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He Y, Lu W, Jee YH, Wang Y, Tsuo K, Qian DC, Diao JA, Huang H, Patel CJ, Byun J, Pasaniuc B, Atkinson EG, Amos CI, Moll M, Cho MH, Martin AR. Multi-trait and multi-ancestry genetic analysis of comorbid lung diseases and traits improves genetic discovery and polygenic risk prediction. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.25.24312558. [PMID: 39252935 PMCID: PMC11383478 DOI: 10.1101/2024.08.25.24312558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
While respiratory diseases such as COPD and asthma share many risk factors, most studies investigate them in insolation and in predominantly European ancestry populations. Here, we conducted the most powerful multi-trait and -ancestry genetic analysis of respiratory diseases and auxiliary traits to date. Our approach improves the power of genetic discovery across traits and ancestries, identifying 44 novel loci associated with lung function in individuals of East Asian ancestry. Using these results, we developed PRSxtra (cross TRait and Ancestry), a multi-trait and -ancestry polygenic risk score approach that leverages shared components of heritable risk via pleiotropic effects. PRSxtra significantly improved the prediction of asthma, COPD, and lung cancer compared to trait- and ancestry-matched PRS in a multi-ancestry cohort from the All of Us Research Program, especially in diverse populations. PRSxtra identified individuals in the top decile with over four-fold odds of asthma and COPD compared to the first decile. Our results present a new framework for multi-trait and -ancestry studies of respiratory diseases to improve genetic discovery and polygenic prediction.
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Affiliation(s)
- Yixuan He
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Wenhan Lu
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Yon Ho Jee
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ying Wang
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Kristin Tsuo
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, MA, USA
| | - David C Qian
- Department of Thoracic Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James A Diao
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Hailiang Huang
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Chirag J Patel
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
| | - Jinyoung Byun
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Bogdan Pasaniuc
- Bioinformatics Interdepartmental Program, University of California, Los Angeles, CA, USA
- Department of Human Genetics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Computational Medicine, University of California, Los Angeles
| | - Elizabeth G Atkinson
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Christopher I Amos
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Matthew Moll
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Section on Pulmonary, Critical Care, Sleep and Allergy, Department of Veteran Affairs, Boston Healthcare System, West Roxbury, MA, USA
| | - Michael H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alicia R Martin
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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Cassius De Linval Q, Barat M, Aissaoui M, Talabard MP, Martin C, Malamut G, Canniff E, Soyer P, Revel MP, Chassagnon G. Imaging findings of thoracic manifestations of Crohn's disease and ulcerative colitis. Insights Imaging 2024; 15:197. [PMID: 39112694 PMCID: PMC11306860 DOI: 10.1186/s13244-024-01742-4] [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: 01/30/2024] [Accepted: 06/16/2024] [Indexed: 08/10/2024] Open
Abstract
Thoracic manifestations of inflammatory bowel disease (IBD) are rare, occurring in less than 1% of patients. Unlike most other extra-intestinal manifestations, they predominate in patients with ulcerative colitis rather than in Crohn's disease. In most patients, thoracic involvement follows the onset of IBD by several years. However, thoracic involvement may also occur synchronously or even precede the onset of digestive symptoms. The thoracic manifestations of IBD include airway involvement and parenchymal lung abnormalities. Airways are the most frequent anatomical site for thoracic involvement in IBD. Airway manifestations usually develop several years after the onset of intestinal manifestations, preferentially when the latter are stable or in remission. Airway manifestations include bronchial wall thickening, bronchiectasis, small airway disease, and tracheal wall thickening. Parenchymal lung abnormalities are less prevalent in IBD and include organizing pneumonia, necrobiotic nodules, noncaseating granulomatous nodules, drug-induced pneumonia, and rarely interstitial lung diseases. The differential diagnosis between organizing pneumonia, necrobiotic nodules, and noncaseating granulomatous nodules is difficult and usually requires histopathological analysis for a definite diagnosis. Radiologists play a key role in the detection of thoracic manifestations of Crohn's disease and ulcerative colitis and, therefore, need to be familiar with their imaging findings. This article aims to offer an overview of the imaging findings of thoracic manifestations in patients with Crohn's disease or ulcerative colitis. CRITICAL RELEVANCE STATEMENT: Thoracic manifestations of Crohn's disease and ulcerative colitis include tracheal involvement, bronchiectasis, small airway disease, and parenchymal lung abnormalities such as organizing pneumonia and necrobiotic nodules. These rare manifestations (< 1% of patients) more often affect patients with ulcerative colitis. KEY POINTS: Thoracic manifestations of inflammatory bowel disease are rare, occurring in less than 1% of patients. Thoracic manifestations are more frequent in patients with ulcerative colitis than Crohn's disease. Bronchial disease is the most frequent thoracic manifestation of Crohn's disease and ulcerative colitis.
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Affiliation(s)
- Quentin Cassius De Linval
- Department of Radiology, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Maxime Barat
- Department of Radiology, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
- Université Paris Cité, 85 Boulevard Saint-Germain, 75006, Paris, France
| | - Mathilde Aissaoui
- Department of Radiology, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
- Université Paris Cité, 85 Boulevard Saint-Germain, 75006, Paris, France
| | - Marie-Pauline Talabard
- Department of Radiology, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Clémence Martin
- Université Paris Cité, 85 Boulevard Saint-Germain, 75006, Paris, France
- Respiratory Medicine and Cystic Fibrosis National Reference Center, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Georgia Malamut
- Université Paris Cité, 85 Boulevard Saint-Germain, 75006, Paris, France
- Department of Gastroenterology, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Emma Canniff
- Department of Radiology, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
- Université Paris Cité, 85 Boulevard Saint-Germain, 75006, Paris, France
| | - Philippe Soyer
- Department of Radiology, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
- Université Paris Cité, 85 Boulevard Saint-Germain, 75006, Paris, France
| | - Marie-Pierre Revel
- Department of Radiology, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France
- Université Paris Cité, 85 Boulevard Saint-Germain, 75006, Paris, France
| | - Guillaume Chassagnon
- Department of Radiology, Hôpital Cochin, AP-HP.Centre Université Paris Cité, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France.
- Université Paris Cité, 85 Boulevard Saint-Germain, 75006, Paris, France.
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Beaty W, Katragadda A, Condos R, Dane B, Sarkar S, Shaffer E, Chang S. Pulmonary Crohn's Disease Masquerading as Lymphoma. ACG Case Rep J 2024; 11:e01247. [PMID: 38179265 PMCID: PMC10766257 DOI: 10.14309/crj.0000000000001247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024] Open
Abstract
Although extraintestinal manifestations of inflammatory bowel disease (IBD) are common, pulmonary IBD is extremely rare. Owing to its nonspecific clinical, radiologic, and pathologic features, pulmonary IBD is difficult to diagnose and may mimic more concerning disease processes. We present a rare case of a patient with known Crohn's disease whose initial presentation was highly suspicious for malignancy before further investigation revealed pulmonary IBD.
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Affiliation(s)
- William Beaty
- New York University Grossman School of Medicine, New York, NY
| | - Anila Katragadda
- Kansas City University College of Osteopathic Medicine Kansas City, MO
| | - Rany Condos
- Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Bari Dane
- Department of Radiology, New York University Grossman School of Medicine, New York, NY
| | - Suparna Sarkar
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Emily Shaffer
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Shannon Chang
- Department of Medicine, New York University Grossman School of Medicine, New York, NY
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Nakai S, Morikawa M, Hiramatsu T, Murakami Y, Nishimoto K, Matsushima S, Harada M, Uto T, Sato J, Imokawa S, Suda T. Tracheobronchitis and laryngitis associated with Crohn's disease. Respir Med Case Rep 2023; 46:101918. [PMID: 37822764 PMCID: PMC10562908 DOI: 10.1016/j.rmcr.2023.101918] [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] [Received: 04/16/2023] [Revised: 08/17/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023] Open
Abstract
We report a 68-year-old woman with tracheobronchitis and laryngitis associated with Crohn's disease (CD), which was discovered during the evaluation of suspected lung cancer. She had no symptoms induced by these upper airway diseases (UADs). Bronchoscopy revealed swelling of the epiglottis with edematous change and a mass like epiglottis fold. There were nodular and edematous changes in the trachea and bilateral main bronchus. Histological findings demonstrated infiltration by numerous lymphocytes and plasma cells. Dexamethasone as the premedication for chemotherapy against lung cancer was efficacious for these extraintestinal manifestations of CD. Our case was rare in that bronchial lesion and UADs appeared concomitantly.
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Affiliation(s)
- Shogo Nakai
- Division of Respiratory Medicine, Iwata City Hospital, 512-3, Ookubo, Iwata, Shizuoka, 438-8550, Japan
| | - Moeko Morikawa
- Division of Respiratory Medicine, Iwata City Hospital, 512-3, Ookubo, Iwata, Shizuoka, 438-8550, Japan
| | - Toshiya Hiramatsu
- Division of Respiratory Medicine, Iwata City Hospital, 512-3, Ookubo, Iwata, Shizuoka, 438-8550, Japan
| | - Yurina Murakami
- Division of Respiratory Medicine, Iwata City Hospital, 512-3, Ookubo, Iwata, Shizuoka, 438-8550, Japan
| | - Koji Nishimoto
- Division of Respiratory Medicine, Iwata City Hospital, 512-3, Ookubo, Iwata, Shizuoka, 438-8550, Japan
| | - Sayomi Matsushima
- Division of Respiratory Medicine, Iwata City Hospital, 512-3, Ookubo, Iwata, Shizuoka, 438-8550, Japan
| | - Masanori Harada
- Division of Respiratory Medicine, Iwata City Hospital, 512-3, Ookubo, Iwata, Shizuoka, 438-8550, Japan
| | - Tomohiro Uto
- Division of Respiratory Medicine, Iwata City Hospital, 512-3, Ookubo, Iwata, Shizuoka, 438-8550, Japan
| | - Jun Sato
- Division of Respiratory Medicine, Iwata City Hospital, 512-3, Ookubo, Iwata, Shizuoka, 438-8550, Japan
| | - Shiro Imokawa
- Division of Respiratory Medicine, Iwata City Hospital, 512-3, Ookubo, Iwata, Shizuoka, 438-8550, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1, Handayama, Higashi-ku, Hamamatus, 431-3192, Japan
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5
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Ren K, Yong C, Wang Y, Wei H, Zhao K, He B, Cui M, Chen Y, Wang J. Cytomegalovirus Pneumonia in Inflammatory Bowel Disease: Literature Review and Clinical Recommendations. Infect Drug Resist 2023; 16:6195-6208. [PMID: 37724090 PMCID: PMC10505384 DOI: 10.2147/idr.s420244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/22/2023] [Indexed: 09/20/2023] Open
Abstract
Aim The objective was to elucidate the correlation between CMVP and immunosuppressive therapy in IBD patients, we hope this review could expand on the significance of CMV as an opportunistic pathogen and the potential impact on morbidity and mortality in IBD patients. Methods Records and clinical trajectories linked to CMVP in IBD patients were extracted from the PubMed database, irrespective of language barriers. The reference lists incorporated in these studies were manually inspected. Conclusions were generated using straightforward descriptive analysis. Results In total, 18 IBD patients, including Crohn's disease (CD, 67%) and Ulcerative Colitis (UC, 33%), affected by CMVP were identified from 17 published articles. A minority of these patients (17%) exhibited active disease, whereas the majority (83%) presented with quiescent disease. Fever (100%) and dyspnea (44%) emerged as the most prevalent clinical symptoms. All the patients had undergone immunosuppressive therapy. A significant proportion, up to 89%, had received thiopurine treatment prior to the CMVP diagnosis. Interestingly, none of the patients were subjected to biological therapy. Half of the patients manifested with Hemophagocytic Lymphohistiocytosis (HLH). Almost all patients (94%) were administered antiviral treatment and a substantial 83% experienced full recovery. Immunosuppressive agents were either tapered or discontinued altogether. A subset of patients, 17%, suffered fatal outcomes. Conclusion Our findings underscore the need for heightened suspicion of CMVP in IBD patients who exhibit symptoms such as fever and dyspnea. During the COVID-19 pandemic, CMVP should be considered a potential differential diagnosis. It was observed that CMVP primarily transpires during CD remission. Azathioprine emerged as the predominant immunosuppressant linked to CMV reactivation. The prompt application of effective antiviral therapy can substantially enhance patient outcomes. CMV vaccine might serve as a viable prevention strategy.
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Affiliation(s)
- Keyu Ren
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People’s Republic of China
| | - Chunming Yong
- Department of Emergency, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People’s Republic of China
| | - Yanting Wang
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People’s Republic of China
| | - Hongyun Wei
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People’s Republic of China
| | - Kun Zhao
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People’s Republic of China
| | - Baoguo He
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People’s Republic of China
| | - Mingjuan Cui
- Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People’s Republic of China
| | - Yunqing Chen
- Department of Pathology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People’s Republic of China
| | - Jin Wang
- Department of Pathology, School of Basic Medicine, Qingdao University, Qingdao, Shandong, 266000, People’s Republic of China
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Suzuki A, Noro R, Omori J, Terasaki Y, Tanaka T, Fujita K, Takano N, Sakurai Y, Suga M, Hayashi A, Okamura K, Saito Y, Kasahara K, Iwakiri K, Kubota K, Seike M. Pulmonary manifestation of inflammatory bowel disease: Two case reports. Respir Med Case Rep 2023; 45:101914. [PMID: 37719886 PMCID: PMC10500478 DOI: 10.1016/j.rmcr.2023.101914] [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] [Received: 04/05/2023] [Revised: 08/22/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023] Open
Abstract
Pulmonary involvement associated with inflammatory bowel disease (IBD) are a rare extraintestinal manifestation (EIM) of inflammatory bowel disease (IBD), we herein presented two cases. Case 1: 53-year-old man with Crohn's disease treated with mesalazine and azathioprine. Pulmonary nodular shadows were incidentally detected on chest imaging, and revealed granulomas through transbronchial lung biopsy. Case 2: 68-year-old man with ulcerative colitis treated with mesalazine. He presented with fever and respiratory symptoms, and chest imaging showed multiple nodular infiltrates. He was diagnosed with organizing pneumonia by lung biopsy. Both cases were diagnosed to have pulmonary involvement associated with inflammatory bowel disease (IBD) according to multidisciplinary examination including positron emission tomography-computed tomography (FDG-PET) and pathological test. Pulmonary manifestations with IBD may not always require discontinuation of drugs or additional use of steroids or immunosuppressants.
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Affiliation(s)
- Ayana Suzuki
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Rintaro Noro
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Jun Omori
- Department of Gastroenterology and Hepatology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yasuhiro Terasaki
- Department of Pathology, Nippon Medical School Hospital, Tokyo, Japan
| | - Toru Tanaka
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Kazue Fujita
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Natsuki Takano
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Yumi Sakurai
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Miyuri Suga
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Anna Hayashi
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Ken Okamura
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Yoshinobu Saito
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Kazuo Kasahara
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Katsuhiko Iwakiri
- Department of Gastroenterology and Hepatology, Nippon Medical School Hospital, Tokyo, Japan
| | - Kaoru Kubota
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Masahiro Seike
- Department of Respiratory Medicine, Nippon Medical School Hospital, Tokyo, Japan
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Kisiel MA, Sedvall M, Malinovschi A, Franklin KA, Gislason T, Shlunssen V, Johansson A, Modig L, Jogi R, Holm M, Svanes C, Lindholdt L, Carlson M, Janson C. Inflammatory bowel disease and asthma. Results from the RHINE study. Respir Med 2023:107307. [PMID: 37271300 DOI: 10.1016/j.rmed.2023.107307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Asthma and inflammatory bowel disease (IBD) are common inflammatory diseases. The aim of this study was to investigate the associations of IBD with asthma and respiratory symptoms. METHODS This study is based on 13,499 participants from seven northern European countries that filled in a postal questionnaire on asthma, respiratory symptoms, IBD including ulcerative colitis and Crohn's disease and various lifestyle variables. RESULTS There were 195 participants with IBD. The prevalence of asthma (14.5 vs 8.1%, p = 0.001), different respiratory symptoms (range 11.9-36.8% vs range 6.0-18.6%, p < 0.005), non-infectious rhinitis (52.1 vs. 41.6%, p = 0.004) and chronic rhinosinusitis (11.6 vs 6.0%, p = 0.001) were higher in subjects with IBD than in those without IBD. In multivariable regression analysis, the association between IBD and asthma was statistically significant (OR 1.95 (95% CI 1.28-2.96)) after adjusting for confounders such as sex, BMI, smoking history, educational level and physical activity. There was a significant association between asthma and ulcerative colitis (adjusted OR 2.02 (95% CI 1.27-2.19)), and asthma but not Crohn's disease (adjusted OR 1.66 (95% CI 0.69-3.95)). A significant gender interaction was found with a significant association between IBD and asthma in women but not in men ((OR 2.72 (95% CI 1.67-4.46) vs OR 0.87 (95% CI 0.35-2.19), p = 0.038). CONCLUSIONS Patients with IBD, particularly those with ulcerative colitis and female, have a higher prevalence of asthma and respiratory symptoms. Our findings indicate that it is important to consider respiratory symptoms and disorders when examining patients with manifest or suspected IBD.
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Affiliation(s)
- Marta A Kisiel
- Department of Medical Sciences: Environmental and Occupational Medicine, Uppsala University, Uppsala, Sweden.
| | - Martin Sedvall
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
| | - Karl A Franklin
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Thorarinn Gislason
- The Medical Faculty, University of Iceland, Reykjavik, Iceland; Department of Sleep, Landspitali University Hospital Reykjavik, Reykjavik, Iceland
| | - Vivi Shlunssen
- Dept of Public Health, Danish Ramazzini Centre, Aarhus University and the National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Ane Johansson
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lars Modig
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, Umeå University, Umeå, Sweden
| | - Rain Jogi
- The Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Mathias Holm
- Section of Occupational and Environmental Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Svanes
- Dept of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Louise Lindholdt
- Dept of Public Health, Danish Ramazzini Centre, Aarhus University and the National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Marie Carlson
- Department of Medical Sciences, Gastroenterology Research Group, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
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Vlăsceanu S, Bobocea A, Petreanu CA, Bădărău IA, Moldovan H, Gheorghiță D, Antoniac IV, Mirea L, Diaconu CC, Savu C. Pulmonary Crohn's Disease or Crohn's Disease with Lung Sarcoidosis? A Case Report and Literature Review. Healthcare (Basel) 2022; 10:2267. [PMID: 36421591 PMCID: PMC9690086 DOI: 10.3390/healthcare10112267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Crohn's disease and ulcerative hemorrhagic colitis are forms of granulomatous inflammatory intestinal disease, which usually affects the gastrointestinal tract. There are also reported rare localizations at the skin, kidney, joints, liver and eye level. Pulmonary involvement is relatively rare, and it is most commonly reported in suppuration with bronchiectasis. On the other hand, sarcoidosis is, in principle, a thoracic localization of a granulomatosis disease, although bowel, skin and intestinal disorders are described. There is not a clear line to separate Crohn's disease from sarcoidosis with, possibly because they are, in fact, considered to have the same inflammatory granulomatosis disease pathology. The diagnoses of the two entities, sarcoidosis and Crohn's disease, are based on non-pathognomonic, inclusive clinical and paraclinical criteria, without elements of the mutual exclusion of typical locations. CASE REPORT We present a very rare case of a young male, already diagnosed with small-bowel Crohn's disease. Granulomatous lung disease with major hemoptysis requires emergency surgery. An intraoperative assessment revealed a necrotic hemorrhagic lesion located in the left lower lobe and a lobectomy was performed. The final pathological report showed the presence of non-caseous granulomatous inflammation, with the identification of specific multinucleated giant cells. CONCLUSIONS The identical diagnostic principles of Crohn's disease and sarcoidosis, Crohn's disease as a predecessor to pulmonary lesions, the clinical picture and the necrotico-hemorrhagic appearance of the unilateral pulmonary lesion, which are similar to aggressive necrotico-hemorrhagic or perforating intestinal forms, are arguments in favor of the diagnosis of pulmonary Crohn's disease and not pulmonary sarcoidosis. At the same time, in general, the two diseases have overlapping elements, suggesting they are, in fact, not the same disease with different facets.
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Affiliation(s)
- Silviu Vlăsceanu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Marius Nasta” National Institute of Pneumology, 050159 Bucharest, Romania
| | - Andrei Bobocea
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Marius Nasta” National Institute of Pneumology, 050159 Bucharest, Romania
| | - Cornel Adrian Petreanu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Marius Nasta” National Institute of Pneumology, 050159 Bucharest, Romania
| | - Ioana Anca Bădărău
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Horațiu Moldovan
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
- Academy of Romanian Scientists, 050045 Bucharest, Romania
| | - Daniela Gheorghiță
- Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 060042 Bucharest, Romania
| | - Iulian-Vasile Antoniac
- Academy of Romanian Scientists, 050045 Bucharest, Romania
- Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 060042 Bucharest, Romania
| | - Liliana Mirea
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Anesthesiology and Intensive Care, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania
| | - Camelia Cristina Diaconu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Academy of Romanian Scientists, 050045 Bucharest, Romania
- Department of Internal Medicine, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
| | - Cornel Savu
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Thoracic Surgery, “Marius Nasta” National Institute of Pneumology, 050159 Bucharest, Romania
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9
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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; 23:7287. [PMID: 35806292 PMCID: PMC9266732 DOI: 10.3390/ijms23137287] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [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
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10
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Gomollón F, Gisbert JP, Guerra I, Plaza R, Pajares Villarroya R, Moreno Almazán L, López Martín MC, Domínguez Antonaya M, Vera Mendoza MI, Aparicio J, Martínez V, Tagarro I, Fernández-Nistal A, Lumbreras S, Maté C, Montoto C. Clinical characteristics and prognostic factors for Crohn's disease relapses using natural language processing and machine learning: a pilot study. Eur J Gastroenterol Hepatol 2022; 34:389-397. [PMID: 34882644 PMCID: PMC8876385 DOI: 10.1097/meg.0000000000002317] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The impact of relapses on disease burden in Crohn's disease (CD) warrants searching for predictive factors to anticipate relapses. This requires analysis of large datasets, including elusive free-text annotations from electronic health records. This study aims to describe clinical characteristics and treatment with biologics of CD patients and generate a data-driven predictive model for relapse using natural language processing (NLP) and machine learning (ML). METHODS We performed a multicenter, retrospective study using a previously validated corpus of CD patient data from eight hospitals of the Spanish National Healthcare Network from 1 January 2014 to 31 December 2018 using NLP. Predictive models were created with ML algorithms, namely, logistic regression, decision trees, and random forests. RESULTS CD phenotype, analyzed in 5938 CD patients, was predominantly inflammatory, and tobacco smoking appeared as a risk factor, confirming previous clinical studies. We also documented treatments, treatment switches, and time to discontinuation in biologics-treated CD patients. We found correlations between CD and patient family history of gastrointestinal neoplasms. Our predictive model ranked 25 000 variables for their potential as risk factors for CD relapse. Of highest relative importance were past relapses and patients' age, as well as leukocyte, hemoglobin, and fibrinogen levels. CONCLUSION Through NLP, we identified variables such as smoking as a risk factor and described treatment patterns with biologics in CD patients. CD relapse prediction highlighted the importance of patients' age and some biochemistry values, though it proved highly challenging and merits the assessment of risk factors for relapse in a clinical setting.
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Affiliation(s)
| | - Javier P. Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD)
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11
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Zhang J, Liu MH, Gao X, Dong C, Li YX. Vedolizumab-associated diffuse interstitial lung disease in patients with ulcerative colitis: A case report. World J Clin Cases 2022; 10:1716-1722. [PMID: 35211614 PMCID: PMC8855246 DOI: 10.12998/wjcc.v10.i5.1716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/18/2021] [Accepted: 01/05/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vedolizumab, a newer class of integrin antagonist biological agents, has been applied to treat patients with moderate-to-severe Crohn’s disease (CD) and ulcerative colitis (UC), especially for patients who are refractory to traditional therapies and tumor necrosis factor antagonists. However, some rare but life-threatening adverse effects warrant pharmacovigilance. We describe the first fatal case of vedolizumab-associated severe diffuse interstitial lung disease in China.
CASE SUMMARY We present a case of new-onset diffuse parenchymal lung disease developing under treatment with vedolizumab in a patient with UC. After two doses of vedolizumab, he developed persistent fever and progressively worsening dyspnea. Extensive workups, including bronchoalveolar lavage, transbronchial lung biopsy and metagenomic next-generation sequencing, identified no infectious causes, and other potential causes (such as tumors and cardiogenic pulmonary edema) were also excluded. As a result, a diagnosis of vedolizumab-related interstitial lung disease was established. Unfortunately, although corticosteroids and empiric antibiotics were administered, the patient eventually died of respiratory failure.
CONCLUSION Vedolizumab-related interstitial lung disease in patients with UC is rare but potentially lethal. Gastroenterologists and pulmonologists should be aware of vedolizumab-related adverse drug reactions.
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Affiliation(s)
- Jie Zhang
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Mei-Hong Liu
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Xue Gao
- Department of Pathology, First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Chang Dong
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Yan-Xia Li
- Department of Pulmonary and Critical Care Medicine, First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
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12
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Inborn Errors in the LRR Domain of Nod2 and Their Potential Consequences on the Function of the Receptor. Cells 2021; 10:cells10082031. [PMID: 34440800 PMCID: PMC8392326 DOI: 10.3390/cells10082031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022] Open
Abstract
The innate immune system plays a critical role in the early detection of pathogens, primarily by relying on pattern-recognition receptor (PRR) signaling molecules. Nucleotide-binding oligomerization domain 2 (NOD2) is a cytoplasmic receptor that recognizes invading molecules and danger signals inside the cells. Recent studies highlight the importance of NOD2′s function in maintaining the homeostasis of human body microbiota and innate immune responses, including induction of proinflammatory cytokines, regulation of autophagy, modulation of endoplasmic reticulum (ER) stress, etc. In addition, there is extensive cross-talk between NOD2 and the Toll-like receptors that are so important in the induction and tuning of adaptive immunity. Polymorphisms of NOD2′s encoding gene are associated with several pathological conditions, highlighting NOD2′s functional importance. In this study, we summarize NOD2′s role in cellular signaling pathways and take a look at the possible consequences of common NOD2 polymorphisms on the structure and function of this receptor.
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13
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Wolfe A, Lee TJ, Gillespie CT, Rao S, Walter JM. Tracheitis as the Initial Presentation of Crohn's Disease. Am J Respir Crit Care Med 2021; 203:e9-e10. [PMID: 33096005 DOI: 10.1164/rccm.202002-0244im] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Alexis Wolfe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Thomas J Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, and
| | - Colin T Gillespie
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
| | - Sambasiva Rao
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - James M Walter
- Division of Pulmonary and Critical Care Medicine, Department of Medicine
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14
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Abu Shtaya A, Cohen S, Kogan Y, Shteinberg M, Sagool O. Crohn's Disease with Atypical Extra-Intestinal Manifestations Developing Under Treatment with Vedolizumab. Eur J Case Rep Intern Med 2021; 8:002265. [PMID: 33768073 DOI: 10.12890/2021_002265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 01/20/2021] [Indexed: 11/05/2022] Open
Abstract
Crohn's disease is a chronic inflammatory bowel disease that can affect any part of the GI tract, which is frequently associated with extra-intestinal manifestations. Pulmonary parenchymal disease is very uncommon and usually considered to be debilitating and harder to diagnose. Pulmonary granulomas are rarely described in the literature as a complication of Crohn's disease. Here, we present a patient with Crohn's disease exacerbation who developed granulomatous lung disease under treatment with vedolizumab. Our case may add evidence to the emerging theory that gut-selective biologic agents could lead to upregulation of some pro-inflammatory factors leading to the evolution of pulmonary disease. LEARNING POINTS Pulmonary parenchymal diseases are rare in Crohn's disease but they can be debilitating and life-threatening as they are usually tardily diagnosed; awareness of this association is of high value and could potentially shorten the time to a definite diagnosis.Pulmonary manifestations of Crohn's disease could be subclinical without any respiratory complaints and not diagnosed with conventional imaging modalities such as chest x-ray.Gut-selective biologic agents could lead to the emergence of extra-intestinal manifestations due to upregulation of multiple pro-inflammatory cytokines.
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Affiliation(s)
- Aasem Abu Shtaya
- Department of Internal Medicine "B", Lady Davis Carmel Medical Center, Haifa, Israel.,Technion - Israel Institute of Technology, The B. Rappaport Faculty of Medicine, Haifa, Israel
| | - Shai Cohen
- Department of Internal Medicine "B", Lady Davis Carmel Medical Center, Haifa, Israel.,Technion - Israel Institute of Technology, The B. Rappaport Faculty of Medicine, Haifa, Israel
| | - Yana Kogan
- Technion - Israel Institute of Technology, The B. Rappaport Faculty of Medicine, Haifa, Israel.,Pulmonology Institute and CF center, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Michal Shteinberg
- Technion - Israel Institute of Technology, The B. Rappaport Faculty of Medicine, Haifa, Israel.,Pulmonology Institute and CF center, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Ori Sagool
- Technion - Israel Institute of Technology, The B. Rappaport Faculty of Medicine, Haifa, Israel.,Department of Gastroenterology, Lady Davis Carmel Medical Center, Haifa, Israel
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15
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Clofent D, Álvarez A, Traversi L, Culebras M, Loor K, Polverino E. Comorbidities and mortality risk factors for patients with bronchiectasis. Expert Rev Respir Med 2021; 15:623-634. [PMID: 33583300 DOI: 10.1080/17476348.2021.1886084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Comorbidities in patients with bronchiectasis are common and have a significant impact on clinical outcomes, contributing to lower quality of life, lung function, and exacerbation frequency. At least 13 comorbidities have been associated with a higher risk of mortality in bronchiectasis patients. Nonetheless, the kind of relationship between bronchiectasis and comorbidities is heterogeneous and poorly understood.Areas covered: different biological mechanisms leading to bronchiectasis could have a role in the development of the associated comorbidities. Some comorbidities could have a causal relationship with bronchiectasis, possibly through a variable degree of systemic inflammation, such as in rheumatic disorders and bowel inflammatory diseases. Other comorbidities, such as COPD or asthma, could be associated through airway inflammation and there is an uncertain cause-effect relationship. Finally, shared risk factors could link different comorbidities to bronchiectasis such as in the case of cardiovascular diseases, where the known link between chronic systemic inflammation and pulmonary infection could play a significant role.Expert opinion: Although different tools have been developed to assess the role of comorbidities in bronchiectasis , we believe that the implementation of current strategies to manage them is absolutely necessary and could significantly improve long-term prognosis in patients with bronchiectasis.
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Affiliation(s)
- David Clofent
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Antonio Álvarez
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Letizia Traversi
- Department of Medicine and Surgery, Respiratory Diseases, Università dell'Insubria, Varese, Italy
| | - Mario Culebras
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Karina Loor
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Eva Polverino
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
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16
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Zabrowski D, Abraham D, Rosenthal G, Kader H. Development of peripheral eosinophilia in inflammatory bowel disease patients on infliximab treated at a tertiary pediatric inflammatory bowel disease center is associated with clinically active disease but does not result in loss of efficacy or adverse outcomes. JGH OPEN 2020; 4:636-641. [PMID: 32782950 PMCID: PMC7411706 DOI: 10.1002/jgh3.12308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/11/2020] [Accepted: 01/23/2020] [Indexed: 11/17/2022]
Abstract
Introduction Inflammatory bowel disease (IBD) consisting of Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory conditions affecting the gastrointestinal tract. Infliximab (IFX) is a chimeric anti‐tumor necrosis factor antibody used to treat moderate to severe IBD. Eosinophils are commonly found in chronically inflamed tissues in IBD. Peripheral eosinophilia (PE) was previously implicated as a marker of disease severity at diagnosis. The main aim of this study was to investigate whether in IBD patients on IFX, development of PE is associated with adverse outcomes and poor IFX efficacy. Methods A comprehensive retrospective chart review of IBD patients on IFX (January 2006 to July 2015) treated at a tertiary pediatric IBD center was performed. Data was collected at time specified points over a 24 month period and included demographics, atopy, disease severity, development of PE, human antichimeric antibodies (HACA), infusion reactions, cancer, psoriasis, and loss of clinical response. Results One hundred twenty‐one IBD patients starting IFX (67 male), mean age of 12.4 years (range 4–22 years old), met inclusion criteria. Of them, 36.3% had ≥1 PE episode (CD: 25 male, 11 female; UC: 6 male, 2 female). Mean absolute eosinophil count (AEC) did not change over time. PE was associated with clinically active disease. Among patients who developed PE, adverse outcomes were not significantly different versus those who did not have PE. Conclusions In a cohort of primarily pediatric IBD patients on IFX, PE was associated with clinically active disease; however, PE was not related to increased incidence of adverse outcomes or loss of drug efficacy.
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Affiliation(s)
- Douglas Zabrowski
- Department of Pediatrics, Division of Pediatric Gastroenterology/Nutrition University of Maryland School of Medicine Baltimore Maryland USA
| | - Danielle Abraham
- Department of Epidemiology and Public Health University of Maryland School of Medicine Baltimore Maryland USA
| | - Geoffrey Rosenthal
- Department of Epidemiology and Public Health University of Maryland School of Medicine Baltimore Maryland USA.,Department of Pediatrics, Division of Cardiology University of Maryland School of Medicine Baltimore Maryland USA
| | - Howard Kader
- Department of Pediatrics, Division of Pediatric Gastroenterology/Nutrition University of Maryland School of Medicine Baltimore Maryland USA
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17
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Kaur G, Olayinka O, Chacho MS, El-Fanek H, Vidhun R. Pulmonary Symptoms as the First Manifestation of Crohn's Disease. Cureus 2020; 12:e9379. [PMID: 32850247 PMCID: PMC7445386 DOI: 10.7759/cureus.9379] [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] [Indexed: 11/05/2022] Open
Abstract
Crohn's disease is a granulomatous systemic illness with extra-intestinal manifestations. Of these extra-intestinal manifestations, lung involvement (0.4%) is the rare manifestation. Bronchopulmonary signs and symptoms are underrecognized, so suspicion should be high when granulomas are seen in lung biopsies. We report the case of a 27-year-old female who presented with bilateral pleuritic chest pain and shortness of breath. Chest X-ray showed left lung masses measuring up to 3.3 cm in the greatest dimension with right mid lung nodular opacity. Given the possibility of metastatic disease, positron emission tomography CT (PET-CT) scan was done, which showed activity in multiple liver lesions and multiple bilateral lung nodules. Both liver and lung biopsies were done, which showed multiple necrotizing and non-necrotizing granulomas. The patient was discharged home on antibiotics and antifungals. Few months later, she presented with loose stools and abdominal pain. CT scan of the abdomen and pelvis showed diffuse colonic wall thickening concerning for colitis. Colonoscopy showed ulcerated mucosa involving multiple parts of the colon. Biopsy of the colon showed mild to moderate acute colitis with submucosal non-necrotizing epithelioid granulomas, consistent with Crohn's disease.
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18
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Eliadou E, Moleiro J, Ribaldone DG, Astegiano M, Rothfuss K, Taxonera C, Ghalim F, Carbonnel F, Verstockt B, Festa S, Maia L, Berrozpe A, Zagorowicz E, Savarino E, Ellul P, Vavricka SR, Calvo M, Koutroubakis I, Hoentjen F, Salazar LF, Callela F, Cañete Pizarro F, Soufleris K, Sonnenberg E, Cavicchi M, Wypych J, Hommel C, Ghiani A, Fiorino G. Interstitial and Granulomatous Lung Disease in Inflammatory Bowel Disease Patients. J Crohns Colitis 2020; 14:480-489. [PMID: 31602473 DOI: 10.1093/ecco-jcc/jjz165] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Interstitial lung [ILD] disease and granulomatous lung disease [GLD] are rare respiratory disorders that have been associated with inflammatory bowel disease [IBD]. Clinical presentation is polymorphic and aetiology is unclear. METHODS This was an ECCO-CONFER project. Cases of concomitant ILD or GLD and IBD, or drug-induced ILD/GLD, were collected. The criteria for diagnosing ILD and GLD were based on definitions from the American Thoracic Society and the European Respiratory Society and on the discretion of reporting clinician. RESULTS We identified 31 patients with ILD. The majority had ulcerative colitis [UC] [n = 22]. Drug-related ILD was found in 64% of these patients, 25 patients [80.6%] required hospitalisation, and one required non-invasive ventilation. The causative drug was stopped in all drug-related ILD, and 87% of patients received systemic steroids. At follow-up, 16% of patients had no respiratory symptoms, 16% had partial improvement, 55% had ongoing symptoms, and there were no data in 13%. One patient was referred for lung transplantation, and one death from lung fibrosis was reported. We also identified 22 GLD patients: most had Crohn's disease [CD] [n = 17]. Drug-related GLD was found in 36% of patients and 10 patients [45.4%] required hospitalisation. The causative drug was stopped in all drug-related GLD, and 81% of patients received systemic steroids. Remission of both conditions was achieved in almost all patients. CONCLUSIONS ILD and GLD, although rare, can cause significant morbidity. In our series, over half of cases were drug-related and therefore focused pharmacovigilance is needed to identify and manage these cases.
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Affiliation(s)
- Elena Eliadou
- Gastroenterology Department, Manchester Royal Infirmary, Manchester UK
| | - Joana Moleiro
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | | | - Marco Astegiano
- Gastroenterologia-U, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Katja Rothfuss
- Robert-Bosch Hospital, Department of Gastroenterology, Hepatology and Endocrinology, Stuttgart, Germany
| | - Carlos Taxonera
- Department of Gastroenterology, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain
| | - Fahd Ghalim
- Gastroenterology Department, Kremlin Bicêtre Hospital, University Paris Sud, Paris, France
| | - Franck Carbonnel
- Gastroenterology Department, Kremlin Bicêtre Hospital, University Paris Sud, Paris, France
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, and Department of CHROMETA, KU Leuven, Leuven, Belgium
| | - Stefano Festa
- Ospedale San Filippo Neri, UOS Malattie Infiammatorie Croniche Intestinali Porto, Portugal
| | - Luís Maia
- Gastroenterology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - Ana Berrozpe
- IBD Unit, Bellvitge's Hospital, Barcelona, SpainWarsaw, Poland
| | - Edyta Zagorowicz
- Maria Sklodowska Curie Memorial Cancer Centre and Institute of Oncology, Department of Gastroenterology,Warsaw, Poland
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology,University of Padua, Padua, Italy
| | - Pierre Ellul
- Division of Gastroenterology, Mater Dei Hospital, Valleta, Malta
| | - Stephan R Vavricka
- Department of Gastroenterology and Hepatology, Center for Gastroenterology and Hepatology, Zurich, Switzerland
| | - Marta Calvo
- Gastroenterology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Frank Hoentjen
- Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Francesca Callela
- UOC Gastroenterologia, Ospedale San Giuseppe, Empoli, Firenze, Italy
| | | | - Konstantinos Soufleris
- Department of Gastroenterology, Theagenion Cancer Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - Maryan Cavicchi
- Department of Gatroenterology, Clinique de Bercy, Creteil, France
| | - Joanna Wypych
- Surgery & Gastroenterology Department, Copernicus Hospital, Gdansk, Poland
| | - Christophe Hommel
- Department of Gastroenterology and Hepatology, CHU UCL Namur, Yvoir, Belgium,Catholic University of Louvain, Brussels, Belgium
| | - Alessandro Ghiani
- Schillerhoehe Lung Clinic [Robert-Bosch-Hospital], Department of Pneumology and Respiratory Medicine, Gerlingen, Germany
| | - Gionata Fiorino
- Humanitas Clinical and Research Center, Gastroenterology Department, Rozzano, Milan, Italy.,Humanitas University, Department of Biomedical Sciences, Rozzano, Milan, Italy
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19
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Álvarez Troncoso J, Ramos Ruperto L, Robles Marhuenda Á. Enfermedad de Crohn con afectación pulmonar grave. Arch Bronconeumol 2020; 56:324. [DOI: 10.1016/j.arbres.2019.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 04/04/2019] [Accepted: 04/23/2019] [Indexed: 02/07/2023]
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20
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Ahmed U, Kayode O, Ahmed F, Shinkar M, Murphy CF. Lung parenchymal manifestation of Crohn's disease. Br J Hosp Med (Lond) 2019; 80:iii. [PMID: 31059326 DOI: 10.12968/hmed.2019.80.5.iii] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Usama Ahmed
- Core Surgical Trainee, Department of Ear Nose and Throat Surgery, Colchester General Hospital, Colchester, Essex CO4 5JL
| | - Oyindamola Kayode
- Core Medical Trainee, Department of Respiratory Medicine, Colchester General Hospital, Colchester, Essex
| | - Faheem Ahmed
- Foundation Year 2 Doctor, King's College London, London
| | - Madhuri Shinkar
- Consultant Histopathologist, Department of Pathology, Colchester General Hospital, Colchester, Essex
| | - Colm F Murphy
- Consultant Radiologist, Department of Radiology, Colchester General Hospital, Colchester, Essex
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Maglione M, Aksamit T, Santamaria F. Paediatric and adult bronchiectasis: Specific management with coexisting asthma, COPD, rheumatological disease and inflammatory bowel disease. Respirology 2019; 24:1063-1072. [PMID: 31222879 DOI: 10.1111/resp.13615] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 05/18/2019] [Accepted: 05/21/2019] [Indexed: 12/18/2022]
Abstract
Bronchiectasis, conventionally defined as irreversible dilatation of the bronchial tree, is generally suspected on a clinical basis and confirmed by means of chest high-resolution computed tomography. Clinical manifestations, including chronic productive cough and endobronchial suppuration with persistent chest infection and inflammation, may deeply affect quality of life, both in children/adolescents and adults. Despite many cases being idiopathic or post-infectious, a number of specific aetiologies have been traditionally associated with bronchiectasis, such as cystic fibrosis (CF), primary ciliary dyskinesia or immunodeficiencies. Nevertheless, bronchiectasis may also develop in patients with bronchial asthma; chronic obstructive pulmonary disease; and, less commonly, rheumatological disorders and inflammatory bowel diseases. Available literature on the development of bronchiectasis in these conditions and on its management is limited, particularly in children. However, bronchiectasis may complicate the clinical course of the underlying condition at any age, and appropriate management requires an integration of multiple skills in a team of complementary experts to provide the most appropriate care to affected children and adolescents. The present review aims at summarizing the current knowledge and available evidence on the management of bronchiectasis in the other conditions mentioned and focuses on the new therapeutic strategies that are emerging as promising tools for improving patients' quality of life.
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Affiliation(s)
- Marco Maglione
- Department of Translational Medical Sciences, Section of Paediatrics, Federico II University, Naples, Italy
| | - Timothy Aksamit
- Pulmonary Disease and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Section of Paediatrics, Federico II University, Naples, Italy
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Athayde RABD, Costa FMD, Nascimento ECTD, Sales RKBD, Costa AN. Pulmonary involvement in Crohn's disease. ACTA ACUST UNITED AC 2019; 44:519-521. [PMID: 30726329 PMCID: PMC6459741 DOI: 10.1590/s1806-37562018000000055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Rodolfo Augusto Bacelar de Athayde
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Felipe Marques da Costa
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | | | - Roberta Karla Barbosa de Sales
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
| | - Andre Nathan Costa
- . Divisão de Pneumologia, Instituto do Coração - InCor - Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP) Brasil
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23
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Farkas ZC, Keshishyan S, Chakinala RC, Frager S, Saeed F, Yusuf Y, Shilagani C, Bodin R, Harris K, Aronow WS. Tracheobronchitis with stridor in a patient with ulcerative colitis. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:445. [PMID: 30596075 DOI: 10.21037/atm.2018.10.47] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Bronchopulmonary involvement is a rare but well documented extraintestinal manifestation of inflammatory bowel disease (IBD). IBD-related pulmonary disease can range from subglottic stenosis to tracheobronchitis to interstitial lung disease and is often misdiagnosed on initial presentation. We present a case of tracheobronchitis with stridor in a 23-year-old-woman with well controlled ulcerative colitis (UC).
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Affiliation(s)
- Zahava C Farkas
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Sevak Keshishyan
- Division of Pulmonary and Critical Care, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Raja Chandra Chakinala
- Department of Medicine, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Shalom Frager
- Division of Gastroenterology and Hepatobiliary Diseases, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Faisal Saeed
- Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Yasmin Yusuf
- Department of Pathology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Chaitanya Shilagani
- Department of Radiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Roxana Bodin
- Division of Gastroenterology and Hepatobiliary Diseases, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Kassem Harris
- Division of Pulmonary and Critical Care, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Wilbert S Aronow
- Division of Pulmonary and Critical Care, Westchester Medical Center and New York Medical College, Valhalla, NY, USA.,Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
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Moeser A, Lerche M, Wirtz H, Stallmach A. [Aspects of pulmonary involvement in inflammatory bowel disease]. Internist (Berl) 2018; 59:876-885. [PMID: 30116854 DOI: 10.1007/s00108-018-0473-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The incidence of pulmonary manifestations of inflammatory bowel disease (IBD) appears to be much higher than previously assumed. In prospective studies, subclinical pulmonary interstitial infiltrates or pathological lung function were found in 40%-60% of IBD patients, both in children and adults. Pulmonary disorders can affect any part of the respiratory system, the most frequent pattern being inflammation of the large airways often associated with bronchiectasis. The differential diagnosis should include drug-related pulmonary disease and infectious causes when receiving immunosuppressive therapy. The diagnostic approach consists of a thorough history and clinical status as well as lung function tests including body plethysmography and high-resolution computed tomography of the thorax. Bronchoscopy with broncheoalveolar lavage and sample collection for histology as well as exclusion of pulmonary embolism may be indicated. Pulmonary disease in association with IBD can develop at any time during the course of IBD: in rare cases, symptoms can evolve even before gastrointestinal symptoms appear. On the other hand, there are frequent reports on the occurrence of pulmonary inflammation after proctocolectomy in patients with ulcerative colitis. The pathophysiologic background is largely unknown, but there seems to be an interaction between gastrointestinal and pulmonary inflammation. The mainstay of therapy are inhaled or systemic corticosteroids. Most patterns of pulmonary involvement in IBD respond well to corticosteroid therapy. Rarely, serious and persisting complications occur, such as strictures or stenosis of the large airways.
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Affiliation(s)
- A Moeser
- Institut für Infektionsmedizin und Krankenhaushygiene, Klinik für Innere Medizin/FB Pneumologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - M Lerche
- Abteilung für Pneumologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - H Wirtz
- Abteilung für Pneumologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - A Stallmach
- Klinik für Innere Medizin IV, Universitätsklinikum Jena, Am Klinikum 1, Jena, Deutschland
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25
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Mora Carpio AL, Stempel JM, de Lima Corvino D, Garvia V, Climaco A. Granulomatous response to invasive pulmonary aspergillosis in an immunotherapy-naive host, a maladaptive response? Respir Med Case Rep 2018; 24:158-162. [PMID: 29977786 PMCID: PMC6010647 DOI: 10.1016/j.rmcr.2018.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/13/2018] [Accepted: 05/13/2018] [Indexed: 11/29/2022] Open
Abstract
Pulmonary aspergillosis causes a wide spectrum of disease, ranging from asymptomatic airway colonization to severe invasive disease, contingent on the host's immune status and underlying pulmonary anatomy. The invasive form of aspergillosis is a rare occurrence in the immunocompetent population. Nevertheless, patients with a compromised innate immune response are at greatest risk. We present a case of a patient with known Crohn's disease who developed invasive pulmonary aspergillosis. His clinical picture was further complicated by an uncommon immune response characterized by the development of granulomas encasing the Aspergillus forms found on his lung biopsy, likely representing a maladaptive response, possibly related to the effects of his granulomatous disease in the lungs. He was successfully treated with antifungal therapy and video assisted thoracoscopic surgery with placement of thoracostomy tube drainage for a parapneumonic effusion. We will discuss the factors leading to his atypical presentation and clinical outcome.
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Affiliation(s)
- Andres L. Mora Carpio
- Internal Medicine Department, Einstein Medical Center, 5501 Old York Road, Klein Building, Suite 363, Philadelphia PA 19141, USA
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Shin D, Park BK, Seo J, Won SY, Lee MK, Hong YK, Cho YS. Pulmonary Extraintestinal Manifestation of Crohn's Disease Treated Successfully with Adalimumab. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 72:141-145. [DOI: 10.4166/kjg.2018.72.3.141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Dongyeol Shin
- Division of Gastroenterology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Byung Kyu Park
- Division of Gastroenterology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jeonghun Seo
- Division of Gastroenterology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sun Young Won
- Division of Gastroenterology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Mi Kyoung Lee
- Department of Pathology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yong Kook Hong
- Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yong Suk Cho
- Division of Gastroenterology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Inoue K, Kusunoki T, Fujii T. Organizing pneumonia as an extraintestinal manifestation of Crohn's disease in a child. Pediatr Pulmonol 2017; 52:E64-E66. [PMID: 28493298 DOI: 10.1002/ppul.23717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/04/2017] [Indexed: 11/07/2022]
Abstract
Crohn's disease (CD) is a chronic inflammatory disorder with an unknown etiology that commonly involves the gastrointestinal tract, and bronchopulmonary manifestations only occur in 0.4% of cases. There have not been any reports about pulmonary involvement in pediatric CD patients. We experienced a 14-year-old boy with Crohn's disease diagnosed with organizing pneumonia by chest CT-guided biopsy examination. His pneumonia was intractable despite the administration of multiple antibiotics, and steroid therapy was very effective. In pediatric patients with CD whose lung disease does not respond to antibiotics, OP should be considered as a possible diagnosis.
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Affiliation(s)
- Kenji Inoue
- Shiga Medical Center for Children, Moriyama, Shiga, Japan
| | | | - Tatsuya Fujii
- Shiga Medical Center for Children, Moriyama, Shiga, Japan
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29
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Chew MT, Chak E, Matsukuma K. A Rare Cause of Pulmonary Nodules. Case Rep Gastroenterol 2016; 10:633-639. [PMID: 27920654 PMCID: PMC5121564 DOI: 10.1159/000452198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/03/2016] [Indexed: 01/23/2023] Open
Abstract
Crohn's disease is a chronic, idiopathic autoimmune disorder that primarily targets the gastrointestinal (GI) system. It is characterized by transmural inflammation of the GI tract that can occur anywhere from the mouth to the anus. Not infrequently, the disease may also have extraintestinal manifestations (EIMs) that can affect almost any organ system. It is estimated that EIMs affect up to 36% of patients with Crohn's disease, but the incidence and prevalence of pulmonary involvement are variable in the literature and may be as low as 0.4%. There are few case reports documenting pulmonary manifestations, as they are often overlooked, especially if respiratory symptoms are present before the diagnosis of GI manifestations, as in the present case. A 44-year-old otherwise healthy woman presented with nonspecific respiratory complaints, recurrent pneumonias, and multiple computed tomography images showing diffuse, migratory, nodular, and consolidative parenchymal lung disease, with a largely unremarkable infectious and rheumatologic evaluation. Lung biopsy revealed necrotizing and nonnecrotizing granulomas, raising concern for sarcoidosis. Subsequent imaging revealed an incidental mass in the cecum. Biopsy of the cecum lesion revealed acute cryptitis, crypt abscess, and a single poorly formed granuloma, suggesting the possibility of Crohn's disease. In this report, we present a patient whose pulmonary manifestations ultimately led to the diagnosis of Crohn's disease.
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Affiliation(s)
- Michael Tsuyoshi Chew
- Department of Internal Medicine, University of California at Davis, Sacramento, CA, USA
| | - Eric Chak
- Department of Gastroenterology, University of California at Davis, Sacramento, CA, USA
| | - Karen Matsukuma
- Department of Pathology and Laboratory Medicine, University of California at Davis, Sacramento, CA, USA
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30
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Cushing K, Kanuri N, Ciorba M. Pneumococcal Disease in Inflammatory Bowel Disease: Justification to Vaccinate at Diagnosis. Gastroenterology 2016; 151:365-6. [PMID: 27375193 PMCID: PMC5438198 DOI: 10.1053/j.gastro.2016.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Kelly Cushing
- Washington University, Department of Gastroenterology, 660 South Euclid Ave, St. Louis, MO 63110. Support provided by the T32DK007130 grant
| | - Navya Kanuri
- Washington University, Department of Gastroenterology, 660 South Euclid Ave, St. Louis, MO 63110
| | - Matthew Ciorba
- Washington University, Department of Gastroenterology, 660 South Euclid Ave, St. Louis, MO 63110
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31
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Raymond SB, Gee MS, Anupindi SA, Shailam R, Kaplan JL, Nimkin K. CT and MRI of Rare Extraintestinal Manifestations of Inflammatory Bowel Disease in Children and Adolescents. J Pediatr Gastroenterol Nutr 2016; 63:e1-9. [PMID: 27050046 DOI: 10.1097/mpg.0000000000001225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Inflammatory bowel disease (IBD) is associated with a spectrum of extraintestinal manifestations (EIMs) affecting many organ systems. EIMs can occur in more than 40% of patients with IBD and are associated with significant morbidity. They occur at any time point in the course of disease, often during an active phase of bowel inflammation, but sometimes preceding bowel disease. Prompt recognition of EIMs enables timely and more effective therapy. Physicians who image patients with IBD should be aware of the myriad extraintestinal conditions that may be detected on imaging studies, both within and outside of the abdomen, as they may predate the diagnosis of IBD. Cross-sectional imaging of unusual conditions associated with IBD will be presented, including pathology in the hepatobiliary, pancreatic, genitourinary, musculoskeletal, mucocutaneous, vascular, neurologic, and pulmonary systems.
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Affiliation(s)
- Scott B Raymond
- *Department of Radiology†Department of Radiology, Division of Pediatric Radiology, Massachusetts General Hospital, Boston, MA‡Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA§Department of Pediatrics, Division of Pediatric Gastroenterology, MassGeneral Hospital for Children, Boston, MA
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32
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Ongun EA, Artan R, Bingol A, Dursun O. A rare aspect of Crohn's disease: Pulmonary involvement in a child. Indian J Crit Care Med 2016; 20:114-6. [PMID: 27076713 PMCID: PMC4810924 DOI: 10.4103/0972-5229.175941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Crohn's disease (CD), known as the disease of gastrointestinal system, is a granulamatous systemic disorder with extraintestinal manifestations including the respiratory system. The resemblance in the embriological origins and the immunities of both organ systems' mucosae, also the circulating immune complexes and the autoantibodies are accepted as contributing factors. The shift of inflammation may become prominent when the colon is removed after colectomy and independent of the bowel disease activity; pulmonary involvement may be exarbecated. In the pediatric population, CD associated pulmonary involvement is very rare, mainly in the form of subclinical alterations and the data are limited mostly to case reports. Therefore, it is possibly overlooked since the diagnosis relies on suspicion. We represent a 5-year-old CD patient with previous bronchiolitis episodes that might have resulted from CD-associated pulmonary involvement; whom later developed severe pneumonia resulting in acute respiratory distress syndrome and bronchiectasia following a colectomy operation.
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Affiliation(s)
- Ebru Atike Ongun
- Department of Pediatrics, Division of Pediatric Critical Care, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Reha Artan
- Department of Pediatrics, Division of Pediatric Gastroenterology, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Aysen Bingol
- Department of Pediatrics, Division of Pediatric Pulmonology, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Oguz Dursun
- Department of Pediatrics, Division of Pediatric Critical Care, School of Medicine, Akdeniz University, Antalya, Turkey
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Patients with Active Luminal Crohn's Disease Have Evidence of Significant Functional and Clinical Pulmonary Involvement. Inflamm Bowel Dis 2015; 21:1817-24. [PMID: 26086595 DOI: 10.1097/mib.0000000000000442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pulmonary involvement is a recognized extraintestinal complication of inflammatory bowel disease and is associated with airway inflammation. Changes in pulmonary function were previously described as being subclinical. The purpose of this study was to compare pulmonary findings in a large case series of patients with active and quiescent Crohn's disease (CD). METHODS CD patients, prospectively enrolled between May 2011 and May 2012, completed a demographic questionnaire and Harvey-Bradshaw Index to define disease activity. Each patient also completed blood work, a chest x-ray, pulmonary function testing, respiratory symptom and dyspnea scoring, and a 6-minute walk test. Results are reported as mean ± SE or descriptively as a percent and were analyzed using t tests and chi-square or Fisher's exact tests, respectively. Multivariable linear regression models were built for continuous outcomes and logistic regression models for categorical outcomes. RESULTS Ninety-five patients (54 remission, 41 active disease), 58.9% males, with a mean age of 41 ± 1 years were enrolled. Patients with active disease compared with those in remission had lower absolute ratios of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) (0.74 ± 0.01 versus 0.77 ± 0.01, P = 0.023), higher degrees of peripheral airway obstruction (34.1% versus 16.7%, P = 0.049), more frequent respiratory symptoms (29.3% versus 9.3%, P = 0.012) and higher Medical Research Council (MRC) dyspnea scales (MRC 2 or 3, 58.5% versus 22.2%, P = 0.001), respectively. CONCLUSIONS CD patients with active disease display clinical pulmonary dysfunction compared with those in remission.
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Affiliation(s)
- Stephen A Geller
- Department of Pathology and Laboratory Medicine - David Geffen School of Medicine - University of California, Los Angeles/CA - USA . ; Department of Pathology and Laboratory Medicine - Weill Cornell Medical College, New York/NY - USA
| | - Fernando P F de Campos
- Internal Medicine Division - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
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35
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Tontini GE, Vecchi M, Pastorelli L, Neurath MF, Neumann H. Differential diagnosis in inflammatory bowel disease colitis: State of the art and future perspectives. World J Gastroenterol 2015; 21:21-46. [PMID: 25574078 PMCID: PMC4284336 DOI: 10.3748/wjg.v21.i1.21] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 07/31/2014] [Accepted: 09/16/2014] [Indexed: 02/06/2023] Open
Abstract
Distinction between Crohn’s disease of the colon-rectum and ulcerative colitis or inflammatory bowel disease (IBD) type unclassified can be of pivotal importance for a tailored clinical management, as each entity often involves specific therapeutic strategies and prognosis. Nonetheless, no gold standard is available and the uncertainty of diagnosis may frequently lead to misclassification or repeated examinations. Hence, we have performed a literature search to address the problem of differential diagnosis in IBD colitis, revised current and emerging diagnostic tools and refined disease classification strategies. Nowadays, the differential diagnosis is an untangled issue, and the proper diagnosis cannot be reached in up to 10% of patients presenting with IBD colitis. This topic is receiving emerging attention, as medical therapies, surgical approaches and leading prognostic outcomes require more and more disease-specific strategies in IBD patients. The optimization of standard diagnostic approaches based on clinical features, biomarkers, radiology, endoscopy and histopathology appears to provide only marginal benefits. Conversely, emerging diagnostic techniques in the field of gastrointestinal endoscopy, molecular pathology, genetics, epigenetics, metabolomics and proteomics have already shown promising results. Novel advanced endoscopic imaging techniques and biomarkers can shed new light for the differential diagnosis of IBD, better reflecting diverse disease behaviors based on specific pathogenic pathways.
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