Airway Involvement in Ulcerative Colitis

Constrictive Bronchiolitis and Ulcerative Colitis

“…Only two of 33 patients in the largest reported case series by Camus et al (2) had small airway disease. The three case reports in the literature of constrictive bronchiolitis had different clinical presentations to ours (3,5,6). One patient had ulcerative colitis and no cough or sputum production, but also had exertional dyspnea, severe airflow obstruction, a negative rheumatoid factor and ANA, and biopsy-proven constrictive bronchiolitis (2,5).…”

“…The three case reports in the literature of constrictive bronchiolitis had different clinical presentations to ours (3,5,6). One patient had ulcerative colitis and no cough or sputum production, but also had exertional dyspnea, severe airflow obstruction, a negative rheumatoid factor and ANA, and biopsy-proven constrictive bronchiolitis (2,5). The second patient had dyspnea, productive cough, moderate airflow obstruction and bronchoscopy changes suggesting chronic bronchitis beginning before the diagnosis of colitis.…”

“…There is an insufficient number of case descriptions of pulmonary involvement in ulcerative colitis to postulate the disease process or the extent of potential lung involvement. Case series of large airway involvement in ulcerative colitis describe tracheobronchitis, chronic "suppurative" bronchitis or bronchiectasis as being anatomically localized, with no continuous involvement of the large and small airways (2,5). Constrictive bronchiolitis is usually a lesion of the bronchioles with luminal narrowing by scarring (15).…”

Extraintestinal Manifestations of Ulcerative Colitis

“…In general, these symptoms do not respond to antibiotics, but do respond to inhaled steroids (Higenbottam, Cochrane et al, 1980). Studies have shown that in UC patients, colonic and pulmonary flares often parallel each other, suggesting a common embryonic origin of the colonic and pulmonary epithelium (Higenbottam, Cochrane et al, 1980;Wilcox et al, 1987). Furthermore, the histopathology of sclerosing cholangitis, another EIM of UC, has been shown to be quite similar to that of the airway inflammation associated with UC (Janssen et al, 2006).…”

“…CT scan: CT scans, especially High Resolution CT (HRCT) scans are more sensitive than plain chest films in differentiating between the pulmonary complications of UC. Irregular narrowing of the trachea or main bronchi can be seen in large airway involvement, thickened bronchial walls and dilated airways with mucoid impaction can be seen with bronchial involvement, and bilateral consolidation and peripheral (pleural-based) ground glass opacities are observed in BOOP (Epler, 2001;Garg et al, 1993;Spira et al, 1998;Wilcox, Miller et al, 1987). 4.…”