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 high-resolution 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.

Keywords: Airways; Bronchiolitis; Inflammatory bowel diseases.

Figure 1

Possible pathogenesis of airway involvement and disease in the event of inflammatory bowel diseases. COPD: Chronic obstructive pulmonary disease; MALT: Mucosa associated lymphoid tissue.

Figure 2

Proposed diagnostic algorithm for the evaluation of airway disease in inflammatory bowel diseases. IBD: Inflammatory bowel disease; PFT: Pulmonary function tests; HRCT: High resolution computed tomography; UAD: Upper airway disease; COPD: Chronic obstructive pulmonary disease; AATD: A1 antitrypsin deficiency.