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Zeng Q, Hu D, Li Y, Zhou Z, Wu J, Li X, Yu X. Evaluating the causal association between bronchiectasis and different types of inflammatory bowel disease: a two-sample Mendelian randomization study. Front Immunol 2024; 15:1365108. [PMID: 38638444 PMCID: PMC11024297 DOI: 10.3389/fimmu.2024.1365108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/22/2024] [Indexed: 04/20/2024] Open
Abstract
Background and objectives Previous observational studies have established a connection between bronchiectasis and inflammatory bowel disease (IBD), but none of these studies have provided a clear explanation for the underlying cause of this relationship. The present study thus implemented Mendelian randomization (MR) design to explore possible bidirectional relationships between IBD and bronchiectasis risk, with an additional focus on Crohn's disease (CD) and ulcerative colitis (UC) as IBD subtypes. Materials and methods A large genome-wide association study (GWAS)-derived data pool was leveraged to examine the relationships between bronchiectasis and IBD, CD, and UC. Two-sample MR analyses were performed with an inverse variance weighted (IVW) approach supplemented with the MR-Egger and weighted median methods. Sensitivity analyses were used to further assess the reliability of the main MR study findings. The possibility of reverse causation was also evaluated using a reverse MR approach. Results The IVW MR analytical approach revealed that IBD (p = 0.074), UC (p = 0.094), and CD (p = 0.644) had no significant impact on the incidence of bronchiectasis, with the converse also being true (p = 0.471, p = 0.700, and p = 0.099, respectively). Conclusion This MR analysis demonstrated that the higher occurrence of bronchiectasis in patients with IBD is not caused by genetic predisposition.
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Affiliation(s)
- Qian Zeng
- Department of General Practice, Shenzhen Luohu Hospital Group Luohu People’s Hospital, The Third Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Da Hu
- Department of General Practice, Shenzhen Luohu Hospital Group Luohu People’s Hospital, The Third Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Yuan Li
- Department of General Practice, Shenzhen Luohu Hospital Group Luohu People’s Hospital, The Third Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Zhiwei Zhou
- Department of Gastroenterology, Shenzhen Luohu Hospital Group Luohu People’s Hospital, The Third Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Jinfeng Wu
- Department of Gastroenterology, Shenzhen Luohu Hospital Group Luohu People’s Hospital, The Third Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Xiaodong Li
- Department of Gastroenterology, Shenzhen Luohu Hospital Group Luohu People’s Hospital, The Third Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
| | - Xiqiu Yu
- Department of Gastroenterology, Shenzhen Luohu Hospital Group Luohu People’s Hospital, The Third Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong, China
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2
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Cozzi D, Bartolucci M, Giannelli F, Cavigli E, Campolmi I, Rinaldi F, Miele V. Parenchymal Cavitations in Pulmonary Tuberculosis: Comparison between Lung Ultrasound, Chest X-ray and Computed Tomography. Diagnostics (Basel) 2024; 14:522. [PMID: 38472994 DOI: 10.3390/diagnostics14050522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
This article aims to detect lung cavitations using lung ultrasound (LUS) in a cohort of patients with pulmonary tuberculosis (TB) and correlate the findings with chest computed tomography (CT) and chest X-ray (CXR) to obtain LUS diagnostic sensitivity. Patients with suspected TB were enrolled after being evaluated with CXR and chest CT. A blinded radiologist performed LUS within 3 days after admission at the Infectious Diseases Department. Finally, 82 patients were enrolled in this study. Bronchoalveolar lavage (BAL) confirmed TB in 58/82 (71%). Chest CT showed pulmonary cavitations in 38/82 (43.6%; 32 TB patients and 6 non-TB ones), LUS in 15/82 (18.3%; 11 TB patients and 4 non-TB ones) and CXR in 27/82 (33%; 23 TB patients and 4 non-TB ones). Twelve patients with multiple cavitations were detected with CT and only one with LUS. LUS sensitivity was 39.5%, specificity 100%, PPV 100% and NPV 65.7%. CXR sensitivity was 68.4% and specificity 97.8%. No false positive cases were found. LUS sensitivity was rather low, as many cavitated consolidations did not reach the pleural surface. Aerated cavitations could be detected with LUS with relative confidence, highlighting a thin air crescent sign towards the pleural surface within a hypoechoic area of consolidation, easily distinguishable from a dynamic or static air bronchogram.
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Affiliation(s)
- Diletta Cozzi
- Radiology Emergency Department, Careggi University Hospital, 50139 Florence, Italy
| | | | - Federico Giannelli
- Department of Radiology, Azienda USL Toscana Centro, Mugello Hospital, 50032 Borgo San Lorenzo, Italy
| | - Edoardo Cavigli
- Radiology Emergency Department, Careggi University Hospital, 50139 Florence, Italy
- Department of Radiology, Azienda USL Toscana Centro, San Giovanni di Dio Hospital, 50143 Florence, Italy
| | - Irene Campolmi
- Department of Infectious and Tropical Diseases, Careggi University Hospital, 50134 Florence, Italy
| | - Francesca Rinaldi
- Department of Infectious Diseases, Azienda Ospedaliero Universitaria Maggiore della Carità, 28100 Novara, Italy
| | - Vittorio Miele
- Radiology Emergency Department, Careggi University Hospital, 50139 Florence, Italy
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3
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Miao S, Qiu H. The microbiome in the pathogenesis of lung cancer: The role of microbiome in lung cancer pathogenesis. APMIS 2024; 132:68-80. [PMID: 37974493 DOI: 10.1111/apm.13359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Abstract
As one of the malignant tumors with high incidence rate and high mortality, lung cancer seriously threatens the life safety of patients. Research shows that microorganisms are closely related to lung cancer. The microbiome is symbiotic with the host and plays a vital role in the functions of the human body. Microbiota dysbiosis is correlated with development of lung cancer. However, the underlying mechanisms are poorly understood. This paper summarizes the composition characteristics of the gut-lung axis microbiome and intratumoral microbiome in patients with lung cancer. We then expound five potential carcinogenic mechanisms based on microorganisms, such as genotoxicity, metabolism, inflammation, immune response, and angiogenesis. Next, we list three high-throughput sequencing methods, and finally looks forward to the prospect of microorganisms as novel targets for early diagnosis and treatment of lung cancer.
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Affiliation(s)
- Sainan Miao
- School of Nursing, Anhui Medical University, Hefei, China
| | - Huan Qiu
- School of Nursing, Anhui Medical University, Hefei, China
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4
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Cavalli CAM, Gabbiadini R, Dal Buono A, Quadarella A, De Marco A, Repici A, Bezzio C, Simonetta E, Aliberti S, Armuzzi A. Lung Involvement in Inflammatory Bowel Diseases: Shared Pathways and Unwanted Connections. J Clin Med 2023; 12:6419. [PMID: 37835065 PMCID: PMC10573999 DOI: 10.3390/jcm12196419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/01/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
Inflammatory bowel diseases (IBDs) are chronic, relapsing inflammatory disorders of the gastrointestinal tract, frequently associated with extraintestinal manifestations (EIMs) that can severely affect IBD patients' quality of life, sometimes even becoming life-threatening. Respiratory diseases have always been considered a rare and subsequently neglected extraintestinal manifestations of IBD. However, increasing evidence has demonstrated that respiratory involvement is frequent in IBD patients, even in the absence of respiratory symptoms. Airway inflammation is the most common milieu of IBD-related involvement, with bronchiectasis being the most common manifestation. Furthermore, significant differences in prevalence and types of involvement are present between Crohn's disease and ulcerative colitis. The same embryological origin of respiratory and gastrointestinal tissue, in addition to exposure to common antigens and cytokine networks, may all play a potential role in the respiratory involvement. Furthermore, other causes such as drug-related toxicity and infections must always be considered. This article aims at reviewing the current evidence on the association between IBD and respiratory diseases. The purpose is to raise awareness of respiratory manifestation among IBD specialists and emphasize the need for identifying respiratory diseases in early stages to promptly treat these conditions, avoid worsening morbidity, and prevent lung damage.
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Affiliation(s)
- Carolina Aliai Micol Cavalli
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.A.M.C.); (R.G.); (A.D.B.); (A.Q.); (A.D.M.); (C.B.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (A.R.); (S.A.)
| | - Roberto Gabbiadini
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.A.M.C.); (R.G.); (A.D.B.); (A.Q.); (A.D.M.); (C.B.)
| | - Arianna Dal Buono
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.A.M.C.); (R.G.); (A.D.B.); (A.Q.); (A.D.M.); (C.B.)
| | - Alessandro Quadarella
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.A.M.C.); (R.G.); (A.D.B.); (A.Q.); (A.D.M.); (C.B.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (A.R.); (S.A.)
| | - Alessandro De Marco
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.A.M.C.); (R.G.); (A.D.B.); (A.Q.); (A.D.M.); (C.B.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (A.R.); (S.A.)
| | - Alessandro Repici
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (A.R.); (S.A.)
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Cristina Bezzio
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.A.M.C.); (R.G.); (A.D.B.); (A.Q.); (A.D.M.); (C.B.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (A.R.); (S.A.)
| | - Edoardo Simonetta
- Respiratory Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (A.R.); (S.A.)
- Respiratory Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Alessandro Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (C.A.M.C.); (R.G.); (A.D.B.); (A.Q.); (A.D.M.); (C.B.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (A.R.); (S.A.)
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León-Román F, Pintado-Cort B, García-Asenjo JAL, García-Casado D, Cusacovich I, Loucel M, Recio-Moreno B, Muñiz-González F. Growing Pulmonary Nodule of Unknown Origin in a 61-Year-Old Woman. Am J Med 2023; 136:446-448. [PMID: 36649834 DOI: 10.1016/j.amjmed.2022.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023]
Affiliation(s)
| | | | | | | | - Ivan Cusacovich
- Internal Medicine Department, Hospital Recoletas Campo Grande, Valladolid, Spain; Internal Medicine Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Mauricio Loucel
- Thoracic Surgery Department, Hospital Recoletas Campo Grande, Valladolid, Spain; Thoracic Surgery Department, Hospital Clínico Universitario, Valladolid, Spain
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Luo L, Li H, Tang J, Liao Z, Wang F, Jin Y, Zhou F, Feng J, Li X. Clinical characteristics and outcomes of MPO-ANCA-associated glomerulonephritis with bronchiectasis: A retrospective case-control study. Semin Arthritis Rheum 2022; 57:152082. [DOI: 10.1016/j.semarthrit.2022.152082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/27/2022] [Accepted: 08/10/2022] [Indexed: 10/15/2022]
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Behçet's Disease: A Radiological Review of Vascular and Parenchymal Pulmonary Involvement. Diagnostics (Basel) 2022; 12:diagnostics12112868. [PMID: 36428928 PMCID: PMC9689730 DOI: 10.3390/diagnostics12112868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
Behcet's disease (BD) is a chronic systemic inflammatory disorder characterized by underlying chronic vasculitis of both large- and small-caliber vessels. Thoracic involvement in BD can occur with various types of manifestations, which can be detected with contrast-enhanced MSCT scanning. In addition, MR can be useful in diagnosis. Characteristic features are aneurysms of the pulmonary arteries that can cause severe hemoptysis and SVC thrombosis that manifests as SVC syndrome. Other manifestations are aortic and bronchial artery aneurysms, alveolar hemorrhage, pulmonary infarction, and rarely pleural effusion. Achieving the right diagnosis of these manifestations is important for setting the correct therapy and improving the patient's outcome.
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8
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Pemmasani G, Loftus EV, Tremaine WJ. Prevalence of Pulmonary Diseases in Association with Inflammatory Bowel Disease. Dig Dis Sci 2022; 67:5187-5194. [PMID: 35142913 DOI: 10.1007/s10620-022-07385-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/09/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Prior reports from small studies suggested an increased prevalence of respiratory diseases in patients with inflammatory bowel disease (IBD). Large population-based contemporary studies evaluating this association are lacking. METHODS In this retrospective observational cohort study utilizing the US Nationwide Readmissions Database year 2014, IBD patients ≥ 15 years of age were identified. Outcomes analyzed were the differences in the rates of diagnosed respiratory diseases between IBD and age- and sex-matched non-IBD control groups, and between patients with ulcerative colitis (UC) and Crohn disease (CD). RESULTS The IBD study cohort and the matched non-IBD control group had 87,506 patients each (mean age, 52 years; 57% females). In patients with IBD, obstructive respiratory diseases were the most prevalent (asthma, 8.6%; and chronic obstructive pulmonary disease, 8.7%) followed by pleural diseases (1.9%). Compared with the non-IBD cohort, patients with IBD had a 46% higher rate of bronchiectasis, 52% higher rate of pulmonary vasculitis and interstitial pneumonia, 35% higher risk for lung nodules, 16% higher rate of pulmonary fibrosis, and a 5.5% higher rate of asthma. Among patients with IBD, patients with CD, compared with UC, had a 34% lower age/sex-adjusted risk for bronchiectasis, 56% lower risk for pulmonary vasculitis, 14% lower risk for pleural diseases, and approximately 30% higher risk for chronic obstructive pulmonary diseases. CONCLUSION In this large population-based cohort study, patients with IBD had higher rates of certain respiratory diseases compared with the general population without IBD, and significant differences were present between CD and UC.
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Affiliation(s)
- Gayatri Pemmasani
- Department of Medicine, SUNY Upstate Medical Center, Syracuse, NY, USA.
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - William J Tremaine
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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9
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Alhalabi M, Ali Deeb S, Ali F, Abbas A. Ulcerative colitis-associated bronchiectasis: A rare extraintestinal manifestation of inflammatory bowel disease: A case report. Medicine (Baltimore) 2022; 101:e30202. [PMID: 36042661 PMCID: PMC9410614 DOI: 10.1097/md.0000000000030203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Inflammatory bowel disease patients may suffer from extraintestinal manifestations. Although muscles, joints, and skin are the most commonly affected, respiratory involvement is more prevalent than previously believed, and the majority of these patients have no symptoms. Although the large airways are the most frequently affected, the small airways, lung parenchyma, and pulmonary vasculature may also be affected. PATIENT CONCERNS A 24-year-old nonsmoking Syrian female was referred to the pulmonary medicine clinic in December 2020 due to a chronic cough. Her cough had been present for the last year, it was described as scratchy, and produced small amounts of mucoid sputum occasionally. She denied any related wheeze, hemoptysis, weight loss, or night sweats. Multiple courses of antibiotics were prescribed by many doctors, also previous chest radiographs were reported as normal. She was diagnosed with ulcerative colitis in 2012 after presentation with abdominal pain and per rectal bleeding. The diagnosis was confirmed via colonoscopy and colon biopsies, with no prior surgery. Her past medications included prednisone, mesalamine, azathioprine, and infliximab. Tests, including complete blood count, C-reactive protein (CRP), fecal calprotectin, and chest X-ray, were normal. DIAGNOSIS Ulcerative colitis-associated bronchiectasis was established through history and clinical examination beside pulmonary function test, which revealed a mild obstructive pattern, and a chest computed tomography follow-up that revealed bilateral bronchiectasis. INTERVENTIONS Bronchiectasis was treated with inhaled oral steroids and sputum expectoration while she continued mesalamine and azathioprine for ulcerative colitis. OUTCOME Cough improvement and sustained ulcerative colitis remission. CONCLUSIONS Identification of inflammatory bowel disease pulmonary exacerbation is probably poor, as pulmonary symptoms might emerge at any moment during the illness, and are most commonly diagnosed later in life and with the disassociation of inflammatory bowel disease activity. Pulmonologists should be involved in the care of inflammatory bowel disease patients who developed lung symptoms.
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Affiliation(s)
- Marouf Alhalabi
- Gastroenterology department of Damascus hospital, Damascus, Syria
- *Correspondence: Marouf Alhalabi, Damascus, Almujtahed Street, Damascus Hospital (e-mail: )
| | - Sawsan Ali Deeb
- Gastroenterology department of Damascus hospital, Damascus, Syria
| | - Fadwa Ali
- Gastroenterology department of Damascus hospital, Damascus, Syria
| | - Ahmad Abbas
- Gastroenterology department of Damascus hospital, Damascus, Syria
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Schmid F, Chao CM, Däbritz J. Pathophysiological Concepts and Management of Pulmonary Manifestation of Pediatric Inflammatory Bowel Disease. Int J Mol Sci 2022; 23:ijms23137287. [PMID: 35806292 PMCID: PMC9266732 DOI: 10.3390/ijms23137287] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023] Open
Abstract
Pulmonary manifestation (PM) of inflammatory bowel disease (IBD) in children is a rare condition. The exact pathogenesis is still unclear, but several explanatory concepts were postulated and several case reports in children were published. We performed a systematic Medline search between April 1976 and April 2022. Different pathophysiological concepts were identified, including the shared embryological origin, “miss-homing” of intestinal based neutrophils and T lymphocytes, inflammatory triggering via certain molecules (tripeptide proline-glycine-proline, interleukin 25), genetic factors and alterations in the microbiome. Most pediatric IBD patients with PM are asymptomatic, but can show alterations in pulmonary function tests and breathing tests. In children, the pulmonary parenchyma is more affected than the airways, leading histologically mainly to organizing pneumonia. Medication-associated lung injury has to be considered in pulmonary symptomatic pediatric IBD patients treated with certain agents (i.e., mesalamine, sulfasalazine or infliximab). Furthermore, the risk of pulmonary embolism is generally increased in pediatric IBD patients. The initial treatment of PM is based on corticosteroids, either inhaled for the larger airways or systemic for smaller airways and parenchymal disease. In summary, this review article summarizes the current knowledge about PM in pediatric IBD patients, focusing on pathophysiological and clinical aspects.
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Affiliation(s)
- Florian Schmid
- Catholic Children’s Hospital Wilhelmstift, 22149 Hamburg, Germany;
| | - Cho-Ming Chao
- Department of Pediatrics, University Medical Center Rostock, 18057 Rostock, Germany;
- Cardio-Pulmonary Institute (CPI), University of Giessen and Marburg Lung Center (UGMLC), German Center of Lung Research (DZL), Justus-Liebig-University, 35398 Giessen, Germany
| | - Jan Däbritz
- Department of Pediatrics, University Medical Center Greifswald, 17475 Greifswald, Germany
- Correspondence:
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11
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The Role of Magnetic Resonance Enterography in Crohn’s Disease: A Review of Recent Literature. Diagnostics (Basel) 2022; 12:diagnostics12051236. [PMID: 35626391 PMCID: PMC9140029 DOI: 10.3390/diagnostics12051236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/06/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022] Open
Abstract
Inflammatory bowel disease (IBD) is the term used to identify a form of chronic inflammation of the gastrointestinal tract that primarily contemplates two major entities: ulcerative colitis (UC) and Crohn’s disease (CD). The classic signs are abdominal pain and diarrhoea that correlate with the localization of gastro-enteric disease, although in this pathology extraintestinal symptoms may coexist. The diagnosis of CD relies on a synergistic combination of clinical, laboratory (stool and biochemical), cross-sectional imaging evaluation, as well as endoscopic and histologic assessments. The purpose of this paper is to prove the role of imaging in the diagnosis and follow-up of patients with CD with particular focus on recent innovations of magnetic resonance enterography (MRE) as a pivotal diagnostic tool, analysing the MRE study protocol and imaging features during the various phases of disease activity and its complications.
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12
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Xia K, Gao R, Wu X, Sun J, Wan J, Wu T, Fichna J, Yin L, Chen C. Characterization of Specific Signatures of the Oral Cavity, Sputum, and Ileum Microbiota in Patients With Crohn’s Disease. Front Cell Infect Microbiol 2022; 12:864944. [PMID: 35493739 PMCID: PMC9045729 DOI: 10.3389/fcimb.2022.864944] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Crohn’s disease (CD) is a chronic nonspecific inflammatory bowel disease (IBD) with an increasing incidence worldwide. The etiology of CD is still obscure, but microbial dysbiosis has been recognized as an essential factor contributing to CD. However, few studies have revealed the microbiome’s signatures and reciprocal correlations between multiple sites in patients with CD over different disease stages. This study investigated the specific microbial architectures of the oral cavity, sputum, and ileum in patients with CD in the active and remission stages. Methods Microbial samples from the oral cavity, sputum, and ileum were collected from patients with CD in the active and remission stages and healthy controls. The microbial composition was assessed by 16S ribosomal RNA (rRNA) gene sequencing. In addition, bioinformatics methods were used to demonstrate the microbial signatures, functional changes, and correlations between microbiota and clinical data in CD. Results Compared with healthy controls, a distinct microbiota dysbiosis in the oral cavity, sputum, and ileum of patients with CD was identified, characterized by alterations in microbiota biodiversity and composition. The oral cavity and sputum microbiota showed significantly lower microbial diversity in patients with CD than in healthy controls. In terms of microbiota composition, the microbiota changes in the oral cavity of patients with CD were similar to those in the sputum, while they were different from those in the ileum. In the oral cavity and sputum of patients with CD, a lower relative abundance of Firmicutes and Actinobacteria was observed compared to healthy controls, which was most prominent in the active stage. In contrast, an increased relative abundance of Fusobacteria, Porphyromonas, and Haemophilus was observed in patients with CD. The predicted metabolic pathways involved in the oral cavity, sputum, and ileum were similar, predominantly involving metabolism, environmental information processing, and genetic information processing. Conclusion The results revealed the alterations of microbiota architecture in the oral cavity, sputum, and ileum of patients with CD, which varied across disease stages. Studying microbiota dysbiosis may bring new insights into the etiology of CD and lead to novel treatments.
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Affiliation(s)
- Kai Xia
- Diagnostic and Treatment Center for Refractory Diseases of Abdomen Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Kai Xia, ; Lu Yin, ; Chunqiu Chen,
| | - Renyuan Gao
- Diagnostic and Treatment Center for Refractory Diseases of Abdomen Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaocai Wu
- Diagnostic and Treatment Center for Refractory Diseases of Abdomen Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing Sun
- Diagnostic and Treatment Center for Refractory Diseases of Abdomen Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jian Wan
- Diagnostic and Treatment Center for Refractory Diseases of Abdomen Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tianqi Wu
- Diagnostic and Treatment Center for Refractory Diseases of Abdomen Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jakub Fichna
- Department of Biochemistry, Medical University of Lodz, Lodz, Poland
| | - Lu Yin
- Diagnostic and Treatment Center for Refractory Diseases of Abdomen Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Kai Xia, ; Lu Yin, ; Chunqiu Chen,
| | - Chunqiu Chen
- Diagnostic and Treatment Center for Refractory Diseases of Abdomen Surgery, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Kai Xia, ; Lu Yin, ; Chunqiu Chen,
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Todd NW, Atamas SP, Hines SE, Luzina IG, Shah NG, Britt EJ, Ghio AJ, Galvin JR. Demystifying idiopathic interstitial pneumonia: time for more etiology-focused nomenclature in interstitial lung disease. Expert Rev Respir Med 2022; 16:235-245. [PMID: 35034567 PMCID: PMC8983480 DOI: 10.1080/17476348.2022.2030710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION A major focus of interstitial lung disease (ILD) has centered on disorders termed idiopathic interstitial pneumonias (IIPs) which include, among others, idiopathic pulmonary fibrosis, idiopathic nonspecific interstitial pneumonia, cryptogenic organizing pneumonia, and respiratory bronchiolitis-interstitial lung disease. AREAS COVERED We review the radiologic and histologic patterns for the nine disorders classified by multidisciplinary approach as IIP, and describe the remarkable amount of published epidemiologic, translational, and molecular studies demonstrating their associations with numerous yet definitive environmental exposures, occupational exposures, pulmonary diseases, systemic diseases, medication toxicities, and genetic variants. EXPERT OPINION In the 21st century, these disorders termed IIPs are rarely idiopathic, but rather are well-described radiologic and histologic patterns of lung injury that are associated with a wide array of diverse etiologies. Accordingly, the idiopathic nomenclature is misleading and confusing, and may also promote a lack of inquisitiveness, suggesting the end rather than the beginning of a thorough diagnostic process to identify ILD etiology and initiate patient-centered management. A shift toward more etiology-focused nomenclature will be beneficial to all, including patients hoping for better life quality and disease outcome, general medicine and pulmonary physicians furthering their ILD knowledge, and expert ILD clinicians and researchers who are advancing the ILD field.
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Affiliation(s)
- Nevins W. Todd
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA,,Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | - Sergei P. Atamas
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA,,Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | - Stella E. Hines
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Irina G. Luzina
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA,,Baltimore Veterans Affairs Medical Center, Baltimore, Maryland, USA
| | - Nirav G. Shah
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Edward J. Britt
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Andrew J. Ghio
- Environmental Protection Agency, Research Triangle Park, North Carolina, USA
| | - Jeffrey R. Galvin
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA,,Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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14
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CT findings of non-neoplastic central airways diseases. Jpn J Radiol 2021; 40:107-119. [PMID: 34398372 DOI: 10.1007/s11604-021-01190-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/10/2021] [Indexed: 01/02/2023]
Abstract
Non-neoplastic lesions of central airways are uncommon entities with different etiologies, with either focal or diffuse involvement of the tracheobronchial tree. Clinical symptoms of non-neoplastic tracheobronchial diseases are non-specific, and diagnosis is difficult, especially in the early stages. Three-dimensional computed tomography (3D-CT) is an evaluable tool as it allows to assess and characterize tracheobronchial wall lesions and meanwhile it enables the evaluation of airways surrounding structures. Multiplanar reconstructions (MPR), minimum intensity projections (MinIP), and 3D Volume Rendering (VR) (in particular, virtual bronchoscopy) also provide information on the site and of the length of airway alterations. This review will be discussed about (1) primary airway disorders, such as relapsing polychondritis, tracheobronchophathia osteochondroplastica, and tracheobronchomegaly, (2) airway diseases, related to granulomatosis with polyangiitis, Chron's disease, Behcet's disease, sarcoidosis, amyloidosis, infections, intubation and transplantation, (3) tracheobronchial malacia, and (4) acute tracheobronchial injury. 3D-CT findings, especially with MPR and 3D VR reconstructions, allows us to evaluate tracheobronchial disease morphologically in detail.
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15
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Jochmann A, Trachsel D, Hammer J. Inflammatory bowel disease and the lung in paediatric patients. Breathe (Sheff) 2021; 17:200269. [PMID: 34295391 PMCID: PMC8291939 DOI: 10.1183/20734735.0269-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 04/15/2021] [Indexed: 02/06/2023] Open
Abstract
The prevalence of inflammatory bowel disease (IBD) has increased over the past 20 years. Pulmonary involvement in paediatric IBD is rare but may be missed since the spectrum of symptoms is broad and mimics other diseases. The most important differential diagnoses of pulmonary manifestations of IBD are infections and therapy-related side-effects. There is no gold standard to diagnose respiratory manifestations in children with IBD. Diagnostic tests should be chosen according to history and clinical presentation. Treatment of respiratory manifestations of IBD includes inhaled or oral corticosteroids and initiation or step-up of immunomodulatory IBD therapies. Pulmonary involvement in paediatric IBD is rare but may be underdiagnosed. The spectrum of symptoms is broad and mimics other diseases. The differentiation between IBD-related and drug-induced pulmonary manifestation can be challenging.https://bit.ly/3uZBvpA
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Affiliation(s)
- Anja Jochmann
- Division of Respiratory and Critical Care Medicine, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Daniel Trachsel
- Division of Respiratory and Critical Care Medicine, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Jürg Hammer
- Division of Respiratory and Critical Care Medicine, University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
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16
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Ground-glass opacity (GGO): a review of the differential diagnosis in the era of COVID-19. Jpn J Radiol 2021; 39:721-732. [PMID: 33900542 PMCID: PMC8071755 DOI: 10.1007/s11604-021-01120-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/07/2021] [Indexed: 02/06/2023]
Abstract
Thoracic imaging is fundamental in the diagnostic route of Coronavirus disease 2019 (COVID-19) especially in patients admitted to hospitals. In particular, chest computed tomography (CT) has a key role in identifying the typical features of the infection. Ground-glass opacities (GGO) are one of the main CT findings, but their presence is not specific for this viral pneumonia. In fact, GGO is a radiological sign of different pathologies with both acute and subacute/chronic clinical manifestations. In the evaluation of a subject with focal or diffuse GGO, the radiologist has to know the patient’s medical history to obtain a valid diagnostic hypothesis. The authors describe the various CT appearance of GGO, related to the onset of symptoms, focusing also on the ancillary signs that can help radiologist to obtain a correct and prompt diagnosis.
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17
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Chong WH, Ibrahim A, Saha BK. Not all nodules with PET hypermetabolic activity are malignant: a case of lung granuloma in ulcerative colitis. BMJ Case Rep 2021; 14:14/4/e242154. [PMID: 33846194 PMCID: PMC8048001 DOI: 10.1136/bcr-2021-242154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Woon Hean Chong
- Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, New York, USA
| | - Ammoura Ibrahim
- Department of Pathology, Albany Medical Center, Albany, New York, USA
| | - Biplab K Saha
- Pulmonary and Critical Care Medicine, Ozarks Medical Center, West Plains, Missouri, USA
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18
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Kröner PT, Lee A, Farraye FA. Respiratory Tract Manifestations of Inflammatory Bowel Disease. Inflamm Bowel Dis 2021; 27:563-574. [PMID: 32448912 DOI: 10.1093/ibd/izaa112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Indexed: 12/12/2022]
Abstract
Inflammatory bowel disease can manifest in many extraintestinal organ systems. The most frequently involved extraintestinal locations include the mucocutaneous, hepatobiliary, and ocular organ systems. The respiratory tract is less commonly involved and is therefore frequently overlooked. Consequently, it is believed that involvement of the respiratory tract in patients with inflammatory bowel disease is underreported. The pathogenesis is thought to be multifactorial, involving the common embryologic origin shared by the respiratory and luminal digestive tract, molecular mimicry, and immunologic interactions leading to immune-complex deposition in affected tissue. The spectrum of manifestations of the respiratory tract related to inflammatory bowel disease is broad. It not only includes direct involvement of the respiratory tract (ie, airways, interstitium, and pleura) but also can result as a consequence of systemic involvement such as in thromboembolic events. In addition, it may also be related to other conditions that affect the respiratory tract such as sarcoidosis and alpha-1 antitrypsin deficiency. Though some conditions related to respiratory tract involvement might be subclinical, others may have life-threatening consequences. It is critical to approach patients with suspected inflammatory bowel disease-related respiratory tract involvement in concert with pulmonology, infectious diseases, and any other pertinent experts, as treatments may require a multidisciplinary overlap of measures. Therefore, it is of paramount importance for the clinician to be aware of the array of respiratory tract manifestations of patients with inflammatory bowel disease, in addition to the possible spectrum of therapeutic measures.
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Affiliation(s)
- Paul T Kröner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL
| | - Augustine Lee
- Division of Pulmonary, Allergy and Sleep Medicine, Mayo Clinic, Jacksonville, FL
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL
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19
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Contrast-Enhanced Ultrasound (CEUS) in Non-Traumatic Abdominal Emergencies. Ultrasound Int Open 2021; 6:E76-E86. [PMID: 33728394 PMCID: PMC7954641 DOI: 10.1055/a-1347-5875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 05/01/2021] [Indexed: 02/08/2023] Open
Abstract
Conventional ultrasound imaging (US) is the first-line investigation in acute
non-traumatic abdominal emergencies, but sometimes it needs further
examinations, such as computed tomography (CT), to reach a certain
diagnosis. Contrast-enhanced ultrasound (CEUS), through injection of
contrast medium, may provide the radiologist with additional information
that could not be investigated with baseline US. It could help reach a
diagnosis and rapidly determine the proper therapy in an emergency setting.
The purpose of this review is to explain and illustrate the various
possibilities and limitations of CEUS in acute non-traumatic abdominal
diseases, in particular acute inflammation, parenchymal infarcts, and
hemorrhages.
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20
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Gut Microbiota: the Emerging Link to Lung Homeostasis and Disease. J Bacteriol 2021; 203:JB.00454-20. [PMID: 33077630 DOI: 10.1128/jb.00454-20] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The gut microbiota plays a crucial role in the development of the immune system and confers benefits or disease susceptibility to the host. Emerging studies have indicated the gut microbiota could affect pulmonary health and disease through cross talk between the gut microbiota and the lungs. Gut microbiota dysbiosis could lead to acute or chronic lung disease, such as asthma, tuberculosis, and lung cancer. In addition, the composition of the gut microbiota may be associated with different lung diseases, the prevalence of which also varies by age. Modulation of the gut microbiota through short-chain fatty acids, probiotics, and micronutrients may present potential therapeutic strategies to protect against lung diseases. In this review, we will provide an overview of the cross-talk between the gut microbiota and the lungs, as well as elucidate the underlying pathogenesis and/or potential therapeutic strategies of some lung diseases from the point of view of the gut microbiota.
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21
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Cozzi D, Moroni C, Cavigli E, Bindi A, Bonini MC, Fattorini C, Miele V. Behçet disease in Emergency Department: a rare case presenting with haemoptysis and massive pulmonary arterial aneurysms. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2021; 38:e2021014. [PMID: 34316254 PMCID: PMC8288210 DOI: 10.36141/svdld.v38i2.10957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/08/2021] [Indexed: 11/03/2022]
Abstract
Behçet disease (BD) is a systemic disorder caused by underlying vasculitis of unknown origin. In this paper we present a case of a 26-year-old male patient who was admitted at our Emergency Department with massive haemoptysis due to pulmonary arterial involvement in BD. The discussion of this case helps to remember that BD is the main cause of aneurysm of the pulmonary arteries and a cause of haemoptysis in young patients. Therefore, the radiologist plays a key role in the identification of intrathoracic alterations with chest computed tomography. The knowledge of clinical manifestations and distinctive elements of BD allow an accurate diagnosis and let the patient to be directed towards an appropriate treatment, in order to avoid the onset of life-threatening complications.
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Affiliation(s)
- Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Chiara Moroni
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Edoardo Cavigli
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Alessandra Bindi
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | | | - Caterina Fattorini
- Histopathology and Molecular Diagnostics, Careggi University Hospital, Florence, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
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22
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Myer AS, Shah K, Patel KM. An Infrequent Extraintestinal Manifestation of Ulcerative Colitis: Pulmonary Necrobiotic Nodules. Cureus 2020; 12:e9774. [PMID: 32953292 PMCID: PMC7491691 DOI: 10.7759/cureus.9774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pulmonary necrobiotic nodules are a rare extraintestinal manifestation (EIM) of inflammatory bowel disease (IBD), which are often overlooked when diagnosing cavitary pulmonary nodules. We present this case to highlight the importance of a thorough differential diagnosis, which includes EIMs of ulcerative colitis (UC), in this case as necrobiotic nodules. Herein, we present a 25-year-old male patient with a history of poorly controlled UC who presented with fevers, left-sided abdominal pain, and bloody diarrhea. Imaging revealed cavitary pulmonary nodules without an infectious or malignant etiology. Lung biopsy and pathology confirmed a diagnosis consistent with necrobiotic nodules.
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Affiliation(s)
- Adam S Myer
- Internal Medicine, Stony Brook University, State University of New York, Stony Brook, USA
| | - Kushang Shah
- Internal Medicine, Stony Brook Medicine University Hospital, Stony Brook, USA
| | - Kinner M Patel
- Pulmonary and Critical Care Medicine, Stony Brook University Hospital, Stony Brook, USA
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23
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Abstract
We report a unique case of ulcerative colitis-associated bronchiectasis in a pediatric patient 6 years after colectomy. The patient presented with a chronic cough and had a computed tomography demonstrating bronchiectasis. She was treated with sputum expectoration (airway clearance) via chest physiotherapy and pulse-dose steroids with a prolonged oral taper. Her initial response was excellent; however, she experienced a recurrence of symptoms with de-escalation of airway clearance. Pulmonary extraintestinal manifestations of inflammatory bowel disease are most often diagnosed later in life. Both the severity of this patient's presentation and her age are unique to this case.
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24
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León-Román FX, Mesonero-Gismero F, Pintado-Cort B, López-Frías López-Jurado A, Maiz-Carro L, Gorospe-Sarasúa L, Mercedes-Noboa E, Asensio-Sánchez J, López-San Román A, Nieto-Royo R. Colitis ulcerosa y bronquiectasias: ¿el tratamiento con tofacitinib podría repercutir en los síntomas respiratorios? Arch Bronconeumol 2020; 56:176-178. [DOI: 10.1016/j.arbres.2019.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 08/06/2019] [Accepted: 08/12/2019] [Indexed: 11/28/2022]
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25
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Kim J, Chun J, Lee C, Han K, Choi S, Lee J, Soh H, Choi K, Park S, Kang EA, Lee HJ, Im JP, Kim JS. Increased risk of idiopathic pulmonary fibrosis in inflammatory bowel disease: A nationwide study. J Gastroenterol Hepatol 2020; 35:249-255. [PMID: 31420894 DOI: 10.1111/jgh.14838] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 07/27/2019] [Accepted: 08/12/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM The relationship between inflammatory bowel disease (IBD) and idiopathic pulmonary fibrosis (IPF) remains unclear. We evaluated the risk for developing IPF in patients with IBD using a nationwide population-based study. METHODS Using claims data from the National Health Insurance service in Korea, patients with IBD, including Crohn's disease (CD) and ulcerative colitis (UC), were identified through both the 10th revision of the International Statistical Classification of Diseases and Related Health Problems and rare and intractable disease program codes from January 2010 to December 2013. We compared 38 921 IBD patients with age-matched and sex-matched individuals without IBD in a ratio of 1:3. Patients with newly diagnosed IPF were identified by both the 10th revision of the International Statistical Classification of Diseases and Related Health Problems and rare and intractable disease registration codes. RESULTS During a mean 4.9-year follow-up, the incidence of IPF in patients with IBD was 33.21 per 100 000 person-years. The overall risk of IPF was significantly higher in IBD patients than in non-IBD controls (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.20-2.20; P = 0.003). In patients with CD, the incidence (per 100 000 person-years) of IPF was 26.04; in controls, the incidence was 9.15 (HR, 2.89; 95% CI, 1.46-5.72; P = 0.002). The incidence of IPF in patients with UC tended to be higher than in controls (36.66 vs 26.54 per 100 000 person-years; 95% CI, 0.99-1.99; HR, 1.41; P = 0.066). The risk of developing IPF in patients with IBD was higher in male patients than in female patients (P = 0.093 in CD; P = 0.147 in UC by interaction analysis). CONCLUSIONS Patients with IBD, especially CD, have an increased risk of developing IPF.
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Affiliation(s)
- Jihye Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Jaeyoung Chun
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Changhyun Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Medical Statistics, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seungho Choi
- Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jooyoung Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Internal Medicine and Healthcare Research Institute, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hosim Soh
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kookhwan Choi
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seona Park
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Ae Kang
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Jung Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong Pil Im
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joo Sung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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26
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Labarca G, Drake L, Horta G, Jantz MA, Mehta HJ, Fernandez-Bussy S, Folch E, Majid A, Picco M. Association between inflammatory bowel disease and chronic obstructive pulmonary disease: a systematic review and meta-analysis. BMC Pulm Med 2019; 19:186. [PMID: 31660921 PMCID: PMC6819559 DOI: 10.1186/s12890-019-0963-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 10/18/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION There is evidence of an association between inflammatory bowel disease (IBD) and lung conditions such as chronic obstructive pulmonary disease (COPD). This systematic review and meta-analysis explored the risk of new onset IBD in patients with COPD and new onset COPD in IBD patients. METHODS We performed a systematic review of observational studies exploring the risk of both associations. Two independent reviewers explored the EMBASE, MEDLINE, LILACS and DOAJ databases, and the risk of bias was evaluated using the ROBBINS-I tool. Data from included studies was pooled in a random effect meta-analysis following a DerSimonian-Laird method. The quality of the evidence was ranked using GRADE criteria. RESULTS Four studies including a pooled population of 1355 new cases were included. We found association between new onset IBD in COPD population. The risk of bias was low in most of them. Only one study reported tobacco exposure as a potential confounding factor. The pooled risk ratio (RR) for a new diagnosis of IBD in COPD patients was 2.02 (CI, 1.56 to 2.63), I2 = 72% (GRADE: low). The subgroup analyses for Crohn's disease and ulcerative colitis yielded RRs of 2.29 (CI, 1.51 to 3.48; I2 = 62%), and 1.79 (CI, 1.39 to 2.29; I2 = 19%.), respectively. DISCUSSION According to our findings, the risk of new onset IBD was higher in populations with COPD compared to the general population without this condition. Based on our analysis, we suggest a potential association between IBD and COPD; however, further research exploring the potential effect of confounding variables, especially cigarette smoking, is still needed. REVIEW REGISTER: (PROSPERO: CRD42018096624).
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Affiliation(s)
- Gonzalo Labarca
- Facultad de Medicina, Universidad San Sebastian, Lientur 1457, 4100000, Concepcion, Chile.
| | - Lauren Drake
- A.T. Still University Kirksville College of Osteopathic Medicine, Kirksville, MO, USA
| | - Gloria Horta
- Division of Gastroenterology, Hospital Regional Grant Benavente, Concepcion, Chile
| | - Michael A Jantz
- Division of Pulmonary and Critical Care Medicine, University of Florida-Gainesville, Gainesville, USA
| | - Hiren J Mehta
- Division of Pulmonary and Critical Care Medicine, University of Florida-Gainesville, Gainesville, USA
| | | | - Erik Folch
- Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, USA
| | - Adnan Majid
- Division of Thoracic surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, USA
| | - Michael Picco
- Division of Gastroenterology, Mayo Clinic Jacksonville, Florida, USA
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27
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Cozzi D, Dini C, Mungai F, Puccini B, Rigacci L, Miele V. Primary pulmonary lymphoma: imaging findings in 30 cases. Radiol Med 2019; 124:1262-1269. [PMID: 31583557 DOI: 10.1007/s11547-019-01091-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/25/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE To present our experience of cases of primary pulmonary lymphoma (PPL) found between January 2002 and July 2018, focusing on the radiological features and the differential diagnosis in order to contribute to the difficult role of the radiologist in the disease identification and to help the clinicians to reach the diagnosis. MATERIALS AND METHODS CT scans of 30 patients (14 men and 16 women, aged 58-86, mean age 72 years) with PPL were retrospectively reviewed. All patients had a histopathological confirmation of the disease: MALT lymphoma (23 patients, 76.6%); diffuse large B-cell lymphoma-DLBCL (seven patients, 23.4%). All the staging CT scans were evaluated by three experienced radiologists dedicated to thoracic disease in order to radiologically define the predominant pattern of presentation. RESULTS The following parenchymal patterns were observed: 11 patients with single/multiple nodules, five with masses/mass-like consolidations, 14 with consolidations with air bronchogram, 16 with ground-glass opacity, ten with angiogram sign, 22 with perilymphatic and/or peribronchovascular spread, 15 with associated lymphadenopathies, and 13 with pleural/chest wall involvement. The main characteristics of PPLs were the presence of consolidations and ground-glass opacities, with perilymphatic and/or bronchovascular spread. CONCLUSION All the characteristics of the work should alert the radiologist to consider lymphoma among the possible differential diagnoses, always correlating the results of the CT examination with appropriate clinical laboratory evaluations.
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Affiliation(s)
- Diletta Cozzi
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50123, Florence, Italy
| | - Catia Dini
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50123, Florence, Italy
| | - Francesco Mungai
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50123, Florence, Italy
| | - Benedetta Puccini
- Haematology Unit - Department of Oncology, University Hospital Careggi, Florence, Italy
| | - Luigi Rigacci
- Haematology Unit and Bone Marrow Transplant Unit, San Camillo Forlanini Hospital, Rome, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, University Hospital Careggi, Largo Brambilla 3, 50123, Florence, Italy.
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28
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Bush A, Floto RA. Pathophysiology, causes and genetics of paediatric and adult bronchiectasis. Respirology 2019; 24:1053-1062. [PMID: 30801930 DOI: 10.1111/resp.13509] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/16/2019] [Indexed: 02/06/2023]
Abstract
Bronchiectasis has historically been considered to be irreversible dilatation of the airways, but with modern imaging techniques it has been proposed that 'irreversible' be dropped from the definition. The upper limit of normal for the ratio of airway to arterial development increases with age, and a developmental perspective is essential. Bronchiectasis (and persistent bacterial bronchitis, PBB) is a descriptive term and not a diagnosis, and should be the start not the end of the patient's diagnostic journey. PBB, characterized by airway infection and neutrophilic inflammation but without significant airway dilatation may be a precursor of bronchiectasis, and there are many commonalities in the microbiology and the pathology, which are reviewed in this article. A high index of suspicion is essential, and a history of chronic wet or productive cough for more than 4-8 weeks should prompt investigation. There are numerous underlying causes of bronchiectasis, although in many cases no cause is found. Causes include post-infectious, especially after tuberculosis, adenoviral or pertussis infection; aspiration syndromes; defects in host defence, which may solely affect the airways (cystic fibrosis, not considered in this review, and primary ciliary dyskinesia); and primary ciliary dyskinesia or be systemic, such as common variable immunodeficiency; genetic syndromes; and anatomical defects such as intraluminal airway obstruction (e.g. foreign body), intramural obstruction (e.g. complete cartilage rings) and external airway compression (e.g. by tuberculous lymph nodes). Identification of the underlying cause is important, because some of these conditions have specific treatments and others genetic implications for the family.
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Affiliation(s)
- Andrew Bush
- Department of Paediatrics, Imperial College, London, UK.,Department of Paediatric Respirology, National Heart and Lung Institute, London, UK.,Royal Brompton Harefield NHS Foundation Trust, London, UK
| | - R Andres Floto
- Department of Respiratory Biology, University of Cambridge, Cambridge, UK.,Cambridge Centre for Lung Infection, Royal Papworth Hospital, Cambridge, UK
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