Bronchial Hyperreactivity and Allergic Status in Inflammatory Bowel Disease

Abstract

Background: Despite the known systemic manifestations of inflammatory bowel disease (IBD) and a large number of reports associating lung disease and IBD, the frequency of atopy and bronchial hyperreactivity (BHR) in IBD remains obscure. Objectives: The aim of this study was to investigate the prevalence of abnormal pulmonary function tests, BHR and the atopic status in patients with IBD. Methods: Thirty patients with IBD (19 with ulcerative colitis and 11 with Crohn’s disease; 19 male, 11 female) and 16 controls without any gastrointestinal disease (9 female, 7 male) were included. Patients were questioned with respect to pulmonary and allergic symptoms; subsequently, lung function tests, BHR, skin prick test positivity, peripheral eosinophilia and serum IgE levels were evaluated and compared with those of control subjects. Results: The mean duration of IBD was 5.3 ± 4.8 years. IBD patients had significantly more often respiratory symptoms in comparison with controls (odds ratio, OR: 9.0, p < 0.04). A previous diagnosis of asthma and antiasthmatic drug treatment were noted in 3/30 (10%) IBD patients. Allergic symptoms were more prevalent in IBD patients in comparison with the controls (OR: 13, p < 0.007), particularly in patients with ulcerative colitis (OR: 16, p < 0.004). The mean FEV₁was 3.1 ± 0.9 liters (96 ± 18% predicted), mean methacholine PD₂₀: 14.7 ± 3.6 mg/ml, mean IgE: 190.5 ± 305.6 IU/ml (normal value <94 IU/ml) and the percentage of peripheral eosinophils was 3.1 ± 3.3% in the IBD patients. These values did not result in statistically significant differences in comparison with controls. Furthermore, abnormal lung function and BHR were observed in 8/30 (27%) and 5/30 (17%) IBD patients, respectively. Abnormal lung function tests were more prevalent in the IBD patients than in the controls (OR: 12, p < 0.04). Skin prick tests were positive in 15/30 (50%) IBD patients. The risk of a positive skin prick test increased in the IBD patients in comparison with the controls (OR: 7.0, p < 0.02). Duration and activity of IBD did not influence the prevalence of BHR, allergic and respiratory symptoms, abnormal lung function, high serum IgE levels and skin test positivity. Conclusions: Allergic symptoms, respiratory symptoms, abnormal lung function tests and skin prick test positivity were more common among the IBD patients in comparison with the controls.

Exhaled Nitric Oxide as a Marker of Lung Involvement in Crohn's Disease

“…These abnormalities, which have also been described during clinical remission, are the Iikely consequence of a subclinical inflammatory reaction. This hypothesis draws additional support from the increas ed airway hyper-responsiveness that has been documented in asymptomatic IBD patients (10). Most of these patients are usually asymptomatic; in addition, the procedures necessary to prove pulmonary involvement are quite costly and complicated.…”

Respiratory System Involvement in Inflammatory Bowel Diseases

“…Abnormalities in PFT could be found even in nonsmoking IBD patients with no history of respiratory tract disorder and with normal chest x-ray [28]. Bronchial hypersensitivity in provocation tests with methacholine was observed in 17-71% of IBD patients, more often than in control groups [29][30][31].…”

“…No relationship was found between duration of IBD and pulmonary function test results [26]. Bronchial hyperresponsiveness on methacholine challenge was independent of activity, extent and time of duration of IBD [29][30][31]. Exhaled NO correlated positively with IBD activity [37][38][39], but no relation was found for alveolar epithelial per-meability measured with the use of Tc-99m DTPA aerosol scintigraphy [40,41].…”

Patterns of airway involvement in inflammatory bowel diseases

“…The most common findings include bronchial wall thickening and bronchi-CD and 19 UC patients [25,26] . In a case control study of 64 IBD patients compared to 1346 controls, after adjustment for age, sex and smoking status, IBD patients were more likely to report shortness of breath and sputum production and to a lesser degree, cough [odds ratio (OR) respectively 3.4, 2.5, 1.8], highlighting the importance of relative clinical awareness [27] .…”