Pulmonary complications of inflammatory bowel disease
- Steven E Weinberger, MD
Steven E Weinberger, MD
- Adjunct Professor of Medicine
- University of Pennsylvania School of Medicine
- Executive Vice President and CEO Emeritus
- American College of Physicians
- Mark A Peppercorn, MD
Mark A Peppercorn, MD
- Professor of Medicine
- Harvard Medical School
- Section Editors
- Kevin R Flaherty, MD, MS
Kevin R Flaherty, MD, MS
- Section Editor — Interstitial Lung Disease
- Associate Professor of Medicine
- University of Michigan Health System
- Paul Rutgeerts, MD, PhD, FRCP
Paul Rutgeerts, MD, PhD, FRCP
- Section Editor — Inflammatory Bowel Disease
- Emeritus Professor of Medicine
- University Hospital, Leuven, Belgium
Inflammatory bowel disease (IBD) is associated with a variety of conditions outside of the gastrointestinal tract, termed extraintestinal manifestations of IBD (table 1). Since the original report in 1976 of six patients with unexplained chronic purulent sputum production, involvement of the respiratory tract, although relatively rare, has been increasingly recognized in patients with IBD .
The pulmonary complications of IBD including those related to the medications used to treat IBD are discussed here. An approach to the evaluation and diagnosis of interstitial pneumonia and discussions of the clinical manifestations of Crohn's disease and ulcerative colitis are provided separately. (See "Approach to the adult with interstitial lung disease: Clinical evaluation" and "Approach to the adult with interstitial lung disease: Diagnostic testing" and "Clinical manifestations, diagnosis, and prognosis of ulcerative colitis in adults" and "Clinical manifestations, diagnosis and prognosis of Crohn disease in adults".)
Case series vary in terms of the proportions of patients with ulcerative colitis and Crohn’s disease who have associated lung disease [2-4]. In a series of 52 patients with IBD, abnormal pulmonary function tests were more common in patients with Crohn’s disease than ulcerative colitis (25 versus 6 percent), but abnormal computed tomography was seen in approximately 50 percent of patients with ulcerative colitis or Crohn’s . In a separate series of 33 patients with IBD-associated lung involvement, 27 had ulcerative colitis and six had Crohn's disease .
The pathogenesis of pulmonary parenchymal disease and serositis associated with IBD is unknown. However, the more common airway inflammatory changes are thought to represent the same type of inflammatory changes that occur in the bowel . (See "Immune and microbial mechanisms in the pathogenesis of inflammatory bowel disease".)
PRIMARY RESPIRATORY INVOLVEMENT
Pulmonary complications of IBD include inflammation of small and large airways, pulmonary parenchymal disease, serositis, and pulmonary embolism [6,7]. These abnormalities are generally related to the underlying bowel disease, although interstitial lung disease can also be induced by administration of certain drugs, such as sulfasalazine, 5-aminosalicylic acid, methotrexate, azathioprine, and infliximab [8-12]. Patients with IBD may present with cough, dyspnea, chest pain, or an abnormal chest radiograph obtained for another reason. Often the initial history (including current medications) and physical examination will focus attention on a given type of lung involvement (eg, airway versus parenchymal).
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- PRIMARY RESPIRATORY INVOLVEMENT
- Airway involvement
- Pulmonary parenchymal disease
- - Abnormalities in pulmonary function tests
- - Organizing pneumonia
- - Interstitial lung disease
- - Sarcoidosis
- - Pulmonary infiltrates with eosinophilia
- - Necrobiotic nodules
- Pulmonary embolism
- DRUG-INDUCED COMPLICATIONS
- 5-aminosalicylic acid
- Azathioprine and 6-mercaptopurine
- Airway involvement
- Interstitial lung disease
- Pulmonary embolism
- Drug-induced interstitial lung disease
- Airway involvement
- Pulmonary parenchymal disease
- Pulmonary thromboembolism
- Drug-induced lung disease
- PROPHYLAXIS FOR VENOUS THROMBOEMBOLISM
- SUMMARY AND RECOMMENDATIONS
- Clinical manifestations and diagnosis