Association between inflammatory bowel disease and chronic obstructive pulmonary disease: a systematic review and meta-analysis

Gonzalo Labarca,Sebastian Fernandez-Bussy,Michael Picco,Michael A Jantz,Gloria Horta,Lauren Drake,Adnan Majid,Erik Folch,Hiren J Mehta

doi:10.1186/s12890-019-0963-y

Abstract

IntroductionThere 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.MethodsWe 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.ResultsFour 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.DiscussionAccording 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)

Highlights

There is evidence of an association between inflammatory bowel disease (IBD) and lung conditions such as chronic obstructive pulmonary disease (COPD)
Raj et al included a population of 2192 participants in a respiratory clinic, and only 588 of them were included in the COPD population [31]
Our findings show that the current evidence regarding the risk of new onset IBD in a population with COPD suggests an association between these conditions

Summary

Introduction

There is evidence of an association between inflammatory bowel disease (IBD) and lung conditions such as chronic obstructive pulmonary disease (COPD). Inflammatory bowel disease (IBD), which commonly includes both Crohn’s disease (CD) and ulcerative colitis (UC), is related to several gastrointestinal manifestations, including an increased risk of colorectal cancer. Multisystemic involvement is reported in 25% of IBD patients [1]. The intestine and airway are related in that both are derived from the same embryological structure and share similarities in their in columnar epithelium, mucous glands, goblet cells and lymphoid tissue in their submucosal layers [5]. The loss of immunological tolerance and the immunological disruption that results in response to environmental triggers are common pathways described in both intestinal and airway disease mechanisms [4]. The gut microbiome may have a role in this process; in recent years, several publications have reported a potential contribution from the gut microbiome and its role in the immune response [10, 11]

Methods

Results

Conclusion