Clinical and radiological characteristics of lung disease in inflammatory bowel disease

Abstract

The pulmonary associations of inflammatory bowel disease (IBD) are poorly characterized. The clinical, physiological and high-resolution computed tomographic thorax characteristics of the lung disease in patients with IBD presenting with respiratory symptoms are described.Detailed clinical information was obtained and standard pulmonary physiological tests and thorax high-resolution computed tomography performed on 14 patients with ulcerative colitis (UC) and three with Crohn's disease (CD), 10 male, aged 38±83 yrs.Respiratory symptoms had been present for 2±50 yrs and extraintestinal manifestations were present in three (17.6%). Normal pulmonary physiology (six patients) was associated with the high resolution computed tomographic changes of bronchiectasis, mosaic perfusion and air trapping suggestive of obliterative bronchiolitis and a pattern of centrilobular nodules and branching linear opacities ("tree in bud" appearance) suggestive of either cellular bronchiolitis or bronchiolectasis with mucoid secretions. Bronchiectasis was found in 13 patients (11 UC, 2 CD), 11 had air trapping and five had a "tree in bud" appearance on computed tomography. One patient had a predominantly peripheral reticular pattern at the lung bases similar to that found in cryptogenic fibrosing alveolitis and one patient had a mixed reticular and groundglass pattern in the midzones with a patchy distribution in the central and peripheral portions of the lungs with air trapping. Eleven patients (three with alveolitis) exhibited a clinical and/or physiological response to steroids.Pulmonary abnormalities in ulcerative colitis and Crohn's disease can present years after the onset of the bowel disease and can affect any part of the lungs. Early recognition is important as they can be strikingly steroid-responsive. Eur Respir J 2000; 15: 41±18. The presence of subclinical disease in patients without respiratory symptoms was suggested in one study because result of abnormal pulmonary function found in 38% of UC patients and 54% of CD patients, significantly greater pro-portions than in a healthy control populations [27].Pul-monary function abnormalities include a decrease in gas transfer factor [28±30], an elevated functional residual capacity (FRC) and raised residual volume (RV) during periods of active bowel disease [30±32] and an increased frequency of bronchial hyperresponsiveness [33]. Further-more, alveolar lymphocytosis is evident in bronchoalveolar lavage fluid from CD patients without respiratory symptoms [34].The chest radiograph is often normal in patients with respiratory symptoms and inflammatory bowel disease (IBD) [6,8] and as a result the radiological characteristics remain poorly characterized. Two studies described the high resolution computed tomographic findings in seven patients (in each study) with IBD who presented with cough and sputum production. However, these reports did not correlate the computed tomographic appearances with symptoms or pulmonary physiology or evaluate air trapping with scans performe...

Predictors and risks for death in a population-based study of persons with IBD in Manitoba

“…The increased rates of death from colorectal cancer in both CD and UC and non-Hodgkin's lymphoma in CD are in line with a report from Manitoba over a decade ago 34. We have been among the only jurisdictions to report an increased risk of non-Hodgkin's lymphoma independent of thiopurine use 37.…”

British Thoracic Society Guideline for bronchiectasis in adults

“…60 Bronchiectasis appeared to be the most common feature although other abnormalities were seen on CT scan. In some cases a biopsy revealed evidence of lymphocytic inflammation 59 and a useful clinical response to oral or inhaled corticosteroids was observed.…”

“…In some cases a biopsy revealed evidence of lymphocytic inflammation 59 and a useful clinical response to oral or inhaled corticosteroids was observed. 60 The nature of the steroid treatment and its outcome were not described in detail although alveolitis and bronchiolitis were reported to resolve fully. 60 …”

“…60 The nature of the steroid treatment and its outcome were not described in detail although alveolitis and bronchiolitis were reported to resolve fully. 60 …”

Successful treatment of ulcerative bronchiolitis in a woman with refractoryMycobacterium intracellulareinfection

“…Unlike non-pulmonary extraintestinal manifestations, IBD-related pulmonary disease is much more common in ulcerative colitis (UC) than Crohn's disease 2 3 6 10 11 14. Thoracic manifestations are likely under-reported and under-recognised, as subclinical pulmonary manifestations may be present in up to 50–60% of patients with IBD 1 2 7 15 16. It is important to consider IBD-related pulmonary patients with disease in IBD whose pulmonary pathology may not be completely explained by more common pulmonary diseases 2 6 8…”