Inflammatory bowel diseases, chronic liver diseases and the lung

Abstract

This review is devoted to the distinct associations of inflammatory bowel diseases (IBD) and chronic liver disorders with chronic airway diseases, namely chronic obstructive pulmonary disease and bronchial asthma, and other chronic respiratory disorders in the adult population. While there is strong evidence for the association of chronic airway diseases with IBD, the data are much weaker for the interplay between lung and liver multimorbidities. The association of IBD, encompassing Crohn's disease and ulcerative colitis, with pulmonary disorders is underlined by their heterogeneous respiratory manifestations and impact on chronic airway diseases. The potential relationship between the two most prevalent liver-induced pulmonary vascular entities, i.e. portopulmonary hypertension and hepatopulmonary syndrome, and also between liver disease and other chronic respiratory diseases is also approached. Abnormal lung function tests in liver diseases are described and the role of increased serum bilirubin levels on chronic respiratory problems are considered. @ERSpublications Lung-gut cross-talk: the association of IBD with respiratory multimorbitidies, including COPD and bronchial asthma

Inflammatory bowel disease and airway diseases

“…Several similarities in the underlying pathological mechanisms have been described and may explain the association between IBD and airway diseases[1,2,22-24]. Dysbiosis and an inappropriate immune response to intestinal microbiota are considered key components of the pathophysiological process in IBD[25].…”

“…Similarly, an immune response to lung microbiota seems to occur in airway diseases such as bronchiectasis[26]. A dysregulation of protease activity is present in both IBD[27] and COPD[28], and is associated with the breakdown of connective tissue components and the ensuing remodeling process[1,29]. Alterations in immune cell homing function[1,22] may explain the low grade chronic systemic inflammation that is present in IBD[30], COPD[31], asthma[32-34] and bronchiectasis[35-38].…”

“…A dysregulation of protease activity is present in both IBD[27] and COPD[28], and is associated with the breakdown of connective tissue components and the ensuing remodeling process[1,29]. Alterations in immune cell homing function[1,22] may explain the low grade chronic systemic inflammation that is present in IBD[30], COPD[31], asthma[32-34] and bronchiectasis[35-38]. The hygiene hypothesis, proposing that a lack of exposure to microorganisms during childhood contributes to abnormal immune reactions later in life, may also constitute a common factor linking asthma, IBD and a variety of other conditions[39].…”

“…The majority of studies have addressed the topic from the perspective of airway diseases as an extraintestinal manifestation of IBD[1-7]. However, there is growing evidence regarding an increased risk of IBD occurrence among patients with airway diseases such as asthma[8-11], chronic obstructive pulmonary disease (COPD)[12,13] and bronchiectasis[13].…”

Subclinical Nasal and Lung Lymphocytosis in Ulcerative Colitis

“…IBD patients show significantly decreased lung function test outcomes in comparison to healthy controls. In a review including over 600 patients with UC, more than 50% of patients showed abnormal pulmonary function test results when compared to healthy controls, and the decrease in diffusion capacity of the lung for carbon monoxide (DLCO) was the most common defect [3, 4]. …”