Thorax as an extraintestinal target for inflammatory bowel disease (original) (raw)

Radiological Patterns of Lung Involvement in Inflammatory Bowel Disease

Gastroenterology Research and Practice

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 m...

Crosstalk between the Lungs and the Gut in Inflammatory Bowel Diseases

2017

Pulmonary involvement seems to be a more frequent extraintestinal manifestation of IBD than thus far supposed. In IBD, the respiratory involvement may include a wide range of pathologies. The patients with IBD are in high risk of infections. The drugs used in the treatment of IBD (sulfasalazine, mesalamine, infliximab, and methotrexate) can induce pulmonary diseases as a side effect. Pulmonary function tests and high resolution CT are useful for detecting subclinical or clinical pulmonary involvement in IBD patients. Pulmonary function tests (PFT) and high-resolution CT (HRCT) showed abnormality in about one-quarter of patients with IBD. Corticosteroids, both systemic and aerosolized, are the main therapeutical approach, while antibiotics must also be administered in infections. Early identification is important as early treatment may improve long-term outcomes in these patients.

Bronchial disease in ulcerative colitis

Thorax, 1980

Ten patients with ulcerative colitis, all of whom were non-smokers, presented with a productive cough. In six, the chest radiograph was normal and cough was the only symptom; three of these patients had a minor obstructive ventilatory defect on testing. Four patients complained of exertional dyspnoea and had both an abnormal chest radiograph with bilateral pulmonary shadows and a mixed obstructive and restrictive ventilatory defect. Bronchial epithelial biopsies from four patients (two with and two without pulmonary shadows) revealed basal reserve cell hyperplasia, basement membrane thickening, and submucosal inflammation, changes more usually associated with cigarette smoking. Inhaled beclomethasone diproprionate relieved cough in seven patients. The occurrence of airway epithelial disease in association with ulcerative colitis raises the possibility of a systemic mechanism affecting both bronchial and colonic epithelium. It does not seem likely that sulphasalazine was the cause of the pulmonary syndrome in these subjects.

Inflammatory bowel disease and airway diseases

World Journal of Gastroenterology, 2016

Airway diseases are the most commonly described lung manifestations of inflammatory bowel disease (IBD). However, the similarities in disease pathogenesis and the sharing of important environmental risk factors and genetic susceptibility suggest that there is a complex interplay between IBD and airway diseases. Recent evidence of IBD occurrence among patients with airway diseases and the higher than estimated prevalence of subclinical airway injuries among IBD patients support the hypothesis of a two-way association. Future research efforts should be directed toward further exploration of this association, as airway diseases are highly prevalent conditions with a substantial public health impact.

Airway-centered interstitial fibrosis: etiology, clinical findings and prognosis

Respiratory Research, 2015

Background: Airway-centered Interstitial Fibrosis (ACIF) is a common pathologic pattern observed in our practice. Objectives: The objectives of this study are to describe the causes associated with ACIF in a large sample of patients and its effect on survival. Methods: A retrospective study in three centers of interstitial lung disease in São Paulo, between January of 1995 and December of 2012. The surgical lung biopsy specimens were reviewed by three pathologists. The clinical, functional and tomographic findings were analyzed by a standardized protocol. Results: There were 68 cases of ACIF, most of them women. The mean age was 57 ± 12 yr. Dyspnea, cough, restrictive pattern at spirometry and oxygen desaturation at exercise were common. A reticular pattern with peribronchovascular infiltrates was found in 79% of the cases. The etiologies of ACIF were hypersensitivity pneumonitis in 29 (42.6%), gastroesophageal reflux disease in 17 (25.0%), collagen vascular disease in 4 (5.9%), a combination of them in 15 cases and idiopathic in 3 (4.4%). The median survival was 116 months (95% CI = 58.5-173.5). Lower values of oxygen saturation at rest, presence of cough and some histological findings-organizing tissue in the airways, fibroblastic foci and microscopic honeycombing-were predictors of worse survival. Conclusions: ACIF is an interstitial lung disease with a better survival when compared with IPF. The main etiologies are HP and GERD. The oxygen saturation at rest, the presence of cough and some histological findings are predictors of survival.