Pulmonary Manifestations of Inflammatory Bowel Disease and Treatment Strategies

Subha Ghosh MD, MBA , Himanshu Deshwal MD , Rebecca Haraf MD , Shine Raju MD , Mnahi Bin Saeedan MBBS, MPH , Pralay Sarkar MD, FCCP , Thomas Gildea MD , Carol F. Farver MD , Atul C. Mehta MD, FCCP
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Abstract

Topic Importance

Ulcerative colitis and Crohn’s disease are multisystem illnesses that primarily affect the gut, but present with various extraintestinal manifestations. The pathogenesis behind these clinical features is poorly understood, and pulmonary manifestations of inflammatory bowel disease (IBD) are no exception. Research has suggested an intricate interplay between the mucosal immune system and the microbiotic environment between the gut and the lung, often termed the gut-lung axis. This dysregulated communication is demonstrated in a wide range of pulmonary complications involving the large and small airways, lung parenchyma, serosal tissues, and pulmonary vasculature; fistulous connection between the gastrointestinal tract and thoracic cavity; and drug toxicities. Most of these diseases have been well documented in case reports to respond to corticosteroid treatment regimens. However, a notable lack of treatment recommendations guiding the dosage and duration of steroid use and managing the disease refractory to therapy are available. In addition, the progressive and debilitating disease often remains a therapeutic challenge.

Review Findings

This review sheds light on the different strategies documented to treat the spectrum of pulmonary complications of IBD, including novel therapeutic approaches using immunomodulatory therapy, and summarizes their clinical and radiologic features with pathologic correlation.

Summary

Although their existence is well documented, further research is needed to develop evidence-based guidelines for diagnosing, managing, and preventing pulmonary complications of IBD.

炎症性肠病的肺部表现和治疗策略
主题重要性溃疡性结肠炎和克罗恩病是一种多系统疾病,主要影响肠道,但会出现各种肠道外表现。人们对这些临床特征背后的发病机制知之甚少,炎症性肠病(IBD)的肺部表现也不例外。研究表明,粘膜免疫系统与肠道和肺部之间的微生物环境之间存在着错综复杂的相互作用,这通常被称为肠肺轴。这种失调的交流体现在涉及大、小气道、肺实质、浆膜组织和肺血管的各种肺部并发症;胃肠道和胸腔之间的瘘管连接;以及药物毒性。在病例报告中,这些疾病大多对皮质类固醇治疗方案反应良好。然而,目前明显缺乏指导类固醇使用剂量和持续时间以及处理难治性疾病的治疗建议。本综述揭示了治疗 IBD 肺部并发症的不同策略,包括使用免疫调节疗法的新型治疗方法,并总结了这些并发症的临床和影像学特征以及病理学相关性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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