Alterations in pulmonary function in inflammatory bowel disease are frequent and persist during remission

Pulmonary pathological and functional changes in rats with Crohn's disease and lung injury

AIM: To observe pulmonary pathological and functional changes in rats with Crohn's disease and lung injury.

METHODS: Rats were randomly divided into model group and normal group. Crohn's disease was induced in rats using the 2, 4, 6-trinitrobenzenesulfonic acid/ethanol method. At weeks 1, 2, and 4 after induction of Crohn's disease, pulmonary function testing was performed, and rats were then killed to take samples for HE staining to examine pathological changes in the colon and lung.

RESULTS: Pulmonary pathological changes in rats with Crohn's disease include typical interstitial pneumonia, widening of alveolar septa, vascular congestion, interstitial edema, inflammatory cell infiltration, decrease in the size of alveolar cavities smaller, bronchial wall thickening, emphysema, and bronchiectasis occasionally. Pulmonary functional changes include an initial decrease followed by an increase in airway resistance, an initial increase followed by a decrease in Cl, lowering of MVV, FVC, Fev0.2, and a moderate decrease in PEF and PEF25-75%.

CONCLUSION: Rats with Crohn's disease may develop lung injury, which mainly manifests as interstitial pneumonia and restrictive ventilatory disorders.

Exhaled nitric oxide as a marker of lung involvement in Crohn's disease

Crohn's disease is an inflammatory bowel disease associated with a variety of systemic manifestations, including large and small airway involvement. The latter is most often a subclinical one, and requires expensive and invasive diagnostic approaches. Nitric oxide (NO) can be detected non-invasively in the exhaled air (eNO) and be considered as a surrogate marker of airway inflammation. eNO tested at multiple expiratory flows can be used to distinguish the alveolar concentration of NO (CalvNO) from the total amount of fractional eNO (FeNO). The aim of our study is to compare FeNO and concentration of alveolar nitric oxide (CalvNO) levels and to assess their relationship with pulmonary involvement in Crohn's patients differing in clinical stage and therapeutic regimens versus a group of healthy subjects. Thirty Crohn's patients not showing clinical evidence of pulmonary diseases and 21 non-smoking, non-atopic healthy controls were enrolled. FeNO (14.9±10.2 ppb vs 10.1±6.3 ppb, p=0.049) and CalvNO (4.4±2.2 ppb vs 2.6±1.9; p=0.006) values were found to be significantly higher in Crohn's patients than in healthy controls. Both FeNO and CalvNO correlated positively with the Crohn's Disease Activity Index. In conclusion, our results for FeNO and CalvNO confirm the presence of subclinical pulmonary involvement in Crohn's disease. eNO measurement may be of clinical value in the follow-up of Crohn's patients.

Pulmonary manifestations in inflammatory bowel disease: a prospective study

BACKGROUND

Although pulmonary abnormalities have been recognized in patients with inflammatory bowel diseases (IBD), their prevalence and clinical significance are not known.

AIM

To study the prevalence and clinical significance of pulmonary abnormalities in patients with IBD.

METHODS

Ninety-five non-consecutive patients with IBD (12 Crohn's disease, 83 ulcerative colitis; mean age 41.9 [SD 13] years; 47 women) were prospectively studied from January 2007 to March 2010. Pulmonary function tests (PFT) and high-resolution CT (HRCT) chest were performed in them. PFT were compared to those in 270 healthy (control) subjects matched for age, sex and smoking status.

RESULTS

Twenty-seven (28.5%) patients and 11 (4%) control subjects had abnormal PFT (p < 0.0001). Small airway obstruction was seen in 18 patients, restrictive defect in six and mixed defect in three. Twenty-one (22%) patients had abnormal HRCT findings - bronchiectasis and nodules (nine patients each, including one with nodules who later developed active tuberculosis after infliximab therapy), parenchymal bands (8), mediastinal lymphadenopathy (five, including two with tuberculosis on histology and culture), emphysema (5), brochiolitis (2), pleural effusion or thickening (2), pericardial effusion (2), patchy consolidation (1), ground-glass opacities (1) and lung metastasis (1). Three patients had symptoms (one asthma, two cough).

CONCLUSION

PFT and HRCT chest showed abnormality in about one-quarter of patients with IBD. A majority of patients with these abnormalities were asymptomatic.

Methotrexate-induced pneumonitis in Crohn's disease. Case report and review of the literature

Methotrexate (MTX) is a folate-antagonist used in several neoplastic and inflammatory diseases. Reports of pulmonary complications in patients given low-dose MTX therapy are increasing. Pulmonary toxicity from MTX has a variable frequency and can present with different forms. Most often MTX-induced pneumonia in patients affected by rheumatoid arthritis (RA) is reported.In this paper we describe a case of MTX-related pneumonitis in a relatively young woman affected by Crohn's disease who presented non-productive cough, fever and dyspnea on exercise. Chest X-ray demonstrated bilateral interstitial infiltrates and at computed tomography (CT) ground-glass opacities appeared in both lungs. At spirometry an obstructive defect was demonstrated. A rapid improvement of symptoms and the regression of radiographic and spirometric alterations was achieved through MTX withdrawal and the introduction of corticosteroid therapy.

Pulmonary diseases associated with inflammatory bowel diseases

Among the extra-intestinal manifestations of inflammatory bowel diseases, those involving the lung are relatively rare. However, there is a wide array of such manifestations, spanning from drug-related pathologies to airway disease, fistulas, granulomatous diseases, autoimmune and thromboembolic disorders. Although infrequent, people dealing with inflammatory bowel diseases must be aware of these conditions, sometimes life-threatening, to avoid further impairment of the health status of the patients and to alleviate their symptoms by prompt recognition and treatment.

Respiratory involvement in inflammatory bowel diseases

Inflammatory bowel diseases (IBD) include ulcerative colitis (UC) and Crohn's disease (CD) and are due to a dysregulation of the antimicrobial defense normally provided by the intestinal mucosa. This inflammatory process may extend outside the bowel to many organs and also to the respiratory tract. The respiratory involvement in IBD may be completely asymptomatic and detected only at lung function assessment, or it may present as bronchial disease or lung parenchymal alterations. Corticosteroids, both systemic and aerosolized, are the mainstay of the therapeutical approach, while antibiotics must be also administered in the case of infectious and suppurative processes, whose sequels sometimes require surgical intervention. The relatively high incidence of bronchopulmonary complications in IBD suggests the need for a careful investigation of these patients in order to detect a possible respiratory involvement, even when they are asymptomatic.

Value of fractional exhaled nitric oxide (FE NO) for the diagnosis of pulmonary involvement due to inflammatory bowel disease

BACKGROUND

Pulmonary involvement due to inflammatory bowel disease (IBD) is frequent when evaluating a patient with IBD and pulmonary involvement remains complicated. Most of the patients are asymptomatic and the methods used are mostly invasive or expensive procedures. The aim of this prospective study is to evaluate the value of the fractional exhaled nitric oxide (FE(NO)) level for the diagnosis of pulmonary involvement due to IBD and to investigate any correlation between FE(NO) level and disease activity.

METHODS

Thirty-three nonsmoker patients with IBD (25 ulcerative colitis [UC] and 8 Crohn's Disease [CD]) who were free of corticosteroid treatment and 25 healthy subjects as a control group were enrolled in this study. All patients with IBD were investigated for pulmonary involvement with medical history, physical examination, chest roentgenogram, oxygen saturation, blood eosinophil levels, pulmonary function tests (PFTs), high-resolution computed tomography (HRCT), and FE(NO) level.

RESULTS

Pulmonary involvement was established in 15 patients (45.5%) with IBD. The FE(NO) level was higher in patients with pulmonary involvement than without pulmonary involvement and healthy controls independent from the pulmonary symptoms, eosinophil count, duration of disease, activity of disease, and surgery history (FE(NO): 32 +/- 20; 24 +/- 8; 14 +/- 8 ppb, respectively) (P < 0.05). In addition, diffusion capacity (DLCO) was found to be significantly lower in patients with CD compared with UC (P < 0.05).

CONCLUSIONS

This study showed that an increased FE(NO) level may be used for identifying patients with IBD who need further pulmonary evaluation.

Pulmonary involvement and allergic disorders in inflammatory bowel disease

Inflammatory bowel disease (IBD) has been associated with either clinical or subclinical airway and parenchymal lung involvement and interstitial lung complications. Several studies have reported that atopy has a high prevalence in IBD patients. Overlapping allergic disorders seem to be present in both the respiratory and gastrointestinal systems. The purpose of this review is to update clinicians on recent available literature and to discuss the need for a highly suspicious approach by clinicians.

Pulmonary Crohn's disease: A rare extra-intestinal manifestation treated with infliximab

Crohn's disease is a chronic inflammatory bowel disease often presenting with extra-intestinal manifestations. However, pulmonary involvement is quite rare. We report a case of Crohn's disease with pulmonary extra-intestinal manifestation (bronchiolitis obliterans organizing pneumonia-like changes) treated with infliximab. Furthermore, we present an overview of cases of inflammatory bowel disease with lung involvement, treated with tumor necrosis factor-α antagonists. In this case, when infliximab was given, a significant resolution of the pulmonary changes was achieved.

Asymptomatic presentation of mesalamine-induced lung injury in an adolescent with Crohn disease

The present report describes the case of a 14-year-old boy receiving mesalamine for Crohn disease who was discovered to have incidental pulmonary infiltrates on chest radiograph and CT scan shortly after increasing the dose of this medication. Despite the significant radiographic abnormalities, he had no respiratory symptoms. He had normal oxygenation and normal pulmonary function tests including spirometry, lung volumes and diffusion capacity. Transbronchial biopsies showed patchy interstitial fibrosis with ill-defined non-necrotising granulomas and lymphoid aggregates. Pulmonary infiltrates resolved within 6 weeks of discontinuation of mesalamine and the addition of low-dose daily corticosteroids. This case likely represents an asymptomatic "early stage" of mesalamine-induced lung injury preceding the onset of symptoms. Alternatively, mesalamine may induce asymptomatic lung injury more commonly than is presently suspected. To the best of our knowledge this is the first time this complication has been reported without respiratory symptoms.

Pneumothorax as a presenting feature of granulomatous disease of the lung in a patient with Crohn's disease

Pulmonary disease and abnormalities of pulmonary function testing have been described in patients with Crohn's disease. The case of a 25-year-old female presenting with pneumothorax as a complication of Crohn's-related granulomatous lung disease is described here. The patient presented with symptoms of dyspnoea and chest pain, a chest radiograph revealed a pneumothorax on the right side. This pneumothorax did not resolve with intercostal tube drainage. Video-assisted thoracoscopy was performed at which small blebs were observed on the surface of the lung. Histology from a resected specimen of lung tissue demonstrated noncaseating granulomas. Colonoscopy was performed to investigate synchronous iron deficiency anaemia. This showed changes typical of Crohn's colitis. Granulomas were identified on histological examination of colonic tissue. Although pulmonary involvement in Crohn's disease has become increasingly recognised, pneumothorax has not been described previously.

Prevalence of inflammatory bowel disease in patients with airways disease

BACKGROUND

Case reports and case series have suggested an association between inflammatory bowel disease (IBD) and airways disease, but there are no data demonstrating a higher prevalence of IBD among patients with airways disease. Furthermore, no consistent radiological, pulmonary or pathological abnormalities have been demonstrated in patients with both conditions.

AIMS

To determine the prevalence of IBD among patients with airways disease and to evaluate clinical and pathophysiological features.

METHODS

A retrospective analysis of outpatients with airways disease over a 10-year period.

RESULTS

IBD was four times more prevalent among patients with airways disease compared with published local IBD prevalence [Odds Ratio 4.26, 95% CI 1.48, 11.71, p=0.006; Crohn's disease OR 5.96, 95% CI 1.94, 18.31, p=0.002 and ulcerative colitis OR 4.21, 95% CI 1.71, 10.41, p=0.001]. IBD was more frequent in all types of airways disease except asthma; the association was particularly strong for conditions associated with productive cough. All except 1 patient had established IBD before the onset of respiratory symptoms. There were no obvious radiological differences between ulcerative colitis and Crohn's disease cases. There was a trend for a higher lymphocyte count (despite a tendency to lower blood lymphocyte count) but lower sputum neutrophil count in patients with Crohn's disease compared with ulcerative colitis. There were no significant differences in physiological measurements of pulmonary function between the two types of IBD.

CONCLUSION

Our findings support an association between airways disease and inflammatory bowel disease, particularly non-asthmatic airways disease with productive cough.

Pulmonary complications resembling Wegener's granulomatosis in ulcerative colitis with elevated proteinase-3 anti-neutrophil cytoplasmic antibody

After a 17-year-old woman with ulcerative colitis was treated with granulocyte apheresis, chest imaging showed multiple nodular infiltrates, including one which seemed to have a cavity. Wegener's granulomatosis was suspected because proteinase-3 anti-neutrophil cytoplasmic antibody levels were increased. Transbronchial lung biopsy specimen showed nonspecific findings. Chest imaging showed clearing of pulmonary infiltrates without any therapy or discontinuation of mesalazine, which is known to cause lung toxicity. To the best of our knowledge, this is the first report of extra-intestinal pulmonary complications of ulcerative colitis with elevated proteinase-3 anti-neutrophil cytoplasmic antibody resembling Wegener's granulomatosis and spontaneous improvement.

Pulmonary abnormalities in inflammatory bowel disease

Extraintestinal manifestations of inflammatory bowel disease (IBD) is a common clinical problem affecting up to half of all IBD patients; pulmonary disease, however, ranks among less common extraintestinal manifestations of IBD. Pulmonary disease in patients with IBD is most frequently drug induced due to treatment with sulfasalazine or mesalamine leading to eosinophilic pneumonia and fibrosing alveolitis or due to treatment with methotrexate leading to pneumonitis. Recently, various opportunistic infections have been shown to be a further important cause of pulmonary abnormalities in those IBD patients who are treated with immunosuppressants such as anti TNF-α monoclonal antibodies, methotrexate, azathioprine or calcineurin antagonists. In not drug related pulmonary disease a wide spectrum of disease entities ranging from small and large airway dysfunction to obstructive and interstitial lung disorders exist. Patients with lung disorders and inflammatory bowel disease should be evaluated for drug-induced lung disease and opportunistic infections prior to considering pulmonary disease as an extraintestinal manifestation of inflammatory bowel disease.

Pulmonary involvement in inflammatory bowel disease

Clinically significant pulmonary involvement in inflammatory bowel disease is uncommon, and presentation to thoracic surgeons is rare. A literature review found no such cases in the cardiothoracic surgery network (CTSNET) journals. We describe a patient presenting with a lung mass presumed to be lung cancer that ultimately transpired to be pulmonary involvement of inflammatory bowel disease.

Thoracic manifestations of inflammatory bowel disease

BACKGROUND

A growing number of case reports suggest that pulmonary disease occurs in association with inflammatory bowel disease (IBD) more frequently than previously recognized. Screening studies have also identified pulmonary abnormalities in a significant proportion of IBD patients.

METHODS

A focused literature review of respiratory abnormalities in IBD patients and 55 English-language case series documenting 171 instances of respiratory pathology in 155 patients with known IBD.

RESULTS

Screening studies using respiratory symptoms, high-resolution CT, and pulmonary function testing support a high prevalence of respiratory abnormalities among patients with IBD. Case reports and series document a spectrum of respiratory system involvement that spans from larynx to pleura, with bronchiectasis as the single most common disorder. IBD patients have a threefold risk of venous thromboembolism, and recent investigations have also revealed possible ties between IBD and other diseases involving the respiratory system, including sarcoidosis, asthma, and alpha(1)-antitrypsin deficiency.

CONCLUSION

Respiratory symptoms and diagnosed respiratory system disorders are more common among patients with IBD than generally appreciated. The spectrum of respiratory disorders occurring among patients with IBD is very broad. Diseases of the large airways are the most common form of involvement, with bronchiectasis being the most frequently reported form of IBD-associated lung disease.

Respiratory symptoms in patients with inflammatory bowel disease and the impact of dietary salicylates

BACKGROUND

Respiratory symptoms are over-represented in inflammatory bowel disease. There are similarities between the epidemiology of inflammatory bowel disease and that of respiratory conditions for which an adverse influence of salicylate has been identified. Natural salicylates exist within our diet.

AIMS

To determine whether a lower intake of dietary salicylates is associated with less active inflammatory bowel disease and fewer concurrent respiratory symptoms.

PATIENTS AND METHODS

Respiratory status, inflammatory bowel disease activity, quality of life, and dietary habits were established in 73 patients with Crohn's disease and 69 with ulcerative colitis, using a self-administered questionnaire and peak expiratory flow rate readings. Harvey-Bradshaw and Simple Birmingham/Royal Free Colitis indices, an internally validated respiratory score, and estimated weekly dietary salicylate intake, were calculated for each patient.

RESULTS

There was at least one respiratory symptom in 63.4% of patients. The commonest underlying respiratory diagnosis was asthma. Respiratory impairment was similar in ulcerative colitis and Crohn's disease; 56.3% of Crohn's disease patients with an active respiratory diagnosis had other extra-intestinal manifestations. The dietary salicylate intake was independent of respiratory status, but inversely correlated with ulcerative colitis activity (dietary salicylate intake 37.0mg versus 21.4mg for low and higher Simple Birmingham/Royal Free Colitis index, respectively; p<0.02). A similar association was not seen in Crohn's disease.

CONCLUSIONS

Respiratory impairment is common in inflammatory bowel disease. Higher intake of dietary salicylates is associated with less active colitis and possibly causally so.

Inflammatory bowel disease and the lung: is there a link between surgery and bronchiectasis?

PURPOSE

One-third of patients with inflammatory bowel disease (IBD) has extracolonic manifestations. Inflammatory bowel-associated pulmonary disease is one of the less commonly recognized and more recently described manifestations. Here, we report the experience of our patients with inflammatory bowel-associated bronchiectasis.

METHODS

A retrospective analysis of case notes of patients with IBD and respiratory manifestations was undertaken. Relevant demographic, clinical, radiological, and pulmonary physiology laboratory results were reviewed.

RESULTS

Ten patients with IBD and bronchiectasis were identified. Eight developed respiratory symptoms after surgery for IBD. Five of the ten had ulcerative colitis. Their lung function abnormality is mild to moderate in severity. Small airways disease (forced expiratory flow between 25-75% is <50%) was evident in seven of the ten patients.

CONCLUSIONS

This preliminary study supports an association between surgery for IBD and development of symptomatic lung disease, particularly bronchiectasis, in susceptible patients. The pulmonary manifestations of IBD in some patients may only become clinically significant after surgery and the withdrawal of medical treatment.

Extraintestinal manifestations and complications in inflammatory bowel diseases

Crohn’s disease (CD) and ulcerative colitis (UC) are chronic inflammatory bowel diseases (IBD) that often involve organs other than those of the gastrointestinal tract. These nonintestinal affections are termed extraintestinal symptoms. Differentiating the true extraintestinal manifestations of inflammatory bowel diseases from secondary extraintestinal complications, caused by malnutrition, chronic inflammation or side effects of therapy, may be difficult. This review concentrates on frequency, clinical presentation and therapeutic implications of extraintestinal symptoms in inflammatory bowel diseases. If possible, extraintestinal manifestations are differentiated from extraintestinal complications. Special attention is given to the more recently described sites of involvement; i.e. thromboembolic events, osteoporosis, pulmonary involvement and affection of the central nervous system.

Severe airway stenosis associated with Crohn's disease: case report

Background

Symptomatic respiratory tract involvement is not common in Crohn's disease. Upper-airway obstruction has been reported before in Crohn's disease and usually responds well to steroid treatment.

Case presentation

We report a case of a 32-year old patient with Crohn's disease who presented with progressively worsening dyspnea on exertion. Magnetic Resonance Imaging of the chest and bronchoscopy revealed severe tracheal stenosis and marked inflammation of tracheal mucosa. Histopathology of the lesion showed acute and chronic inflammation and extended ulceration of bronchial mucosa, without granulomas. Tracheal stenosis was attributed to Crohn's disease after exclusion of other possible causes and oral and inhaled steroids were administered. Despite steroid treatment, tracheal stenosis persisted and only mild symptomatic improvement was noted after 8 months of therapy. The patient subsequently underwent rigid bronchoscopy with successful dilatation and ablation of the stenosed areas and remission of her symptoms.

Conclusion

Respiratory involvement in Crohn's disease might be more common than appreciated. Interventional pulmonology techniques should be considered in cases of tracheal stenosis due to Crohn's disease refractory to steroid treatment.

Chronic Cough Due to Nonbronchiectatic Suppurative Airway Disease (Bronchiolitis)

OBJECTIVES

To review the role of nonbronchiectatic suppurative airway disease (bronchiolitis) in the spectrum of causes of cough and its management.

DESIGN/METHODOLOGY

A MEDLINE search (through May 2004) for studies published in the English language since 1980 on human subjects using the medical subject heading terms "cough," "causes of cough," "etiology of cough," "interstitial lung disease," "bronchiolitis," "bronchiolitis obliterans," "diffuse panbronchiolitis," and "inflammatory bowel disease" was performed. Case series and prospective descriptive clinical trials were selected for review. Any references from these studies that were pertinent to the topic were also obtained.

RESULTS/CONCLUSIONS

In patients with cough in whom other more common causes of cough have been excluded, incomplete or irreversible airflow limitation, small airways disease seen on high-resolution CT scan, or purulent secretions seen on bronchoscopy, should suggest nonbronchiectatic suppurative airways disease (bronchiolitis) as a potential primary cause. Successful management depends on the identification of the specific underlying disorder.

The clustering of other chronic inflammatory diseases in inflammatory bowel disease: a population-based study

BACKGROUND & AIMS

We aimed to discern the relative risk for several chronic inflammatory conditions in patients with ulcerative colitis (UC) and Crohn's disease.

METHODS

We used the population-based University of Manitoba IBD Database that includes longitudinal files on all patients from all health system contacts identified by International Classification of Diseases, 9th revision, Clinical Modification codes for visit diagnosis. From the provincial database we extracted a control cohort matching the IBD patients 10:1 by age, sex, and geography. We considered a potential comorbid disease to be present if the patient had 5 or more health system contacts for that diagnosis. The comorbid disease period prevalence was analyzed separately for patients with UC and Crohn's disease and a prevalence ratio was calculated comparing the IBD populations with the matched cohort.

RESULTS

There were 8072 cases of IBD from 1984 to 2003, including UC (n = 3879) and Crohn's disease (n = 4193). There was a mean of approximately 16 person-years of coverage for both patients and control patients. Both UC and Crohn's disease patients had a significantly greater likelihood of having arthritis, asthma, bronchitis, psoriasis, and pericarditis than population controls. An increased risk for chronic renal disease and multiple sclerosis was noted in UC but not Crohn's disease patients. The most common nonintestinal comorbidities identified were arthritis and asthma.

CONCLUSIONS

The finding of asthma as the most common comorbidity increased in Crohn's disease patients compared with the general population is novel. These may be diseases with common causes or complications of one disease that lead to the presentation with another. Studies such as this should encourage further research into the common triggers in the organ systems that lead to autoimmune diseases.

Bronchial Hyperresponsiveness in Patients with Inflammatory Bowel Disease

Pulmonary complications have been described in patients with inflammatory bowel disease. The aim of this study was to evaluate bronchial hyppersponsiveness (BHR) in patients with Crohn's disease (CD) and ulcerative colitis (UC). Fifteen patients (8 men, 7 women, mean age: 42.20 ± 12.20 years) participated in the study. None of the patients had a prior history of respiratory disease or suffered from other systematic disease. Skin prick tests for common allergens (such as pollens, mites, foods and moulds) were administered to all patients of the study. The control group included 15 healthy volunteers (10 men, 5 women, mean age: 40.33 ± 5.06 years). The skin tests showed that 3 of 15 patients with inflammatory bowel disease were sensitive to common allergens (two patients to mix grasses and one to D. Pteronysinnus). In the control group, one subject was sensitive to D. Pteronysinnus. BHR was estimated after methacholine challenge. The frequency of BHR among the patients with inflammatory bowel disease was 7 of 15 (46.60%), compared with only one in the control group who was positive at the maximum dosage of methacholine (16 mg/dl). Our results indicate that there is an increased frequency of BHR in patients with inflammatory bowel disease.

Atopic manifestations are more common in patients with Crohn disease than in the general population

BACKGROUND

The role of TNF-alpha in Crohn disease is now well established and anti-TNF-alpha is frequently used as a second- or third-line treatment. Tumor necrosis factor-alpha (TNF-alpha) is traditionally associated with macrophages but has recently also been found in mast cells of the ileal wall in patients with Crohn disease. As it is well known that mast cells and TNF-alpha play important roles in atopic manifestations like asthma, allergic rhinitis; and eczema the aim of this study was to investigate whether these are seen more commonly in Crohn patients than in the general population.

METHODS

Patients with Crohn disease (n = 308), aged 18-50 years, living in the Linköping region in southeast Sweden, were asked to answer a questionnaire regarding the presence of any kind of atopic manifestations. The questionnaire was also sent to 930 controls collected from the Southeastern Region Population Registry. The controls were matched according to age, sex, and place of residence.

RESULTS

The response rate among the Crohn patients was 91% (280/308) and among controls 84% (779/930). Eczema was a significantly more frequent manifestation, being almost twice as common in Crohn patients (27%) as in the general population (16%). Adjustment by logistic regression for place of residence, gender, age and coexistence of any other atopic manifestation did not change the odds ratios significantly.

CONCLUSION

Atopic manifestations as a group, and eczema as a single manifestation, are significantly more frequent in Crohn patients than in the general population.

Extraintestinal complications of inflammatory bowel disease

Recent studies of extraintestinal manifestations (EIMs) of inflammatory bowel disease (IBD) have demonstrated the importance of genetic predisposition in the etiology of musculoskeletal and cutaneous manifestations. In addition, small studies have shown infliximab to be effective in treating troublesome EIMs, particularly in pyoderma gangrenosum. Other trials have examined the safety of cyclooxygenase-2-specific nonsteroidal inflammatory drugs in IBD. Further work has been done on osteoporosis in IBD, and the American Gastroenterological Association has published a technical review and management guidelines for osteoporosis in a range of gastrointestinal disorders. However, despite further publications, debate remains concerning whether IBD patients with osteoporosis have a significant increase in fracture risk, and whether the bone loss is related to the disease or to its treatment.

Pulmonary manifestations of inflammatory bowel disease

Extraintestinal manifestations of both Crohn's disease and ulcerative colitis (UC) have been well described, although pulmonary findings are often overlooked. We summarize the experience of more than 400 cases of pulmonary manifestations of inflammatory bowel disease (IBD). These manifestations will be categorized by disease mechanism into drug-induced disease, anatomic disease, over-lap syndromes, autoimmune disease, physiologic consequences of IBD, pulmonary function test abnormalities, and nonspecific lung disease. We intend to provide the clinician with a practical working update on the spectrum of pulmonary dysfunction associated with IBD.