, inflammatory triggering via certain molecules (tripeptide proline-glycine-proline, interleukin 25), genetic factors and alterations in the microbiome. Most pediatric IBD patients with PM are asymptomatic, but can show alterations in pulmonary function tests and breathing tests. In children, the pulmonary parenchyma is more affected than the airways, leading histologically mainly to organizing pneumonia. Medication-associated lung injury has to be considered in pulmonary symptomatic pediatric IBD patients treated with certain agents (i.e., mesalamine, sulfasalazine or infliximab). Furthermore, the risk of pulmonary embolism is generally increased in pediatric IBD patients. The initial treatment of PM is based on corticosteroids, either inhaled for the larger airways or systemic for smaller airways and parenchymal disease. In summary, this review article summarizes the current knowledge about PM in pediatric IBD patients, focusing on pathophysiological and clinical aspects.
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Affiliation(s)
- Florian Schmid
- Catholic Children’s Hospital Wilhelmstift, 22149 Hamburg, Germany;
| | - Cho-Ming Chao
- Department of Pediatrics, University Medical Center Rostock, 18057 Rostock, Germany;
- Cardio-Pulmonary Institute (CPI), University of Giessen and Marburg Lung Center (UGMLC), German Center of Lung Research (DZL), Justus-Liebig-University, 35398 Giessen, Germany
| | - Jan Däbritz
- Department of Pediatrics, University Medical Center Greifswald, 17475 Greifswald, Germany
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Sun X, Wang D, Wei L, Ding L, Guo Y, Wang Z, Kong Y, Yang J, Sun L, Sun L. Gut Microbiota and SCFAs Play Key Roles in QingFei Yin Recipe Anti- Streptococcal Pneumonia Effects. Front Cell Infect Microbiol 2021; 11:791466. [PMID: 34950611 PMCID: PMC8688933 DOI: 10.3389/fcimb.2021.791466] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/12/2021] [Indexed: 12/12/2022] Open
Abstract
Emerging evidence has revealed the presence in animals of a bidirectional regulatory “lung-gut axis” that provides resistance to respiratory infections. Clues to the existence of this system stem from observations that respiratory infections are often accompanied by gastrointestinal symptoms, whereby intestinal microbiota appear to play pivotal roles in combating pathogenic infections. Importantly, short-chain fatty acids (SCFAs) produced by the gut microbiota appear to serve as the biological link between host immune defenses and gut flora. Streptococcus pneumoniae (S.pn), the main cause of lower respiratory tract infections, is involved in more than 1.189 million deaths per year. QingFei Yin (QFY) is known for its excellent therapeutic efficacy in combating bacterial lung infections. In this study, effects of S.pn infection on gut homeostasis were assessed using 16S RNA-based microbiota community profiling analysis. In addition, potential mechanisms underlying QFY recipe beneficial therapeutic effects against bacterial pneumonia were explored using S.pn-infected gut microbiota-depleted mice. Results of data analysis indicated that QFY treatment alleviated lung infection-associated pathogenic processes, while also promoting repair of disordered gut flora and counteracting S.pn infection-associated decreases in levels of SCFAs, particularly of acetate and butyrate. Mechanistically, QFY treatment suppressed inflammatory lung injury through inhibition of the host NF-κB-NLRP3 pathway. These results inspired us to identify precise QFY targets and mechanisms underlying QFY anti-inflammatory effects. In addition, we conducted an in-depth evaluation of QFY as a potential treatment for bacterial pneumonia.
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Affiliation(s)
- Xiaozhou Sun
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Dandan Wang
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China., Research Center of Traditional Chinese Medicine, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Lina Wei
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China.,Center of Children's Clinic, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Lizhong Ding
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China.,Center of Children's Clinic, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Yinan Guo
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China.,Center of Children's Clinic, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Zhongtian Wang
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China
| | - Yibu Kong
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China.,Center of Children's Clinic, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Jingjing Yang
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China.,Center of Children's Clinic, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Liwei Sun
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China., Research Center of Traditional Chinese Medicine, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
| | - Liping Sun
- College of Chinese Medicine, Changchun University of Chinese Medicine, Changchun, China.,Center of Children's Clinic, The Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
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Mustansir Dawoodbhoy F, Patel BK, Patel K, Bhatia M, Lee CN, Moochhala SM. Gut Microbiota Dysbiosis as a Target for Improved Post-Surgical Outcomes and Improved Patient Care: A Review of Current Literature. Shock 2021; 55:441-454. [PMID: 32881759 DOI: 10.1097/shk.0000000000001654] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Critical illness results in significant changes in the human gut microbiota, leading to the breakdown of the intestinal barrier function, which plays a role in the pathogenesis of multiple organ dysfunction. Patients with sepsis/acute respiratory distress syndrome (ARDS) have a profoundly distorted intestinal microbiota rhythm, which plays a considerable role in the development of gut-derived infections and intestinal dysbiosis. Despite recent medical developments, postsurgical complications are associated with a high morbidity and mortality rate. Bacterial translocation, which is the movement of bacteria and bacterial products across the intestinal barrier, was shown to be a mechanism behind sepsis. Current research is focusing on a solution by addressing significant factors that contribute to intestinal dysbiosis, which subsequently leads to multiple organ failure and, thus, mortality. It may, however, be challenging to manipulate the microbiota in critically ill patients for enhanced therapeutic gain. Probiotic manipulation is advantageous for maintaining the gut-barrier defense and for modulating the immune response. Based on available published research, this review aims to address the application of potential strategies in the intensive care unit, supplemented with current therapeutics by the administration of probiotics, prebiotics, and fecal microbiota transplant, to reduce post-surgical complications of sepsis/ARDS in critically ill patients.
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Affiliation(s)
| | | | - Kadamb Patel
- School of Applied Sciences, Temasek Polytechnic, Singapore
| | - Madhav Bhatia
- Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch, New Zealand
| | - Chuen Neng Lee
- Department of Surgery, National University of Singapore, Singapore
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LOU Z, ZHAO H, LYU G. [Mechanism and intervention of mucosal immune regulation based on "lung and large intestine being interior-exteriorly related" theory of traditional Chinese medicine]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2020; 49:665-678. [PMID: 33448169 PMCID: PMC8800704 DOI: 10.3785/j.issn.1008-9292.2020.12.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/23/2020] [Indexed: 04/14/2023]
Abstract
The "lung and large intestine being interior-exteriorly related" is one of the classical theories in traditional Chinese medicine, which indicates a close correlation between the lung and large intestine in physiology and pathology, and plays a pivotal role in guiding the treatment of the lung and bowel diseases. Modern medicine has revealed some connections between the lung and large intestine in tissue origin and mucosal immunity, and preliminarily illuminated the material basis and possible regulatory mechanism of the theory. Recently, this theory has been applied to guide the treatment of refractory lung and intestine diseases such as COVID-19 and ulcerative colitis and has obtained reliable efficacy. Existing research results show that the anatomical homogeneity of lung and large intestine promotes the correlation between lung-bowel mucosal immunity, and mucosal immunity and migration and homing of innate lymphocytes are one of the physiological and pathological mechanisms for lung and large intestine to share. Under the guidance of this theory, Chinese medicines with heat-clearing and detoxifying or tonic effects are commonly used in the treatment of the lung and intestinal diseases by regulating lung-bowel mucosal immunity and they can be candidate drugs to treat lung/intestinal diseases simultaneously. However, the existing studies on immune regulation are mainly focused on the expression levels of sIgA and cytokines, as well as the changes in the number of immune cells such as innate lymphocytes and B lymphocytes. While the following aspects need further investigation: the airway/intestinal mucous hypersecretion, the functional changes of pulmonary and intestinal mucosal barrier immune cells, the dynamic process of lung/intestinal mucosal immune interaction, the intervention effect of local pulmonary/intestinal microecology, the correlation and biological basis between the heat-clearing and detoxifying effect and the tonic effect, and its regulation of pulmonary/intestinal mucosal immunity. In this paper, we try to analyze the internal relationship between lung and intestine related diseases from the point of view of the common mucosal immune system of lung and intestine, and summarize the characteristics and rules of traditional Chinese medicine compound and its active ingredients, which have regulatory effect on lung and intestine mucosal immune system, so as to further explain the theoretical connotation of "lung and large intestine being interior-exteriorly related" and provide reference for the research and development of drugs for related diseases.
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Gupta SJ, Gupta VL, Kothari HG, Samarth AR, Gaikwad NR, Parmar SM. Assessment of Occult Pulmonary Involvement in Ulcerative Colitis. Inflamm Intest Dis 2020; 5:144-150. [PMID: 32999887 DOI: 10.1159/000508772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/18/2020] [Indexed: 02/05/2023] Open
Abstract
Introduction Nearly 50% of patients with inflammatory bowel disease (IBD) experience at least one extraintestinal manifestation. Bronchopulmonary involvement is rare in IBD. Pulmonary function test (PFT) abnormality in cases of ulcerative colitis (UC) has been reported to be 17-55%. Occult pulmonary disease may be diagnosed using variables of the PFT. Hence, we aim to evaluate the frequency and type of pulmonary dysfunction in patients with UC in remission. Methods Eighty-three patients of UC in remission and 48 controls underwent the PFT including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), Tiffeneau value (FEV1/FVC), and midexpiratory flow (MEF 25-75%) rate with a spirometer. The patients were divided based on the age of onset of UC into A1 (<16 years), A2 (16-40 years), and A3 (>40 years) and based on the extent of disease into E1 (proctitis), E2 (left-sided colitis), and E3 (extensive colitis). Results Patients with UC had significantly abnormal PFT compared with controls (51 [61.5%] vss. 8 [16.67%]; p = 0.000). Patients with UC commonly had a restrictive pattern (33 [64.47%]) of PFT followed by small airway disease (11 [21.56%]) and obstructive pattern (7 [13.72%]). Pulmonary involvement in cases of UC was more in E3 followed by E2 and E1. Pulmonary involvement was more in the late age of onset of disease. BMI was positively and significantly correlated with FEV1 and FVC. Hemoglobin had a positive and significant correlation with FEV1 while a negative correlation with FEV1/FVC and MEF 25-75%. All predictors except for age were found to contribute in higher risk (OR > 1) for PFT abnormality. Conclusion Patients with UC have chronic pulmonary inflammation leading to different patterns of lung involvement in the form of restrictive, obstructive airway, and small airway disease. Patients with UC commonly have a restrictive pattern of pulmonary involvement. Impairment of the PFT is related to the disease extent and the age of onset of disease. Assessment of the PFT using a spirometer is a noninvasive, simple, cost-effective, and reliable method for early detection of occult pulmonary involvement in patients of UC.
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Affiliation(s)
- Sudhir J Gupta
- Department of Gastroenterology, Government Medical College and Super Specialty Hospital, Nagpur, India
| | - Vineet L Gupta
- Department of Gastroenterology, Government Medical College and Super Specialty Hospital, Nagpur, India
| | - Harit G Kothari
- Department of Gastroenterology, Government Medical College and Super Specialty Hospital, Nagpur, India
| | - Amol R Samarth
- Department of Gastroenterology, Government Medical College and Super Specialty Hospital, Nagpur, India
| | - Nitin R Gaikwad
- Department of Gastroenterology, Government Medical College and Super Specialty Hospital, Nagpur, India
| | - Sahil M Parmar
- Department of Gastroenterology, Government Medical College and Super Specialty Hospital, Nagpur, India
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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: 0.8] [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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11
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Kim J, Chun J, Lee C, Han K, Choi S, Lee J, Soh H, Choi K, Park S, Kang EA, Lee HJ, Im JP, Kim JS. Increased risk of idiopathic pulmonary fibrosis in inflammatory bowel disease: A nationwide study. J Gastroenterol Hepatol 2020; 35:249-255. [PMID: 31420894 DOI: 10.1111/jgh.14838] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 07/27/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM The relationship between inflammatory bowel disease (IBD) and idiopathic pulmonary fibrosis (IPF) remains unclear. We evaluated the risk for developing IPF in patients with IBD using a nationwide population-based study. METHODS Using claims data from the National Health Insurance service in Korea, patients with IBD, including Crohn's disease (CD) and ulcerative colitis (UC), were identified through both the 10th revision of the International Statistical Classification of Diseases and Related Health Problems and rare and intractable disease program codes from January 2010 to December 2013. We compared 38 921 IBD patients with age-matched and sex-matched individuals without IBD in a ratio of 1:3. Patients with newly diagnosed IPF were identified by both the 10th revision of the International Statistical Classification of Diseases and Related Health Problems and rare and intractable disease registration codes. RESULTS During a mean 4.9-year follow-up, the incidence of IPF in patients with IBD was 33.21 per 100 000 person-years. The overall risk of IPF was significantly higher in IBD patients than in non-IBD controls (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.20-2.20; P = 0.003). In patients with CD, the incidence (per 100 000 person-years) of IPF was 26.04; in controls, the incidence was 9.15 (HR, 2.89; 95% CI, 1.46-5.72; P = 0.002). The incidence of IPF in patients with UC tended to be higher than in controls (36.66 vs 26.54 per 100 000 person-years; 95% CI, 0.99-1.99; HR, 1.41; P = 0.066). The risk of developing IPF in patients with IBD was higher in male patients than in female patients (P = 0.093 in CD; P = 0.147 in UC by interaction analysis). CONCLUSIONS Patients with IBD, especially CD, have an increased risk of developing IPF.
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Affiliation(s)
- Jihye Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Jaeyoung Chun
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Changhyun Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Medical Statistics, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seungho Choi
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jooyoung Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hosim Soh
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kookhwan Choi
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seona Park
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Ae Kang
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Jung Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong Pil Im
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joo Sung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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12
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Wypych TP, Wickramasinghe LC, Marsland BJ. The influence of the microbiome on respiratory health. Nat Immunol 2019; 20:1279-1290. [PMID: 31501577 DOI: 10.1038/s41590-019-0451-9] [Citation(s) in RCA: 350] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/18/2019] [Indexed: 02/06/2023]
Abstract
The revolution in microbiota research over the past decade has provided invaluable knowledge about the function of the microbial species that inhabit the human body. It has become widely accepted that these microorganisms, collectively called 'the microbiota', engage in networks of interactions with each other and with the host that aim to benefit both the microbial members and the mammalian members of this unique ecosystem. The lungs, previously thought to be sterile, are now known to harbor a unique microbiota and, additionally, to be influenced by microbial signals from distal body sites, such as the intestine. Here we review the role of the lung and gut microbiotas in respiratory health and disease and highlight the main pathways of communication that underlie the gut-lung axis.
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Affiliation(s)
- Tomasz P Wypych
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
| | - Lakshanie C Wickramasinghe
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Benjamin J Marsland
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
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13
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El Amrousy DM, Hassan S, El-Ashry H, Yousef M, Sharshar R. Pulmonary Function Tests Abnormalities in Children With Inflammatory Bowel Disease: Is It Common? J Pediatr Gastroenterol Nutr 2018; 67:346-350. [PMID: 29620595 DOI: 10.1097/mpg.0000000000001989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the frequency and type of pulmonary dysfunction in newly diagnosed children with inflammatory bowel disease (IBD) and the correlation between pulmonary function tests (PFTs) and IBD activity. METHODS It is an observational case-control study. One hundred newly diagnosed children with IBD were enrolled as the patient group, which was further subdivided into 52 with Crohn disease (CD) and 48 with ulcerative colitis (UC). Fifty healthy children matched for age, sex, height, and body mass index (BMI) served as the control group. PFTs in the form of forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, residual volume (RV), total lung capacity (TLC), mid-forced expiratory flow of 25% to 75% (FEF 25%-75%) and diffusing capacity of the lung for carbon monoxide (DLCO) were evaluated in all studied children. PFTs were measured at diagnosis, every 6 months for a period of 3 years, during remission and at least once during activity in patient group. RESULTS There was significant progressive deterioration in all PFTs in IBD patients compared with their PFTs at the start of the study (P < 0.05) except for FEV1/FVC, RV, and TLC (P > 0.05). There was significant deterioration during disease activity compared with remission state as regards FEV1, FVC, FEF 25% to 75%, and DLCO (P < 0.05). Significant negative correlation was found between disease activity in both UC and CD groups and FEV1, FVC, FEF 25% to 75%, and DLCO. CONCLUSIONS Subclinical PFTs abnormalities are common in pediatric IBD even during remission period. So, periodic PFTs evaluation should be considered in the routine follow-up of IBD children.
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Affiliation(s)
| | | | | | | | - Ragia Sharshar
- Chest Department, Faculty of Medicine, Tanta University, Egypt
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14
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Radiological Patterns of Lung Involvement in Inflammatory Bowel Disease. Gastroenterol Res Pract 2018; 2018:5697846. [PMID: 30158965 PMCID: PMC6109524 DOI: 10.1155/2018/5697846] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 07/25/2018] [Indexed: 12/12/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a form of chronic inflammation of the gastrointestinal tract, including two major entities: ulcerative colitis and Crohn's disease. Although intestinal imaging of IBD is well known, imaging of extraintestinal manifestations is not extensively covered. In particular, the spectrum of IBD-associated or related changes in the chest is broad and may mimic other conditions. The common embryonic origin of intestine and lungs from the foregut, autoimmunity, smoking, and bacterial translocation from the colon may all be involved in the pathogenesis of these manifestations in IBD patients. Chest involvement in IBD can present concomitant with or years after the onset of the bowel disease even postcolectomy and can affect more than one thoracic structure. The purpose of the present paper is to present the different radiological spectrum of IBD-related chest manifestations, including lung parenchyma, airways, serosal surfaces, and pulmonary vasculature. The most prevalent and distinctive pattern of respiratory involvement is large airway inflammation, followed by lung alterations. Pulmonary manifestations are mainly detected by pulmonary function tests and high-resolution computed tomography (HRCT). It is desirable that radiologists know the various radiological patterns of possible respiratory involvement in such patients, especially at HRCT. It is essential for radiologists to work in multidisciplinary teams in order to establish the correct diagnosis and treatment, which rests on corticosteroids at variance with any other form of bronchiectasis.
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15
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Tumor Necrosis Factor Alpha Antagonism Reveals a Gut/Lung Axis That Amplifies Regulatory T Cells in a Pulmonary Fungal Infection. Infect Immun 2018; 86:IAI.00109-18. [PMID: 29581197 DOI: 10.1128/iai.00109-18] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/21/2018] [Indexed: 02/07/2023] Open
Abstract
Tumor necrosis factor (TNF) antagonists are popular therapies for inflammatory diseases. These agents enhance the numbers and function of regulatory T cells (Tregs), which are important in controlling inflammatory diseases. However, elevated Treg levels increase susceptibility to infections, including histoplasmosis. We determined the mechanism by which Tregs expand in TNF-neutralized mice infected with Histoplasma capsulatum Lung CD11c+ CD11b+ dendritic cells (DCs), but not alveolar macrophages, from H. capsulatum-infected mice treated with anti-TNF induced a higher percentage of Tregs than control DCs in vitro CD11b+ CD103+ DCs, understood to be unique to the intestines, were augmented in lungs with anti-TNF treatment. In the absence of this subset, DCs from anti-TNF-treated mice failed to amplify Tregs in vitro CD11b+ CD103+ DCs from TNF-neutralized mice displayed higher retinaldehyde dehydrogenase 2 (RALDH2) gene expression, and CD11b+ CD103+ RALDH+ DCs exhibited greater enzyme activity. To determine if CD11b+ CD103+ DCs migrated from gut to lung, fluorescent beads were delivered to the gut via oral gavage, and the lungs were assessed for bead-containing DCs. Anti-TNF induced migration of CD11b+ CD103+ DCs from the gut to the lung that enhanced the generation of Tregs in H. capsulatum-infected mice. Therefore, TNF neutralization promotes susceptibility to pulmonary H. capsulatum infection by promoting a gut/lung migration of DCs that enhances Tregs.
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16
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Goyal A, Ghoshal UC, Nath A, Jindal S, Mohindra S. Pulmonary function in patients with ulcerative colitis and its relationship with disease severity. JGH OPEN 2017; 1:32-37. [PMID: 30483530 PMCID: PMC6207016 DOI: 10.1002/jgh3.12005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 07/30/2017] [Accepted: 08/07/2017] [Indexed: 12/31/2022]
Abstract
Background and Aim Ulcerative colitis (UC) patients have several extraintestinal and systemic manifestations. As studies on the frequency and predictors of pulmonary involvement in patients with UC are inconsistent, we undertook this prospective study. Methods Eighty-seven patients with UC (in remission 49, 56.3%, active disease 38, 43.6%, median age: 40 years, range: 16-66, 55, 62.2% males) and 50 healthy controls (median age: 38 years, range: 14-69, 34, 68% males) underwent pulmonary function tests (PFTs) including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), Tiffeneau value (FEV1/FVC), mid-expiratory flow rate, and diffusion lung capacity for carbon monoxide with spirometer. Results Subjects with UC and control were comparable in age and gender. PFT was abnormal in 24 (27.5%) patients (active disease 15/38, 39.4%, remission 9/49, 18.4%) and 1 (2%) control (P < 0.005). Of the 24 patients with abnormal PFT, small airway, restrictive, and obstructive defects were detected in 12 (50%), 11 (45.8%), and 1 (4.2%) patients, respectively. Patients with abnormal PFT more often had active disease (15/24, 62.5% vs 23/63, 36.5%; P = 0.03). No relation of PFT abnormalities was found with age, sex, duration of disease, body mass index, serum albumin, and hemoglobin levels, and other extraintestinal manifestation (arthritis/arthralgia) and drugs used to treat UC. Conclusion UC patients with active disease have abnormal pulmonary functions with predominant involvement of small airways. Active UC was more often associated with abnormal PFT than the disease in remission.
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Affiliation(s)
- Ajesh Goyal
- Department of Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Uday C Ghoshal
- Department of Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Alok Nath
- Department of Pulmonology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Shikha Jindal
- Department of Pulmonology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
| | - Samir Mohindra
- Department of Gastroenterology Sanjay Gandhi Postgraduate Institute of Medical Sciences Lucknow India
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17
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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: 41] [Impact Index Per Article: 4.1] [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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18
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Zhao YJ, Wang XM, Su L, Zhu CH, Zhai JS, Zheng N, Zhang M, Li N. Effect of compound dracorhodin enema on pulmonary and colonic expression of interleukin-6 in mice with distal ulcerative colitis. Shijie Huaren Xiaohua Zazhi 2015; 23:3352-3360. [DOI: 10.11569/wcjd.v23.i21.3352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
AIM: To investigate the protective effect of compound dracorhodin enema on the lung and intestine of mice with distal ulcerative colitis (UC).
METHODS: Sixty male BALB/c mice were randomly divided into four groups (n = 15 each): a normal group, a dextran sulfate sodium (DSS) group, a compound dracorhodin enema group, and a DSS + compound dracorhodin enema group. After inducing UC, the normal group and DSS group were given 1 mL saline, and the other two groups were given compound dracorhodin enema [0.075 g/(kg•d), 1 mL] by gavage. After treatment, disease activity index (DAI) score, colonic histopathology score (HI), lung HI score, and hematoxylin-eosin (HE) staining were used to evaluate the severity of inflammation. Enzyme-linked immunosorbent assay (ELISA), immunohistochemistry, and real-time quantitative PCR (RT-QPCR) assay were used to detect the expression of interleukin (IL)-6 in the lung and colon.
RESULTS: Compared with the normal group and compound dracorhodin enema group, DAI score, colonic HI score, and lung HI score were significantly higher in the other two groups (P < 0.05). Compared with the DSS + compound dracorhodin enema group, colonic and pulmonary tissue inflammation was significantly more severe and pulmonary and colonic expression of IL-6 was significantly higher in the DSS group (P < 0.05).
CONCLUSION: Compound dracorhodin enema can decrease the expression of IL-6 and therefore alleviate UC and UC related lung injury in mice.
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19
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Egan JP, Seides BJ, Olivier KN, Addrizzo-Harris D. Successful treatment of ulcerative bronchiolitis in a woman with refractory Mycobacterium intracellulare infection. BMJ Case Rep 2015; 2015:bcr-2015-209604. [PMID: 25926588 DOI: 10.1136/bcr-2015-209604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
We present a case of a woman with medically refractory ulcerative colitis (UC) who developed severe bronchiectasis, bronchitis, bronchiolitis and Mycobacterium intracellulare (MAC) infection 2 years after total colectomy. Despite being on optimal therapy for her MAC and sterilising multiple consecutive sputum cultures, she remained highly symptomatic, and this led to further investigations that revealed the presence of UC-related airways disease. Addition of immunosuppressive therapy to her antimycobacterial treatment resulted in sustained and complete clinical remission of her disease. To our knowledge, this is the only case published in the literature that describes a case of successful treatment of concomitant UC-related pulmonary disease and symptomatic MAC.
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Affiliation(s)
- John Patrick Egan
- Division of Pulmonary, Critical Care and Sleep, New York University Langone Medical Center, New York, New York, USA
| | - Benjamin J Seides
- Department of Interventional Pulmonology, Chicago Chest Center, Elk Grove Village, Illinois, USA
| | | | - Doreen Addrizzo-Harris
- Division of Pulmonary, Critical Care and Sleep, New York University Langone Medical Center, New York, New York, USA
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20
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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: 71] [Impact Index Per Article: 6.5] [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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21
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Wang JY, Wang XY, Wu HY, Sun HY, Liu DM, Zhang W, Jin CX, Wang SR. The association between pulmonary function impairment and colon inflammation in ulcerative colitis patients: A scientific basis for exterior-interior correlation between lung and large intestine. Chin J Integr Med 2014; 22:894-901. [PMID: 24938448 DOI: 10.1007/s11655-014-1842-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Indexed: 02/08/2023]
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Longman RS, Scherl EJ. Medical Management of Extraintestinal Manifestations of Ulcerative Colitis. MEDICAL THERAPY OF ULCERATIVE COLITIS 2014:377-391. [DOI: 10.1007/978-1-4939-1677-1_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2025]
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23
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Specific Link between Lung and Large Intestine: A New Perspective on Neuropeptide Secretion in Lung with Herbal Laxative Stimulation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:547837. [PMID: 24023578 PMCID: PMC3762168 DOI: 10.1155/2013/547837] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 07/19/2013] [Indexed: 01/14/2023]
Abstract
Background. To investigate the specific link between lung and large intestine. Methods. Rat COPD-like model was prepared. Mirabilite or Chinese rhubarb was administrated intragastrically to stimulate the large intestine. Histological analysis of lung inflammation was assessed. The tissues levels of SP, VIP, NK1R, VIPR1, and VIPR2 were measured by using ELISA kits. In addition, mouse model of allergic asthma was prepared. Mirabilite was administrated intragastrically to stimulate the large intestine. Airway responsiveness and lung inflammation were assessed. The tissues levels of SP, VIP, NKA, NKB, NK1R, VIPR1, and VIPR2 were measured by using ELISA kits. Results. Stimulating the intestine with Mangxiao or Dahuang, SP, NK-1R, VIP, VIPR1, and VIPR2 were significantly increased in intestine tissues of rats with COPD and mice with asthma. Meanwhile, the SP and NK1R were significantly decreased, while VIP, VIPR1, and VIPR2 were significantly increased in lung tissues. An abnormal secretion of SP and VIP can be observed in other tissues; however, no marked changes were found in the receptors. The NKA and NKB levels were similar in lung tissues of mice with asthma among groups. Conclusions. Stimulating intestine with Mangxiao or Dahuang can specifically regulate the secretion of SP, VIP, and the receptors in lung tissues.
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Liu Y, Wang XY. Pulmonary-intestinal crosstalk in the pathological process of COPD and IBD: A perspective from the lung and the large intestine being interior-exteriorly related theory. Shijie Huaren Xiaohua Zazhi 2013; 21:886-893. [DOI: 10.11569/wcjd.v21.i10.886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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
Traditional Chinese medicine theory believes that the lung and intestine are closely related physiologically and pathologically. With the help of this, unexpected clinical efficacy can be achieved in the treatment of lung and intestinal diseases. Chronic obstructive pulmonary disease (COPD) and inflammatory bowel disease (IBD) are chronic inflammatory diseases of mucosal tissues that affect the respiratory and gastrointestinal tracts, respectively. Both COPD and IBD are driven by recurrent cycles of inflammation that lead to tissue damage and remodeling and progressively worsen symptoms. There have been no cures for either disease and both require lifelong health maintenance. Exploration of the correlation in the pathological process between COPD and IBD will help us find new ways of treatment of these two diseases.
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25
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Low prevalence of pulmonary involvement in children with inflammatory bowel disease. Respir Med 2012; 106:1048-54. [DOI: 10.1016/j.rmed.2012.03.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 03/12/2012] [Indexed: 02/06/2023]
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Zhou B, Wang XY, Zhu L, Yang X, Jing S, Yang S, Liu G, Zhu LQ, Jia X. Pulmonary pathological and functional changes in rats with Crohn's disease and lung injury. Shijie Huaren Xiaohua Zazhi 2012; 20:824-830. [DOI: 10.11569/wcjd.v20.i10.824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
AIM: To observe pulmonary pathological and functional changes in rats with Crohn's disease and lung injury.
METHODS: Rats were randomly divided into model group and normal group. Crohn's disease was induced in rats using the 2, 4, 6-trinitrobenzenesulfonic acid/ethanol method. At weeks 1, 2, and 4 after induction of Crohn's disease, pulmonary function testing was performed, and rats were then killed to take samples for HE staining to examine pathological changes in the colon and lung.
RESULTS: Pulmonary pathological changes in rats with Crohn's disease include typical interstitial pneumonia, widening of alveolar septa, vascular congestion, interstitial edema, inflammatory cell infiltration, decrease in the size of alveolar cavities smaller, bronchial wall thickening, emphysema, and bronchiectasis occasionally. Pulmonary functional changes include an initial decrease followed by an increase in airway resistance, an initial increase followed by a decrease in Cl, lowering of MVV, FVC, Fev0.2, and a moderate decrease in PEF and PEF25-75%.
CONCLUSION: Rats with Crohn's disease may develop lung injury, which mainly manifests as interstitial pneumonia and restrictive ventilatory disorders.
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Abstract
Chronic obstructive pulmonary disease (COPD) and inflammatory bowel diseases (IBDs) are chronic inflammatory diseases of mucosal tissues that affect the respiratory and gastrointestinal tracts, respectively. They share many similarities in epidemiological and clinical characteristics, as well as in inflammatory pathologies. Importantly, both conditions are accompanied by systemic comorbidities that are largely overlooked in both basic and clinical research. Therefore, consideration of these complications may maximize the efficacy of prevention and treatment approaches. Here, we examine both the intestinal involvement in COPD and the pulmonary manifestations of IBD. We also review the evidence for inflammatory organ cross-talk that may drive these associations, and discuss the current frontiers of research into these issues.
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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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Abstract
OBJECTIVE The purpose of this article is to present the spectrum of inflammatory bowel disease manifestations in the chest, including the airways, lung parenchyma, pulmonary vasculature, and serosal surfaces. CONCLUSION The spectrum of inflammatory bowel disease manifestations in the chest is broad, and the manifestations may mimic other diseases. Knowledge of these manifestations in conjunction with pertinent clinical data is essential for establishing the correct diagnosis and treatment.
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Yılmaz A, Demirci NY, Hoşgün D, Üner E, Erdoğan Y, Gökçek A, Çağlar A. Pulmonary involvement in inflammatory bowel disease. World J Gastroenterol 2010; 16:4952-7. [PMID: 20954282 PMCID: PMC2957604 DOI: 10.3748/wjg.v16.i39.4952] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [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
AIM: To determine the relationship of pulmonary abnormalities and bowel disease activity in inflammatory bowel disease (IBD).
METHODS: Thirty ulcerative colitis (UC) and nine Crohn’s disease patients, and 20 control subjects were enrolled in this prospective study. Detailed clinical information was obtained. Extent and activity of the bowel disease were established endoscopically. Each patient underwent pulmonary function tests and high-resolution computed tomography (HRCT). Blood samples for measurement of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), angiotensin converting enzyme and total IgE were delivered by the patients.
RESULTS: Ten (25.6%) patients had respiratory symptoms. A pulmonary function abnormality was present in 22 of 39 patients. Among all patients, the most prevalent abnormalities in lung functions were a decrease in forced expiratory volume in 1 s (FEV1), FEV1/forced vital capacity (FVC), forced expiratory flow (FEF) 25%-75%, transfer coefficient for carbon monoxide (DLCO), DLCO/alveolar volume. Increased respiratory symptoms score was associated with high endoscopic activity index in UC patients. Endoscopic and clinical activities in UC patients were correlated with FEV1, FEV1/FVC, and FEF 25%-75%. Smoking status, duration of disease and medication were not correlated with pulmonary physiological test results, HRCT abnormalities, clinical/endoscopic disease activity, CRP, ESR or total IgE level or body mass index.
CONCLUSION: It is important that respiratory manifestations are recognized and treated early in IBD. Otherwise, they can lead to destructive and irreversible changes in the airway wall.
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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: 18] [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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33
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Ozyilmaz E, Yildirim B, Erbas G, Akten S, Oguzulgen IK, Tunc B, Tuncer C, Turktas H. Value of fractional exhaled nitric oxide (FE NO) for the diagnosis of pulmonary involvement due to inflammatory bowel disease. Inflamm Bowel Dis 2010; 16:670-6. [PMID: 19705414 DOI: 10.1002/ibd.21085] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Pulmonary involvement due to inflammatory bowel disease (IBD) is frequent when evaluating a patient with IBD and pulmonary involvement remains complicated. Most of the patients are asymptomatic and the methods used are mostly invasive or expensive procedures. The aim of this prospective study is to evaluate the value of the fractional exhaled nitric oxide (FE(NO)) level for the diagnosis of pulmonary involvement due to IBD and to investigate any correlation between FE(NO) level and disease activity. METHODS Thirty-three nonsmoker patients with IBD (25 ulcerative colitis [UC] and 8 Crohn's Disease [CD]) who were free of corticosteroid treatment and 25 healthy subjects as a control group were enrolled in this study. All patients with IBD were investigated for pulmonary involvement with medical history, physical examination, chest roentgenogram, oxygen saturation, blood eosinophil levels, pulmonary function tests (PFTs), high-resolution computed tomography (HRCT), and FE(NO) level. RESULTS Pulmonary involvement was established in 15 patients (45.5%) with IBD. The FE(NO) level was higher in patients with pulmonary involvement than without pulmonary involvement and healthy controls independent from the pulmonary symptoms, eosinophil count, duration of disease, activity of disease, and surgery history (FE(NO): 32 +/- 20; 24 +/- 8; 14 +/- 8 ppb, respectively) (P < 0.05). In addition, diffusion capacity (DLCO) was found to be significantly lower in patients with CD compared with UC (P < 0.05). CONCLUSIONS This study showed that an increased FE(NO) level may be used for identifying patients with IBD who need further pulmonary evaluation.
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Affiliation(s)
- Ezgi Ozyilmaz
- Gazi University School of Medicine, Department of Pulmonary Disease, Ankara, Turkey.
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34
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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: 34] [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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35
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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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Cilloniz R, Chesrown SE, Gonzalez-Peralta RP. Asymptomatic presentation of mesalamine-induced lung injury in an adolescent with Crohn disease. BMJ Case Rep 2009; 2009:bcr09.2008.0908. [PMID: 21686567 DOI: 10.1136/bcr.09.2008.0908] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The present report describes the case of a 14-year-old boy receiving mesalamine for Crohn disease who was discovered to have incidental pulmonary infiltrates on chest radiograph and CT scan shortly after increasing the dose of this medication. Despite the significant radiographic abnormalities, he had no respiratory symptoms. He had normal oxygenation and normal pulmonary function tests including spirometry, lung volumes and diffusion capacity. Transbronchial biopsies showed patchy interstitial fibrosis with ill-defined non-necrotising granulomas and lymphoid aggregates. Pulmonary infiltrates resolved within 6 weeks of discontinuation of mesalamine and the addition of low-dose daily corticosteroids. This case likely represents an asymptomatic "early stage" of mesalamine-induced lung injury preceding the onset of symptoms. Alternatively, mesalamine may induce asymptomatic lung injury more commonly than is presently suspected. To the best of our knowledge this is the first time this complication has been reported without respiratory symptoms.
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Affiliation(s)
- Rafael Cilloniz
- University of Florida, Pediatrics, 1600 SW Archer Rd, PO Box 100296, Gainesville, Florida, 32610, USA
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37
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Abstract
Extraintestinal manifestations of inflammatory bowel disease (IBD) is a common clinical problem affecting up to half of all IBD patients; pulmonary disease, however, ranks among less common extraintestinal manifestations of IBD. Pulmonary disease in patients with IBD is most frequently drug induced due to treatment with sulfasalazine or mesalamine leading to eosinophilic pneumonia and fibrosing alveolitis or due to treatment with methotrexate leading to pneumonitis. Recently, various opportunistic infections have been shown to be a further important cause of pulmonary abnormalities in those IBD patients who are treated with immunosuppressants such as anti TNF-α monoclonal antibodies, methotrexate, azathioprine or calcineurin antagonists. In not drug related pulmonary disease a wide spectrum of disease entities ranging from small and large airway dysfunction to obstructive and interstitial lung disorders exist. Patients with lung disorders and inflammatory bowel disease should be evaluated for drug-induced lung disease and opportunistic infections prior to considering pulmonary disease as an extraintestinal manifestation of inflammatory bowel disease.
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38
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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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39
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Sivagnanam P, Koutsoumpas A, Forbes A. Respiratory symptoms in patients with inflammatory bowel disease and the impact of dietary salicylates. Dig Liver Dis 2007; 39:232-9. [PMID: 16979961 DOI: 10.1016/j.dld.2006.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Revised: 07/29/2006] [Accepted: 08/04/2006] [Indexed: 12/11/2022]
Abstract
BACKGROUND Respiratory symptoms are over-represented in inflammatory bowel disease. There are similarities between the epidemiology of inflammatory bowel disease and that of respiratory conditions for which an adverse influence of salicylate has been identified. Natural salicylates exist within our diet. AIMS To determine whether a lower intake of dietary salicylates is associated with less active inflammatory bowel disease and fewer concurrent respiratory symptoms. PATIENTS AND METHODS Respiratory status, inflammatory bowel disease activity, quality of life, and dietary habits were established in 73 patients with Crohn's disease and 69 with ulcerative colitis, using a self-administered questionnaire and peak expiratory flow rate readings. Harvey-Bradshaw and Simple Birmingham/Royal Free Colitis indices, an internally validated respiratory score, and estimated weekly dietary salicylate intake, were calculated for each patient. RESULTS There was at least one respiratory symptom in 63.4% of patients. The commonest underlying respiratory diagnosis was asthma. Respiratory impairment was similar in ulcerative colitis and Crohn's disease; 56.3% of Crohn's disease patients with an active respiratory diagnosis had other extra-intestinal manifestations. The dietary salicylate intake was independent of respiratory status, but inversely correlated with ulcerative colitis activity (dietary salicylate intake 37.0mg versus 21.4mg for low and higher Simple Birmingham/Royal Free Colitis index, respectively; p<0.02). A similar association was not seen in Crohn's disease. CONCLUSIONS Respiratory impairment is common in inflammatory bowel disease. Higher intake of dietary salicylates is associated with less active colitis and possibly causally so.
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Affiliation(s)
- P Sivagnanam
- Imperial College School of Medicine, South Kensington, London, UK
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40
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Kelly MG, Frizelle FA, Thornley PT, Beckert L, Epton M, Lynch AC. Inflammatory bowel disease and the lung: is there a link between surgery and bronchiectasis? Int J Colorectal Dis 2006; 21:754-7. [PMID: 16625374 DOI: 10.1007/s00384-006-0094-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2006] [Indexed: 02/04/2023]
Abstract
PURPOSE One-third of patients with inflammatory bowel disease (IBD) has extracolonic manifestations. Inflammatory bowel-associated pulmonary disease is one of the less commonly recognized and more recently described manifestations. Here, we report the experience of our patients with inflammatory bowel-associated bronchiectasis. METHODS A retrospective analysis of case notes of patients with IBD and respiratory manifestations was undertaken. Relevant demographic, clinical, radiological, and pulmonary physiology laboratory results were reviewed. RESULTS Ten patients with IBD and bronchiectasis were identified. Eight developed respiratory symptoms after surgery for IBD. Five of the ten had ulcerative colitis. Their lung function abnormality is mild to moderate in severity. Small airways disease (forced expiratory flow between 25-75% is <50%) was evident in seven of the ten patients. CONCLUSIONS This preliminary study supports an association between surgery for IBD and development of symptomatic lung disease, particularly bronchiectasis, in susceptible patients. The pulmonary manifestations of IBD in some patients may only become clinically significant after surgery and the withdrawal of medical treatment.
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Affiliation(s)
- Michael G Kelly
- Canterbury Respiratory Research Group, Department of Surgery, Christchurch Hospital, Private Bag 4710, Christchurch 8001, New Zealand
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41
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Sarıoğlu N, Türkel N, Şakar A, Çelik P, Saruç M, Demir MA, Göktan C, Kırmaz C, Yüceyar H, Yorgancıoğlu A. Lung involvement in inflammatory bowel diseases. Ann Saudi Med 2006; 26:407-8. [PMID: 17019097 PMCID: PMC6074116 DOI: 10.5144/0256-4947.2006.407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Nurhan Sarıoğlu
- Celal Bayar University Medical School Department of Pulmonology, Manisa, Turkey, 1785 sok. No: 61/9 35540 Karşıyaka-Izmir, Turkey
| | - Nurten Türkel
- Celal Bayar University Medical School Department of Gastroenterology, Manisa, Turkey, 1785 sok. No: 61/9 35540 Karşıyaka-Izmir, Turkey
| | - Ayşın Şakar
- Celal Bayar University Medical School Department of Pulmonology, Manisa, Turkey, 1785 sok. No: 61/9 35540 Karşıyaka-Izmir, Turkey
| | - Pınar Çelik
- Celal Bayar University Medical School Department of Pulmonology, Manisa, Turkey, 1785 sok. No: 61/9 35540 Karşıyaka-Izmir, Turkey
| | - Murat Saruç
- Celal Bayar University Medical School Department of Gastroenterology, Manisa, Turkey, 1785 sok. No: 61/9 35540 Karşıyaka-Izmir, Turkey
| | - M. Akif Demir
- Celal Bayar University Medical School Department of Pathology, Manisa, Turkey, 1785 sok. No: 61/9 35540 Karşıyaka-Izmir, Turkey
| | - Cihan Göktan
- Celal Bayar University Medical School Department of Radiology, Manisa, Turkey, 1785 sok. No: 61/9 35540 Karşıyaka-Izmir, Turkey
| | - Cengiz Kırmaz
- Celal Bayar University Medical School Department of Allergy and Immunology, Manisa, Turkey, 1785 sok. No: 61/9 35540 Karşıyaka-Izmir, Turkey, T: +90-236-232 3133, F: +90-236-232 8492, ,
| | - Hakan Yüceyar
- Celal Bayar University Medical School Department of Gastroenterology, Manisa, Turkey, 1785 sok. No: 61/9 35540 Karşıyaka-Izmir, Turkey
| | - Arzu Yorgancıoğlu
- Celal Bayar University Medical School Department of Pulmonology, Manisa, Turkey, 1785 sok. No: 61/9 35540 Karşıyaka-Izmir, Turkey
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Gursoy S, Guven K, Kula M, Canoz O, Yurci A, Unluhizarci K, Ozbakir O, Yucesoy M. Subclinical alveolar involvement in ulcerative colitis. Inflamm Bowel Dis 2005; 11:372-5. [PMID: 15803027 DOI: 10.1097/01.mib.0000164019.83666.af] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Although pulmonary dysfunction has been described in patients with ulcerative colitis (UC), the pathogenesis remains unclear. Our aim was to study alveolar epithelial damage using technetium-99m diethylene triamine penta acetic acid (Tc-99m DTPA) aerosol scintigraphy in patients with UC but without respiratory symptoms. METHODS We enrolled 32 patients (18 women and 14 men; mean age, 36.4 +/- 11.6 yr) with active UC, 10 patients with inactive UC (6 women and 4 men; mean age, 43.4 +/- 11.8 yr), and 31 healthy controls (24 women and 7 men; mean age, 40 +/- 10 yr). Tc-99m DTPA aerosol scintigraphy was performed on all patients and controls. The relationship between alveolar epithelial permeability and the activity, localization, and duration of the disease was studied. RESULTS There was a significant difference between alveolar epithelial permeability results in patients with active UC and those of the controls (P < 0.001). The same correlation was also found between the patients with inactive UC and the control group (P < 0.001). There was no correlation between Tc-99m DTPA alveolar scintigraphic test results and the stage of activity, localization, and duration of the disease. CONCLUSIONS A latent pulmonary involvement may exist in patients with active and inactive UC. The alveolar involvement may be the earliest pulmonary damage, and a DTPA clearance test may show the early changes in pulmonary epithelial permeability that precedes clinical symptoms. Increased alveolar epithelial permeability is an extraintestinal manifestation in patients with UC and is not related to the activity of the colitis.
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Affiliation(s)
- Sebnem Gursoy
- Department of Gastroenterology, Erciyes University School of Medicine, Kayseri, Turkey.
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44
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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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45
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Karadag F, Ozhan MH, Akçiçek E, Günel O, Alper H, Veral A. Is it possible to detect ulcerative colitis-related respiratory syndrome early? Respirology 2001; 6:341-6. [PMID: 11844126 DOI: 10.1046/j.1440-1843.2001.00347.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Obstructive airway disease, bronchiectasis, non-specific parenchymal infiltration and bronchiolitis obliterans organizing pneumonia are seen occasionally in patients with inflammatory bowel disease. In the present study, we evaluated ulcerative colitis (UC) patients for latent pulmonary involvement. METHODS Fifteen patients (nine females, six males, mean age 44 years) were admitted into the study. All patients were free of respiratory symptoms. Ulcerative colitis was active in nine patients and all patients were using anti-inflammatory treatment. Pulmonary function tests (PFT), high resolution computed tomography of thorax (HRCT) and bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy (TBLB) were carried out in all subjects. RESULTS Mild airways obstruction was found in 1 of 13 patients. High resolution CT was abnormal in 4 of 15 patients. Ground glass appearance suggestive of an interstitial lung disease was present in three patients. Radiolucency and pneumocysts were present in the fourth patient suggesting obstructive small airway disease. High resolution CT findings correlated with disease activity (P < 0.05). Fiberoptic bronchoscopy was performed in 10 patients. A mixed type alveolitis was detected in BAL fluid in five patients. In eight patients, TBLB showed alveolar septal thickening by connective tissue, lymphocytic accumulation in the septal area and minimal septal fibrosis, suggesting subclinical pulmonary parenchymal involvement linked to UC. CONCLUSIONS Our data suggest that latent interstitial pulmonary involvement may occur during the course of UC, despite an absence of symptoms of lung disease.
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Affiliation(s)
- F Karadag
- Department of Chest Diseases, Ege University Medical Faculty, Izmir, Turkey.
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46
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Vandenplas O, Casel S, Delos M, Trigaux JP, Melange M, Marchand E. Granulomatous bronchiolitis associated with Crohn's disease. Am J Respir Crit Care Med 1998; 158:1676-9. [PMID: 9817724 DOI: 10.1164/ajrccm.158.5.9801070] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Symptomatic bronchopulmonary disorders have been only occasionally reported in Crohn's disease, although several studies have documented the possibility of latent involvement of the respiratory tract. We report the case of a patient with long-standing Crohn's disease who presented with acute transient chest pain and a recent history of mild dyspnea and nonproductive cough. Chest radiographs were normal, while high-resolution computed tomography demonstrated a mosaic pattern of attenuation that was consistent with a bronchiolar disorder. Pulmonary function tests showed mild airway obstruction and normal diffusion indices. Thoracoscopic lung biopsy demonstrated focal infiltration of the bronchiolar walls by mononuclear cells and non-necrotizing granulomas. To our knowledge, this is the first account of isolated granulomatous bronchiolitis in Crohn's disease. These findings suggest that a granulomatous inflammatory process of the bronchioles could be involved in the development of airway obstruction in patients with Crohn's disease.
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Affiliation(s)
- O Vandenplas
- Service de Pneumologie, Service d'Anatomo-pathologie, Service de Radiologie, Service de Gastro-entérologie, Cliniques Universitaires UCL de Mont-Godinne, Yvoir, Belgium
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47
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Abstract
Lung disease is a rare complication of inflammatory bowel disease (IBD). Herein is a series of seven IBD patients who developed new, persistent and unexplained symptoms of respiratory disease, particularly chronic productive cough. Using a CT scan of the chest, a diagnosis of bronchiectasis was made in five patients, while the diagnosis of chronic bronchitis was made in two patients. Factors, other than IBD, that could account for pulmonary disease in these patients were absent. Several important clinical patterns for IBD-associated large airway disease were uncovered and are reviewed in light of earlier case reports in the medical literature. A discussion regarding the possible pathogenesis of IBD-associated airway disease follows.
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Affiliation(s)
- A Spira
- Department of Medicine, University of Toronto, Ontario, Canada
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48
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Tzanakis N, Bouros D, Samiou M, Panagou P, Mouzas J, Manousos O, Siafakas N. Lung function in patients with inflammatory bowel disease. Respir Med 1998; 92:516-22. [PMID: 9692115 DOI: 10.1016/s0954-6111(98)90301-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Previous studies on baseline pulmonary function testing (PFT) abnormalities in patients with inflammatory bowel disease (IBD) are conflicting because most of them have incorporated patients suffering from both ulcerative colitis (UC) and Crohn's disease (CD). The aim of the study is to investigate whether any PFT abnormalities could be detected in a large group of IBD patients and whether there are differences between the two IBD entities. A total of 132 patients, 47 with CD (mean age 35 years) and 85 with UC (mean age 40 years) were studied. Pulmonary function tests (PFTs), lung transfer factor for carbon monoxide (TLCO) were examined and compared with those of 36 healthy controls. No significant difference of mean values of spirometric indices, TLCO and ABG was found between the two groups of patients and controls, or between patients with CD and UC. However, nine (19%) patients with CD and 15 (17.6%) with UC had a reduction in TLCO, a percentage significantly higher than in controls (P < 0.05). The majority of the patients with TLCO reduction were in an active phase of disease (P < 0.05). Our results suggest that there is no difference in routine PFTs between UC and CD patients, as well as between both these groups and normal controls. However, TLCO abnormalities related to the degree of disease activity are found in patients with both UC and CD.
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Affiliation(s)
- N Tzanakis
- Department of Thoracic Medicine, Medical School University of Crete, Greece
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Abstract
In this article, Graham Rook and John Stanford propose that a group of idiopathic diseases that are often associated with a degree of autoimmunity and arthritis, including rheumatoid arthritis, inflammatory bowel disease, sarcoidosis and psoriasis, are caused by extremely slow-growing bacteria. They suggest that these diseases are one end of a continuous spectrum caused by related slow-growing genera, which ranges from rheumatoid arthritis, through Takayasu's arteritis and Whipple's disease, to reach the conventional mycobacterioses such as tuberculosis and leprosy.
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Affiliation(s)
- G A Rook
- Dept of Medical Microbiology, University College and Middlesex School of Medicine, London, UK
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