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Pulmonary manifestations of inflammatory bowel disease.

Majewski S, Piotrowski W - Arch Med Sci (2015)

Bottom Line: Latent and asymptomatic pulmonary involvement is not unusual.The common link between intestinal disease and lung pathology is unknown, but many hypotheses have been proposed.It is speculated that environmental pollution, common immunological mechanisms and predisposing genetic factors may play a role.

View Article: PubMed Central - PubMed

Affiliation: Department of Pneumology and Allergy, Medical University of Lodz, Lodz, Poland.

ABSTRACT
Bronchopulmonary signs and symptoms are examples of variable extraintestinal manifestations of the inflammatory bowel diseases (IBD). These complications of Crohn's disease (CD) and ulcerative colitis (UC) seem to be underrecognized by both pulmonary physicians and gastroenterologists. The objective of the present review was to gather and summarize information on this particular matter, on the basis of available up-to-date literature. Tracheobronchial involvement is the most prevalent respiratory presentation, whereas IBD-related interstitial lung disease is less frequent. Latent and asymptomatic pulmonary involvement is not unusual. Differential diagnosis should always consider infections (mainly tuberculosis) and drug-induced lung pathology. The common link between intestinal disease and lung pathology is unknown, but many hypotheses have been proposed. It is speculated that environmental pollution, common immunological mechanisms and predisposing genetic factors may play a role.

No MeSH data available.


Related in: MedlinePlus

Chest X-ray of a 19-year-old woman with long standing CD treated with mesalazine. Pulmonary infiltrations and right sided pleural effusion are visible. Due to the presence of fever, dry cough and pleural chest pain, pleuropneumonia was diagnosed and antibiotics were introduced. Because of lack of response to antimicrobial treatment she was referred to a pulmonary physician, who recommended withdrawal of mesalazine. After initial improvement, the general and radiological symptoms relapsed (see Figure 2), suggesting the possibility of IBD-related pathology
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Figure 0001: Chest X-ray of a 19-year-old woman with long standing CD treated with mesalazine. Pulmonary infiltrations and right sided pleural effusion are visible. Due to the presence of fever, dry cough and pleural chest pain, pleuropneumonia was diagnosed and antibiotics were introduced. Because of lack of response to antimicrobial treatment she was referred to a pulmonary physician, who recommended withdrawal of mesalazine. After initial improvement, the general and radiological symptoms relapsed (see Figure 2), suggesting the possibility of IBD-related pathology

Mentions: Radiological presentations of interstitial lung involvement are quite diverse. Pneumonia-like opacities are very frequent [15, 21, 37, 50], especially in patients with OP [42, 47, 51] (Figure 1). Multiple pulmonary nodules of different size and location may be present (Figure 2). The bigger coin lesions may resemble metastatic lung disease [42, 43]. The nodes and small nodules may be located subpleurally [34, 42] (Figure 2). Small cavitations reflecting central necrosis may be present [34]. Tumors with central necrosis may resemble granulomatosis with polyangitis (GPA) and may require thorough differentiation with this disease, especially in cases of UC with positive anti-neutrophil cytoplasmic antibodies (ANCA) in the serum [52–57]. Overlapping of UC with GPA in such cases should be considered [58]. Solitary nodules presenting as primary lung tumors may be found [56]. Interstitial pneumonitis may be another radiological presentation. The HRCT scans in these cases reveal ground-glass opacities, alveolar filling or a reticular pattern [40, 59–61]. Extensive fibrosis is rare [62]. Upper lobe fibrosis may resemble TB infection [63]. Some authors report vanishing patterns of radiological lesions not related to treatment or IBD activity [42]. Spontaneous migration of lung opacities has been reported [64]. In the study of Mahadeva et al. [40], which was designed to detect latent respiratory abnormalities in patients with IBD, abnormal HRCT findings were reported in almost all studied patients. The majority had bronchiectasis, air-trapping and “tree-in-bud” patterns. The HRCT findings consistent with alveolitis were present only in 3 patients. It reflects the low frequency of interstitial lung disease (ILD) and high frequency of tracheobronchial pathology in patients with IBD [59, 65]. More recent reports present similar results [14]. These studies and many case reports show the possibility of coexistence of different forms of lung involvement. It is especially interesting that a high proportion of patients with HRCT abnormality are respiratory-symptom-free [26, 65].


Pulmonary manifestations of inflammatory bowel disease.

Majewski S, Piotrowski W - Arch Med Sci (2015)

Chest X-ray of a 19-year-old woman with long standing CD treated with mesalazine. Pulmonary infiltrations and right sided pleural effusion are visible. Due to the presence of fever, dry cough and pleural chest pain, pleuropneumonia was diagnosed and antibiotics were introduced. Because of lack of response to antimicrobial treatment she was referred to a pulmonary physician, who recommended withdrawal of mesalazine. After initial improvement, the general and radiological symptoms relapsed (see Figure 2), suggesting the possibility of IBD-related pathology
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4697051&req=5

Figure 0001: Chest X-ray of a 19-year-old woman with long standing CD treated with mesalazine. Pulmonary infiltrations and right sided pleural effusion are visible. Due to the presence of fever, dry cough and pleural chest pain, pleuropneumonia was diagnosed and antibiotics were introduced. Because of lack of response to antimicrobial treatment she was referred to a pulmonary physician, who recommended withdrawal of mesalazine. After initial improvement, the general and radiological symptoms relapsed (see Figure 2), suggesting the possibility of IBD-related pathology
Mentions: Radiological presentations of interstitial lung involvement are quite diverse. Pneumonia-like opacities are very frequent [15, 21, 37, 50], especially in patients with OP [42, 47, 51] (Figure 1). Multiple pulmonary nodules of different size and location may be present (Figure 2). The bigger coin lesions may resemble metastatic lung disease [42, 43]. The nodes and small nodules may be located subpleurally [34, 42] (Figure 2). Small cavitations reflecting central necrosis may be present [34]. Tumors with central necrosis may resemble granulomatosis with polyangitis (GPA) and may require thorough differentiation with this disease, especially in cases of UC with positive anti-neutrophil cytoplasmic antibodies (ANCA) in the serum [52–57]. Overlapping of UC with GPA in such cases should be considered [58]. Solitary nodules presenting as primary lung tumors may be found [56]. Interstitial pneumonitis may be another radiological presentation. The HRCT scans in these cases reveal ground-glass opacities, alveolar filling or a reticular pattern [40, 59–61]. Extensive fibrosis is rare [62]. Upper lobe fibrosis may resemble TB infection [63]. Some authors report vanishing patterns of radiological lesions not related to treatment or IBD activity [42]. Spontaneous migration of lung opacities has been reported [64]. In the study of Mahadeva et al. [40], which was designed to detect latent respiratory abnormalities in patients with IBD, abnormal HRCT findings were reported in almost all studied patients. The majority had bronchiectasis, air-trapping and “tree-in-bud” patterns. The HRCT findings consistent with alveolitis were present only in 3 patients. It reflects the low frequency of interstitial lung disease (ILD) and high frequency of tracheobronchial pathology in patients with IBD [59, 65]. More recent reports present similar results [14]. These studies and many case reports show the possibility of coexistence of different forms of lung involvement. It is especially interesting that a high proportion of patients with HRCT abnormality are respiratory-symptom-free [26, 65].

Bottom Line: Latent and asymptomatic pulmonary involvement is not unusual.The common link between intestinal disease and lung pathology is unknown, but many hypotheses have been proposed.It is speculated that environmental pollution, common immunological mechanisms and predisposing genetic factors may play a role.

View Article: PubMed Central - PubMed

Affiliation: Department of Pneumology and Allergy, Medical University of Lodz, Lodz, Poland.

ABSTRACT
Bronchopulmonary signs and symptoms are examples of variable extraintestinal manifestations of the inflammatory bowel diseases (IBD). These complications of Crohn's disease (CD) and ulcerative colitis (UC) seem to be underrecognized by both pulmonary physicians and gastroenterologists. The objective of the present review was to gather and summarize information on this particular matter, on the basis of available up-to-date literature. Tracheobronchial involvement is the most prevalent respiratory presentation, whereas IBD-related interstitial lung disease is less frequent. Latent and asymptomatic pulmonary involvement is not unusual. Differential diagnosis should always consider infections (mainly tuberculosis) and drug-induced lung pathology. The common link between intestinal disease and lung pathology is unknown, but many hypotheses have been proposed. It is speculated that environmental pollution, common immunological mechanisms and predisposing genetic factors may play a role.

No MeSH data available.


Related in: MedlinePlus