Abstract
With the aim of investigating the presence of latent inflammatory process in the lungs of patients with Crohn's disease, 15 patients with Crohn's disease were evaluated by spirometry, the methacholine challenge test, induced sputum, and skin tests for inhaled antigens. Serum IgE, erythrocyte sedimentation rate and hematocrit were also determined. The patients were compared with 20 healthy controls by the Mann-Whitney and Fisher exact tests. Their respiratory physical examination was normal. None had a personal or family history of clinical atopy. None had a previous history of pulmonary disease, smoking or toxic bronchopulmonary exposure. None had sinusitis, migraine, diabetes mellitus, or cardiac failure. Four (26.6%) of the patients with Crohn's disease had a positive methacholine challenge test whereas none of the 20 controls had a positive methacholine test (P = 0.026, Fisher exact test). Patients with Crohn's disease had a higher level of lymphocytes in induced sputum than controls (mean 14.59%, range 3.2-50 vs 5.46%, 0-26.92%, respectively; P = 0.011, Mann-Whitney test). Patients with Crohn's disease and a positive methacholine challenge test had an even higher percentage of lymphocytes in induced sputum compared with patients with Crohn's disease and a negative methacholine test (mean 24.88%, range 12.87-50 vs 10.48%, 3.2-21.69%; P = 0.047, Mann-Whitney test). The simultaneous findings of bronchopulmonary lymphocytosis and bronchial hyperresponsiveness in patients with Crohn's disease were not reported up to now. These results suggest that patients with Crohn's disease present a subclinical inflammatory process despite the absence of pulmonary symptoms.
Highlights
Many extraintestinal manifestations affecting various organs or organ systems have been described in association with inflammatory bowel disease [1] but clinically significant lung involvement is rare [2]
The results of the present study demonstrated that bronchial hyperresponsiveness occurs in a high proportion (26.7%) of adult patients with Crohn’s disease compared to 0% of normal healthy controls
The producing a 20% fall in FEV1 (PD20) values found in these patients, were higher than most of those seen in asthmatic individuals [30]
Summary
Many extraintestinal manifestations affecting various organs or organ systems have been described in association with inflammatory bowel disease [1] but clinically significant lung involvement is rare [2]. Tracheal involvement in Crohn’s disease is even more unusual and consists of mucosal inflammation [10,11,12]. The overall prevalence of concomitant bronchopulmonary manifestations is only 0.4% [16], subclinical alterations in at least half of the adults with Crohn’s disease have been demonstrated [17,18] suggesting underlying bronchial inflammation. This pulmonary involvement can be reflected by an increased lymphocyte count in the bronchoalveolar lavage fluid [19,20] and/or lung function abnormalities [21,22]
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