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World J Gastroenterol. Oct 28, 2013; 19(40): 6794-6804
Published online Oct 28, 2013. doi: 10.3748/wjg.v19.i40.6794
Gut-lung crosstalk in pulmonary involvement with inflammatory bowel diseases
Hui Wang, Jing-Shi Liu, Shao-Hua Peng, Xi-Yun Deng, De-Mao Zhu, Sara Javidiparsijani, Gui-Rong Wang, Dai-Qiang Li, Long-Xuan Li, Yi-Chun Wang, Jun-Ming Luo
Hui Wang, Jing-Shi Liu, Shao-Hua Peng, Xi-Yun Deng, De-Mao Zhu, Sara Javidiparsijani, Gui-Rong Wang, Dai-Qiang Li, Long-Xuan Li, Yi-Chun Wang, Jun-Ming Luo, Department of Radiation Oncology, the Affiliated Hunan Provincial Tumor Hospital, Xiangya Medical School, Central South University, Changsha 410013, Hunan Province, China
Jun-Ming Luo, Department of Pathology, Qinghai Provincial People's Hospital, Xining 810007, Qinghai Province, China
Jing-Shi Liu, Yi-Chun Wang, Department of Anesthesiology, the Affiliated Hunan Provincial Tumor Hospital at Central South University, Changsha 410013, Hunan Province, China
Shao-Hua Peng, Xi-Yun Deng, Department of Pathology, Medical College of Hunan Normal University, Changsha 410013, Hunan Province, China
De-Mao Zhu, Department of Pathology, Changsha Central Hospital, Changsha 410007, Hunan Province, China
Sara Javidiparsijani, Gui-Rong Wang, Department of Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, United States
Dai-Qiang Li, Department of Pathology, the Second Affiliated Hospital, Xiangya Medical School, Central South University, Changsha 410013, Hunan Province, China
Long-Xuan Li, Department of Neurology, Guangdong Medical College Affiliated Hospital, Zhanjiang 524001, Guangdong Province, China
Author contributions: Wang H, Liu JS and Peng SH contributed equally to this work; Luo JM, Wang H, Liu JS, Peng SH, Zhu DM, Deng XY and Wang YC designed the study; Luo JM Wang H, Liu JS and Li LX analyzed data; Luo JM, Wang H and Liu JS wrote the paper; Li DQ, Javidiparsijani S and Wang GR revised the paper and provided important suggestions; all authors have read and approved the final manuscript.
Correspondence to: Jun-Ming Luo, MD, Professor of Pathology, Department of Pathology, Qinghai Provincial People's Hospital, 2 Gonghe Road, Xining 810007, Qinghai Province, China. jluo099@163.com
Telephone: +86-731-89762696 Fax: +86-731-88651999
Received: May 31, 2013
Revised: July 22, 2013
Accepted: September 4, 2013
Published online: October 28, 2013
Processing time: 165 Days and 17.1 Hours
Abstract

Pulmonary abnormalities, dysfunction or hyper-reactivity occurs in association with inflammatory bowel disease (IBD) more frequently than previously recognized. Emerging evidence suggests that subtle inflammation exists in the airways among IBD patients even in the absence of any bronchopulmonary symptoms, and with normal pulmonary functions. The pulmonary impairment is more pronounced in IBD patients with active disease than in those in remission. A growing number of case reports show that the IBD patients develop rapidly progressive respiratory symptoms after colectomy, with failure to isolate bacterial pathogens on repeated sputum culture, and often request oral corticosteroid therapy. All the above evidence indicates that the inflammatory changes in both the intestine and lung during IBD. Clinical or subclinical pulmonary inflammation accompanies the main inflammation of the bowel. Although there are clinical and epidemiological reports of chronic inflammation of the pulmonary and intestinal mucosa in IBD, the detailed mechanisms of pulmonary-intestinal crosstalk remain unknown. The lung has no anatomical connection with the main inflammatory site of the bowel. Why does the inflammatory process shift from the gastrointestinal tract to the airways? The clinical and subclinical pulmonary abnormalities, dysfunction, or hyper-reactivity among IBD patients need further evaluation. Here, we give an overview of the concordance between chronic inflammatory reactions in the airways and the gastrointestinal tract. A better understanding of the possible mechanism of the crosstalk among the distant organs will be beneficial in identifying therapeutic strategies for mucosal inflammatory diseases such as IBD and allergy.

Keywords: Inflammatory bowel disease; Pulmonary symptoms; Gut-lung crosstalk; Biao-Li relationship; Social manner

Core tip: According to traditional Chinese medicine, the lung and the intestine are a pair of related organ systems (Biao-Li). The lung has no anatomical connection with the main inflammatory site of the bowel. Why does the inflammatory process shift from the gastrointestinal tract to the airways? We hypothesize that each individual cell or molecule not only plays its local role in its own organ, but also plays a “social” role to contribute distal communication through the epithelia. Inflammatory bowel disease may be a good example to study crosstalk between the gut and the lungs.