If you have a diagnosis of inflammatory bowel disease, then you should also get evaluated for lung function, according to a recent article in the World Journal of Gastroenterology (Reference 1). This evaluation should include physical examination, chest X-ray, and pulmonary function testing including diffusion capacity of the lungs (DLCO).
Ulcerative colitis and Crohn's disease are the two major forms of inflammatory bowel disease (IBD). In a variety of studies, 25 to 41.5 percent of IBD patients have complications outside the intestines. Over 100 have been described, involving almost every organ system in the body. Lung disorders are of particular importance. The epithelial tissues of the colon and lungs have similarities that may allow the same disease state to affect both sites.
Lung complications include:
1. Chronic bronchial suppuration. This is a syndrome of excessive coughing and expectoration.
2. Bronchiectasis, a condition in which damage to the airways causes them to become enlarged, flabby, and scarred.
3. Bronchiolitis obliterans, a rare and life-threatening lung disease in which the small airways (bronchioles) are compressed and narrowed by inflammation or fibrosis.
4. Bronchiolitis obliterans organizing pneumonia. This resembles infectious pneumonia, but does not respond to antibiotics.
5. Granulomatous bronchiolitis, a disease of the small airways.
6. Tracheobronchitis, inflammation of the windpipe and large airways. This is common and has its own foundation: http://www.tracheobronchitis.org/
7. Tracheobronchial stenosis, narrowing of the windpipe and large airways.
8. Granulomatous disease. This is usually known as an inherited condition of immune dysfunction, producing abscesses called granulomas.
9. Pulmonary vasculitis, inflammation of the blood vessels in the lungs.
10. Diffuse obstructive disease.
11. Pulmonary function testing abnormalities.
12. Localized obstruction of upper airways.
According to Reference 2, inflammatory bowel disease is an increasingly common diagnosis. Improved imaging techniques contribute to successful diagnosis and treatment. The treatment philosophy is focused on altering the natural course of the illness and preventing long-term complications. Old drugs can be used more effectively, and new biologic products can be added to the drug regimen. Steroids remain the old stand-by therapy for inflammation, and may be used in inhalation form for lung complications. A multidisciplinary approach is recommended, as opposed to the older approach of management solely by a gastroenterologist.
Reference:
1. Tzanakis NE et al, “Pulmonary involvement and allergic disorders in inflammatory bowel disease”, World Journal of Gastroenterology 2010 January 21; 16(3): 299-305.
2. Morrison G, “Update in inflammatory bowel disease”, Australian Family Physician 2009 Dec; 38(12): 956-61.
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.