Patterns of airway involvement in inflammatory bowel diseases

Abstract

Extraintestinal manifestations occur commonly in inflammatory bowel diseases (IBD). Pulmonary manifestations (PM) of IBD may be divided in airway disorders, interstitial lung disorders, serositis, pulmonary vasculitis, necrobiotic nodules, drug-induced lung disease, thromboembolic lung disease and enteropulmonary fistulas. Pulmonary involvement may often be asymptomatic and detected solely on the basis of abnormal screening tests. The common embryonic origin of the intestine and the lungs from the primitive foregut, the co-existence of mucosa associated lymphoid tissue in both organs, autoimmunity, smoking and bacterial translocation from the colon to the lungs may all be involved in the pathogenesis of PM in IBD. PM are mainly detected by pulmonary function tests and highresolution computed tomography. This review will focus on the involvement of the airways in the context of IBD, especially stenoses of the large airways, tracheobronchitis, bronchiectasis, bronchitis, mucoid impaction, bronchial granulomas, bronchiolitis, bronchiolitis obliterans syndrome and the co-existence of IBD with asthma, chronic obstructive pulmonary disease, sarcoidosis and a1-antitrypsin deficiency.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Inflammatory bowel diseases; Airways; BronchiolitisCore tip: The lung is commonly involved in inflammatory bowel diseases; however, airway involvement is often overlooked. This review will help gastroenterologists recognize the involvement of the airways in the context of inflammatory bowel diseases (IBD), especially stenoses of the large airways, tracheobronchitis, bronchiectasis, bronchitis, mucoid impaction, bronchial granulomas, bronchiolitis, bronchiolitis obliterans syndrome and the co-existence of IBD with asthma, chronic obstructive pulmonary disease, sarcoidosis and a1-antitrypsin deficiency, and appropriately manage their patients.Papanikolaou I, Kagouridis K, Papiris SA. Patterns of airway involvement in inflammatory bowel diseases. World J Gastrointest Pathophysiol

Respiratory System Involvement in Inflammatory Bowel Diseases

“…On the other hand, there is a large number of case reports that suggest existence of the phenomenon. First such reports appeared in the second half of the 20 th century [13,14] and hundreds have been published since then [15][16][17][18]. It is believed that gut-lung communication is bidirectional, so two ways of approach to the subject can be found in the literature.…”

“…Increased percentage of neutrophils was seen in BAL fluid, and microscopic study of bronchial mucosal biopsy showed infiltrates rich in lymphocytes and plasmatic cells [43]. Bronchiectasis and chronic bronchitis seemed to occur more frequently in the course of UC than CD [16,18,43]. Some authors argued that chronic bronchitis associated with IBD responded well to inhaled glucocorticosteroids [43,46].…”

“…Diseases of the small airways were less frequent, they constituted 3-10% of all cases of respiratory diseases in IBD patients [18]. However, subclinical involvement detected by HRCT and PFT is believed to be more common [24,27,30,32,50].…”

“…According to published data, EIM of IBD can occur anywhere along the airways; however, large and medium-sized bronchi were the most common location -39-50% of published cases [16,18,43]. In 66% of IBD patients with coexisting bronchi disease, bronchiectasis was diagnosed [16].…”

“…Bronchiectasis associated with IBD may be more extensive and severe, compared to bronchiectasis related to other aetiology. The second common pathology was chronic bronchitis [15,16,18]. Productive cough with abundant amounts of purulent sputum dominated in both bronchiectasis and chronic bronchitis [14,[43][44][45].…”