İnflammatory bowel disease
DESCRIPTION
Inflammatory bowel disease and lung Prof Dr Berrin Ceyhan Marmara Univ School of Medicine, ISTANBUL, TURKEY. İnflammatory bowel disease. IBD is a chronic inflammatory disease commonly involving the gastrointestinal system characterised by mucosal inflammation and ulcers Etiology İnfection - PowerPoint PPT PresentationTRANSCRIPT
Inflammatory bowel Inflammatory bowel disease and lungdisease and lung
Prof Dr Berrin CeyhanProf Dr Berrin CeyhanMarmara Univ School of Medicine, Marmara Univ School of Medicine,
ISTANBUL, TURKEYISTANBUL, TURKEY
İnflammatory bowel diseaseİnflammatory bowel disease
IBD is a chronic IBD is a chronic inflammatory disease inflammatory disease commonly involving the commonly involving the gastrointestinal system gastrointestinal system characterised by mucosal characterised by mucosal inflammation and ulcersinflammation and ulcers
EtiologyEtiology İnfectionİnfection Food allergyFood allergy Environmental factorsEnvironmental factors GeneticsGenetics Immunologic factorsImmunologic factors
NormalUC
CD
İnflammatory bowel diseaseİnflammatory bowel disease
The incidence of ulcerative colitis The incidence of ulcerative colitis is 1.5-20.3/100.000 person-yearsis 1.5-20.3/100.000 person-yearsThe incidence of Crohn’s disease The incidence of Crohn’s disease is 0.7-9.8/100.000 person-yearsis 0.7-9.8/100.000 person-years
Frequency of extraintestinal Frequency of extraintestinal manifestations occur in %21-41 of manifestations occur in %21-41 of patients with IBD patients with IBD
Lung and gastrointestinal system Lung and gastrointestinal system are originated from primitiv gut are originated from primitiv gut and they have same pathogenetic and they have same pathogenetic changeschanges
Ulcerative colitisUlcerative colitis Crohn’s diseaseCrohn’s disease
DistributionDistribution Diffuse inflammation extending Diffuse inflammation extending from rectumfrom rectum
Rectal sparing, frequent skip Rectal sparing, frequent skip lesionslesions
InflammationInflammation Diffuse, with mucosal granularity Diffuse, with mucosal granularity or friabilityor friability
Focal and asymmmetric; Focal and asymmmetric; cobblestoning, granularity and cobblestoning, granularity and friability less commonfriability less common
UlcerationUlceration Small ulcers in a diffusely Small ulcers in a diffusely inflamed mucosa; deep ulcers in inflamed mucosa; deep ulcers in severe diseasesevere disease
Afphtoid ulcers; Afphtoid ulcers; linear/serpiginous ulceration; linear/serpiginous ulceration; intervening mucosa often normalintervening mucosa often normal
Colonic lumenColonic lumen Often narrowed in long-standing Often narrowed in long-standing chronic disease; strictures very chronic disease; strictures very rarerare
Strictures commonStrictures common
Extraintestinal manifestations of Extraintestinal manifestations of inflammatory bowel diseaseinflammatory bowel disease
MusculoskletalMusculoskletal Peripheral arthropathyPeripheral arthropathy Ankylosing spondylitisAnkylosing spondylitis SacroileitisSacroileitis Hipertrophic osteoarthropathyHipertrophic osteoarthropathy OsteopeniaOsteopenia OsteoporosisOsteoporosis OsteomalaciaOsteomalacia OsteonecrosisOsteonecrosis Relapsing polychondritisRelapsing polychondritis
DermatologicDermatologic Er. NodosumEr. Nodosum Pyoderma gangrenosumPyoderma gangrenosum StomatitisStomatitis PsoriasisPsoriasis Ert. MultiformeErt. Multiforme Metastatic Crohn’s diseaseMetastatic Crohn’s disease Sweet’s syndromeSweet’s syndrome EpidermolysisEpidermolysis
Hematolojgic
•Anemia
•Leucocytosis
•Leucopenia
•Thrombocytosis
•Thrombocytopenia
•Coagulation abnormalities and hypercoaguable state
Neurologic
•Neuropathy
•Myopathy
•Vasculopathy
•Meningitis
•Seizures
Extraintestinal manifestations of Extraintestinal manifestations of inflammatory bowel diseaseinflammatory bowel disease
OpthalmologicOpthalmologic UveitisUveitis ScleritisScleritis EpiscleritisEpiscleritis Retinal vascular diseaseRetinal vascular disease ConjunctivitisConjunctivitis
GenitourinaryGenitourinary NephrolithiasisNephrolithiasis Obstructive uropathyObstructive uropathy FistulasFistulas AmiloidosisAmiloidosis GlomerulitisGlomerulitis MembranoglomerulonephritisMembranoglomerulonephritis
CardiovascularCardiovascular•PleuropericarditisPleuropericarditis•CardiomyopathyCardiomyopathy•EndocarditisEndocarditis•MyocarditisMyocarditis
PancreaticPancreatic•Granulomatous pancreatitisGranulomatous pancreatitis
Hepatobiliary•Primary sclerosing cholangitis•Pericholangitis•Cirrhosis•Cholangiocarcinoma•Steatosis•Granulomatous hepatitis•Cholelithiasis•Autoimmune hepatitis•Hepatic abscess•Portal vein trombosis
Ulcerative colitis and lung
involvement
Upper airway obstruction
Tracheobronchitis
Bronchiectasis
Constrictive bronchiolitis
Panbronchiolitis
Necrobiotic nodule
Lung bullaeINterstitial lung diseaseBOOPSarcoidosisPulmonary vasculitisPulmonary eosinophiliaWegener granulomatosis?(lack of kidney involvement)Apical fibrosis
Crohn’s disease and lung involvementCrohn’s disease and lung involvement
BOOPBOOP
ILDILD
Subclinical lymhocyctic alveolitisSubclinical lymhocyctic alveolitis
Chronic bronchitisChronic bronchitis
Chronic bronchial suppurationChronic bronchial suppuration
BronchiectasisBronchiectasis
Granulomatous infiltration and peripheral eosinophiliaGranulomatous infiltration and peripheral eosinophilia
Necrobiotic noduleNecrobiotic nodule
33 IBD cases(21 F, 12 M, 17-80 years old) , (27 ulcerative colitis 33 IBD cases(21 F, 12 M, 17-80 years old) , (27 ulcerative colitis and 8 Crohn’s disease) with lung involvement were reported and 8 Crohn’s disease) with lung involvement were reported and 57 IBD cases in literature were reviewedand 57 IBD cases in literature were reviewed
Camus et al Medicine 1993;151Camus et al Medicine 1993;151..
400 IBD cases from literature and a review was published in 400 IBD cases from literature and a review was published in 20032003
Storch I et al Inf Bowel Dis 2003; 9:104-115Storch I et al Inf Bowel Dis 2003; 9:104-115
Milestones in the literature of lung involvement in IBDMilestones in the literature of lung involvement in IBD
Firstly, Kraft et al reported 6 IBD cases (5 ulcerative Firstly, Kraft et al reported 6 IBD cases (5 ulcerative colitis) with lung involvement in 1976 (1400 cases were colitis) with lung involvement in 1976 (1400 cases were screened in 40 years)screened in 40 years)
Kraft et al Arch Intern Med 1976;454.Kraft et al Arch Intern Med 1976;454.
28/33 IBD diagnosis preceded lung involvement, 5/33 lung disease preceded IBD diagnosis
Inactive bowel diease 17(%60.7) active 3(%10.7) postcolectomy 8(%28.6)
Camus et al 1993
Diagnosis of lung involvement mean age: 42.7±2.9 yaş
IBD diagnosis mean age: 35.3±2.9 yearsIBD diagnosis mean age: 35.3±2.9 years
IBD diagnosis preceded 9.3±5.3 years the lung involvement (range: 1 week-36 years)
Symptoms:Symptoms: Stridor, severe dyspnea during 2-3 weeks Stridor, severe dyspnea during 2-3 weeks
Differential diagnosis of subglottik stenosisDifferential diagnosis of subglottik stenosis: Intubation, tuberculosis, : Intubation, tuberculosis, sarkoidosis, amiloidosissarkoidosis, amiloidosis
Bronchoscopy:Bronchoscopy: F Fragile, bleeding tissue and %50-80 obstruction in ragile, bleeding tissue and %50-80 obstruction in the lumenthe lumen
Airway DiseaseAirway Disease
Upper airway obstructionUpper airway obstructionSubglottic inflammation and Subglottic inflammation and stenosis in tracheal obstruction stenosis in tracheal obstruction (3/33 cases in Camus’s cases)(3/33 cases in Camus’s cases)
Treatment: Good response to inhaled and oral steroids, one case stayed in remission state during 8 years
Rupture following biju dilatation was noted in one case who was unresponsive to previous steroid treatment and he died with pneumomediastinum
Biopsy: Granulation tissue and inflammation (plasma cells, lymphocytes, neutrophils, and erythrocytes) in airway, epithelial ulceration and thin fibrin layer
Clinical progress:IBD was diagnosed 10 and 20 years before in two cases , IBD was diagnosed 1 month after pulmonary disease in the other case
Large airway involvementLarge airway involvementChronic bronchitis and bronchiectasis Chronic bronchitis and bronchiectasis
Symptoms; cough, sputum and Symptoms; cough, sputum and dyspnea( mucopurulent sputum up to 800 dyspnea( mucopurulent sputum up to 800 ml/day)ml/day)
15/33 cases in Camus’ cases (13UC, 2 15/33 cases in Camus’ cases (13UC, 2 Crohn)Crohn) Camus et al Medicine 1993;151Camus et al Medicine 1993;151..
9 cases with colectomy and 1 case with 9 cases with colectomy and 1 case with asthmaasthma
Airway disease was diagnosed in 9/22Airway disease was diagnosed in 9/22
pulmonary involvement cases with Crohn’s pulmonary involvement cases with Crohn’s diseasedisease
Omori H et al Inf Bowel Dis 2004Omori H et al Inf Bowel Dis 2004
Radiology:Radiology: Tubuler bronchial opacities, bronchiectasis in Tubuler bronchial opacities, bronchiectasis in CTCT
Lung function test:Lung function test: FEV1/FVC FEV1/FVC
BronchoscopyBronchoscopy: Eritematous and edematous mucosa and : Eritematous and edematous mucosa and inflammation in the wallinflammation in the wall
Bronchial biopsy revealed Bronchial biopsy revealed submucosal lymphocytes, plasma submucosal lymphocytes, plasma cells, neutrophilic infiltration, cells, neutrophilic infiltration, mucosal ulceration, chronic mucosal ulceration, chronic inflammation with abundant plasma inflammation with abundant plasma cells=Bronchial biopsy is mimicking cells=Bronchial biopsy is mimicking colon biopsycolon biopsy
BAL BAL commonly reveals leucocytes, but lymhocytes in one commonly reveals leucocytes, but lymhocytes in one case case 9 cases were in postcolectomy state, airway disease occured 9 cases were in postcolectomy state, airway disease occured in days and weeks after colectomyin days and weeks after colectomy
The mean interval after IBD diagnosis was 7.4±1.9 yearsThe mean interval after IBD diagnosis was 7.4±1.9 yearsExtraintestinal manifestations were detected in 10/15 casesExtraintestinal manifestations were detected in 10/15 cases
Camus et al Medicine 1993;151.Camus et al Medicine 1993;151.
In the other study of 7 cases with large airway disease, In the other study of 7 cases with large airway disease, interval was 12 years (4 months-35 years)interval was 12 years (4 months-35 years)
Spira et al Chest 1998Spira et al Chest 1998
Airway involvement was not associated with intake Airway involvement was not associated with intake of sulphasalazin and 5-ASA of sulphasalazin and 5-ASA
Symptoms of bronchiectasisSymptoms of bronchiectasis and bowel were activated and bowel were activated at the same time at the same time
Bronchiectasis was activated after colectomy (3/7 Bronchiectasis was activated after colectomy (3/7
cases 1-4 months after colectomycases 1-4 months after colectomy))
Bronchial steroid lavage is helpful, (40-80 mg metil prednisolon in serum physiologic in 2-3 days)
There was no response in 2 cases of Camus’ cases, they were in waiting list of transplantation
Immuran and cyclophosphamide were not effective treatment choices
TREATMENTSteroids are more effective in chronic bronchitis than bronchiectasis, therefore inhaled steroids should be started in the early stage and progression to bronchiectasis should be slowed.Lung function test and bronchoscopy show response with inhaled +/- oral steroid
Small airway disease (Chronic bronchiolitisSmall airway disease (Chronic bronchiolitis))
Less common presentationLess common presentationThis disease was diagnosed in 2 UC patients in This disease was diagnosed in 2 UC patients in Camus’ casesCamus’ cases
Both of them had inactive disease and open lung Both of them had inactive disease and open lung biopsy revealed chronic and stenotic chronic biopsy revealed chronic and stenotic chronic bronchiolitis=diffuse panbronchiolitis bronchiolitis=diffuse panbronchiolitis
Chronic bronchiolitis
Diffuse panbronchiolitis (DPB) is diagnosed in non Diffuse panbronchiolitis (DPB) is diagnosed in non Asian peopleAsian people
1 patient with DPB has been reported 5 years before 1 patient with DPB has been reported 5 years before UC diagnosisUC diagnosis
Limited treatment, mild-moderate response to oral steroids Limited treatment, mild-moderate response to oral steroids
1 patient of Camus’ cases responded to steroid, the other one 1 patient of Camus’ cases responded to steroid, the other one was transplantedwas transplanted
Macrolid effect??Macrolid effect??
Bronchiolitis obliterans organised pneumonia Bronchiolitis obliterans organised pneumonia (BOOP)(BOOP)
6 patients in Camus’ cases (5UC, 1 6 patients in Camus’ cases (5UC, 1 Crohn’s disease)Crohn’s disease)
Interval 2 months- 36 yearsInterval 2 months- 36 yearsBOOP was diagnosed 6 months BOOP was diagnosed 6 months before the onset of IBD in one case before the onset of IBD in one case
LFTLFT: Restriction in all subjects: Restriction in all subjects
BAL: BAL: One case with neutrophilia, One case with neutrophilia, one with lymphocytosisone with lymphocytosis
TREATMENTTREATMENT: Steroids were used in 4 patients and led to : Steroids were used in 4 patients and led to complete remission, two patients with mild symptoms complete remission, two patients with mild symptoms improved without any tretment in 2 and 6 monthsimproved without any tretment in 2 and 6 months
There was no relation to sulphasalazine and 5-ASA intake, There was no relation to sulphasalazine and 5-ASA intake, remission occured in one case while taking the drugremission occured in one case while taking the drug
There was no association with colectomyThere was no association with colectomy
Pyoderma gangrenosum in skin (lung and skin biopsies Pyoderma gangrenosum in skin (lung and skin biopsies are similar) have been reportedare similar) have been reported
4 cases with necrobiotic nodules are reported in the 4 cases with necrobiotic nodules are reported in the literatureliterature
2 new cases were included in Camus’ serie, in one of them 2 new cases were included in Camus’ serie, in one of them had p. gangrenosum and pANCA(+). had p. gangrenosum and pANCA(+).
IBD has been diagnosed 11 ve 25 years earlier, both of IBD has been diagnosed 11 ve 25 years earlier, both of them were inactive and one was taking low dose steroid them were inactive and one was taking low dose steroid and sulfasalazine and sulfasalazine
Nekrobiotic parenchymal nodulesNekrobiotic parenchymal nodules
Rounded and cavitated nodules Rounded and cavitated nodules Biopsy: Biopsy: Neutrophilic infiltration in necrotic areaNeutrophilic infiltration in necrotic area
Early nodules show neutrophils and fibrinous exudateThese nodules undergo central necrosis and cavitated to form large necrotic nodules resembling necrotic granulomas
There are no giant cells, no severe vasculitis (there were secondary inflammatory cells in vascular walls), and no non-necrotizing granuloma
IBD complicated by pulmonary vasculitis (Wegener granulomatosis?)
There are vasculitis( inflammatory cells in vascular walls, giant cells, granuloma, cANCA, pANCA and intestinal manifestations (25 cases)
Parencymal necrobiotic nodules
Relationship with skin neutrophilic dermatosis?
Pyoderma gangrenosum was reported in a patient with cavitated lung nodules,who had no IBD history 1 of the 8 patients with neutrophilic dermatosis originally described by Sweet had ulcerative colitis, however pulmonary lesions could not be found
Churg Strauss syndrome was considered in a case with face Churg Strauss syndrome was considered in a case with face swelling, arthralgia, wheezing, nasal congestion, and skin swelling, arthralgia, wheezing, nasal congestion, and skin vasculitisvasculitis
Oral steroids are effectiveOral steroids are effective
Pulmonary infiltrates and eosinophiliaPulmonary infiltrates and eosinophilia
3/33 ( 2UC, 1 Chron) cases were reported in Camus’ paper 3/33 ( 2UC, 1 Chron) cases were reported in Camus’ paper involvement was concomitant, preceding, or following the onset involvement was concomitant, preceding, or following the onset of IBDof IBD
There was no history of sulfasalazine and 5-ASA intakeThere was no history of sulfasalazine and 5-ASA intake
There were peripheral eosinophilia in all subjects and 18% There were peripheral eosinophilia in all subjects and 18% eosinophilia in BAL in one patienteosinophilia in BAL in one patient
Serositis developed in 41 literature cases (32 UC, 9 Crohn)Serositis developed in 41 literature cases (32 UC, 9 Crohn)and one case in Camus’ paperand one case in Camus’ paper
Pleural fluid was rich in neutrophils and lymphocytesPleural fluid was rich in neutrophils and lymphocytes
Tamponade was reported in 3 casesTamponade was reported in 3 cases
Response to steroids was excellentResponse to steroids was excellent
Recurrent episodes of serositis are reportedRecurrent episodes of serositis are reported
SerositisSerositis
DRUG EFFECT
Sulfasalazin induced pneumonitis; fever, infiltration in upper lobes, skin rash, and peripheral eosinophilia (38 cases, 2weeks-8 years)
Drug induced BOOP, granulomatous reaction, interstitial fibrosis, and lupus (15 cases) were reported
Mesalamin(5-ASA); it induces hepatitis and nephritis in addition to the same adverse reactions (7 cases, 5 days-44 months)
Other drugs; methodrexate, azathioprin, anti-TNF
Treatment: Withdrawal of the agent, steroids
1 case in1 case in Camus’ paper; ANA (+) and UC onset was 7 years Camus’ paper; ANA (+) and UC onset was 7 years beforebefore
12 cases were reported in literature (2 DIP, 6 sarcoidosis )12 cases were reported in literature (2 DIP, 6 sarcoidosis )
3 cases were preceding the IBD diagnosis 3 cases were preceding the IBD diagnosis
Drug effect?: 4 case with sulfasalazin, 3 cases with 5-ASA, and 5 Drug effect?: 4 case with sulfasalazin, 3 cases with 5-ASA, and 5
cases with no medicationcases with no medication
Treatment: Treatment: Steroids are effectiveSteroids are effective
İnterstitial lung disease İnterstitial lung disease
Enterokütanöz fistül
Anal fistül
Fistulae (1/3in CD cases)
Ileobronchial fistula (1 case)
Colobronchial fistula (5 cases)
Osephagobronchial fistula (4 cases)
Pulmonary embolism
Thromboembolism risk is high (%1-8)
Homocystein, genetics, drugs, cardiolipin ?
Overlap syndrome
Granulomatous lung disease (46 cases, negative ACE and gallium scanning)
Alpha 1 antitrypsin deficiency (12 cases, 8 had lung involvement)
LABORATORY
Eosinophil (BOOP, drug effect, and eosinophilia+lung
infiltration)
ANA
pANCA
RF
A latent pulmonary involvement was reported with abnormal Tc-A latent pulmonary involvement was reported with abnormal Tc-99mDTPA aerosol scintigraphy in patients with UC but without 99mDTPA aerosol scintigraphy in patients with UC but without respiratory symptoms, and was not related to the disease activityrespiratory symptoms, and was not related to the disease activity
Gursoy S ve ark Inf Bow Dis 2005Gursoy S ve ark Inf Bow Dis 2005
P-A chest X-Ray occasionally shows bronchiectasis and HRCT is not P-A chest X-Ray occasionally shows bronchiectasis and HRCT is not routinely performed in each patientroutinely performed in each patient
SUBCLINIC, LATENT PULMONARY INVOLVEMENTSUBCLINIC, LATENT PULMONARY INVOLVEMENT
Hastalarda akciğer sorunu gözden kaçıyor.Hastalarda akciğer sorunu gözden kaçıyor.
Subclinic alveolitis was describedSubclinic alveolitis was described In Crohn’s disease casesIn Crohn’s disease cases without without respiratory symptoms and with normal X-Ray.respiratory symptoms and with normal X-Ray. Ratio of CD4/CD8 in induced sputum samples was high in 65% of casesRatio of CD4/CD8 in induced sputum samples was high in 65% of cases
Wallaert B et al Chest 1985Wallaert B et al Chest 1985
Fireman Z Am J Gastroenterol 2000Fireman Z Am J Gastroenterol 2000
HRCT showedHRCT showedBonchiectasis 13 /17 (11UC, 2CD)Bonchiectasis 13 /17 (11UC, 2CD)Tree in bud 5/17Tree in bud 5/17Air trapping 11/17Air trapping 11/17ILD 1/17ILD 1/17Groung glass 1/17Groung glass 1/17 Mahadeva et al Eur Respir J 2002;15:41-48Mahadeva et al Eur Respir J 2002;15:41-48
RADIOLOGYRADIOLOGY17 cases with respiratory symptoms (14 UC and 3 CD)17 cases with respiratory symptoms (14 UC and 3 CD)
IBD diagnosis preceded lung involvement in 16/17 (1-25 years)IBD diagnosis preceded lung involvement in 16/17 (1-25 years) 7 patients with colectomy and 3 with extraintestinal manifestations7 patients with colectomy and 3 with extraintestinal manifestations
Smoking: 7 ex-smoker bırakmış, 3 current, and 7 nonsmokerSmoking: 7 ex-smoker bırakmış, 3 current, and 7 nonsmoker
Smoking negatively correlated with severe colitis and colectomySmoking negatively correlated with severe colitis and colectomy
LUNG FUNCTION TESTLUNG FUNCTION TEST
Abnormal lung function tests have been found in patients Abnormal lung function tests have been found in patients without any respiratory symptoms without any respiratory symptoms
Low DLCO has been found in 17/ 32 (53%) nonsmoker Low DLCO has been found in 17/ 32 (53%) nonsmoker UC patients with no symptoms and normal HRCT,UC patients with no symptoms and normal HRCT,
DLCO associated with disease activity DLCO associated with disease activity
Marvisi et al Eur Respir J 2000Marvisi et al Eur Respir J 2000
30/55 (%55) random UC patients had abnormal LFT 30/55 (%55) random UC patients had abnormal LFT 15/55 obstructive15/55 obstructive19/55 abnormal diffusion19/55 abnormal diffusion1/55 restrictive1/55 restrictive5/55 obstructive+abnormal diffusion5/55 obstructive+abnormal diffusion
No relation with smoking, family history, occupation, drugsNo relation with smoking, family history, occupation, drugs
Godet et al Am J Gastroenterol 1997Godet et al Am J Gastroenterol 1997
LFT in 17 IBD patients with respiratory symptoms revealedLFT in 17 IBD patients with respiratory symptoms revealed4 restrictive4 restrictive5 obstructive5 obstructive2 obs+rest2 obs+rest4 Low DLCO4 Low DLCO
6 normal LFT (bronchiectasis, air trapping, tree in bud) 6 normal LFT (bronchiectasis, air trapping, tree in bud)
Mahadeva et al Eur Respir J 2000Mahadeva et al Eur Respir J 2000
BHR and asthma in IBD
3 month-follow-up of 44 random (22 UC, 22Crohn) IBD patients
21/44 (%48) respiratory symptoms11/44 bronchitis4/44 allergic rhinitis1/44 pleuritis4/44(%10) asthma
14/44 (%32) abnormal LFT, 7/44 (%16) abnormal DLCO, and relation to disease activity have been found with FRC and RV
Douglas et al Respir Med 1989
BHR has been shown in 10/14 (%71) children with CD using metacholine challenge test ( no history of clinic, radiologic, and functional airway disease )
2/14 (%17) asthma was diagnosed3/14 (%21) skin prick test was positive
No relation to disease activity, drug, and disease duration
Mansi et al Am J Respir Crit Care Med 2000
BHR has been found in 20% of asymptomatic 25 Crohn patients and 8% of asymptomatic 35 UC patients using metacholine. Female sex and extraintestinal manifestations are risk factors
No relation with smoking, disease activity and disease duration
Kullmann et al Am Respir Crit Care Med 1998
BHR has been found in 45% of IBD patients with normal LFT and without respiratory symptoms. Skin prick tests were positive in 42% of patients
Louis E et al Allergy 1995
IBD patients without allergic symptoms revaled high serum IgE levels
Levo et al Ann Allergy 1986
ResultsResults: : 15/30 respiratory symptoms15/30 respiratory symptoms
14/30 allergic symptoms (more common in UC )14/30 allergic symptoms (more common in UC )
3/30 asthma (1 case concurrent, 1 case diagnosed 6 years before 3/30 asthma (1 case concurrent, 1 case diagnosed 6 years before
IBD onset, 1 case10 years after IBD onset)IBD onset, 1 case10 years after IBD onset)
Ceyhan B ve al Respiration 2003Ceyhan B ve al Respiration 2003
Atopism and BHRAtopism and BHR
Study population Study population 30 patients with IBD (19 UC, 11CD) followed in 30 patients with IBD (19 UC, 11CD) followed in
Gastroenterology Dept of Marmara University Hospital 5.3+/- 4.8 Gastroenterology Dept of Marmara University Hospital 5.3+/- 4.8
years disease duration,years disease duration,
15 non-smoker, 8 current smoker, 7 ex-smoker15 non-smoker, 8 current smoker, 7 ex-smoker
Skin prick testSkin prick test 15/30(50%) 15/30(50%)
11/30(37%) High IgE level 11/30(37%) High IgE level
7/30(24%) positive skin prick test+high IgE level7/30(24%) positive skin prick test+high IgE level
Ceyhan B et al Respiration 2003Ceyhan B et al Respiration 2003
LFTLFT abnormal 8/30 (27%)abnormal 8/30 (27%)
BHR 5/30 (17%) (2 CD, 3 UC)BHR 5/30 (17%) (2 CD, 3 UC)
6/30(20%) rhinitis/sinusitis history6/30(20%) rhinitis/sinusitis history
8/30 (27%) urticaria history8/30 (27%) urticaria history
IBD and lung involvement- SummaryIBD and lung involvement- Summary
In 83% of patients, IBD onset precedes respiratory symptomsIn 83% of patients, IBD onset precedes respiratory symptomsIn 10% of patients lung involvement precedes gastrointestinal symptoms In 10% of patients lung involvement precedes gastrointestinal symptoms
In 7% of patients, diagnosis of lung disease and IBD is concurrentIn 7% of patients, diagnosis of lung disease and IBD is concurrent
Colectomy history is positive in half of IBD patients with airway Colectomy history is positive in half of IBD patients with airway disease.disease.
Colonic surgey may aggravate prior airway diseaseColonic surgey may aggravate prior airway disease
Untreated airway inflammation puts the patient at risk of developing Untreated airway inflammation puts the patient at risk of developing irreversible airway diseaseirreversible airway disease
Local and systemic steroids are effective against airway diseasesLocal and systemic steroids are effective against airway diseases
Small airway disease is usually refractory to inhaled steroids, oral Small airway disease is usually refractory to inhaled steroids, oral steroid effect is slight to modeststeroid effect is slight to modest
The drugs sulfasalzine and 5-ASA may play a role in some casesThe drugs sulfasalzine and 5-ASA may play a role in some cases
Interstitial lung disease is more common in inactive patients taking Interstitial lung disease is more common in inactive patients taking drugsdrugs
Most cases of ILD, necrotic nodules and serositis are very responsive Most cases of ILD, necrotic nodules and serositis are very responsive to steroidsto steroids
The true incidence of pulmonary involvement in IBD patients is unknown because of subclinical pulmonary involvement
Although the incidence of colorectal cancer is known to be increased among patients with UC, the incidence of lung cancer is not increased