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Vol. 70, No. 1, 2003
Issue release date: January–February 2003
Respiration 2003;70:60–66
(DOI:10.1159/000068407)

Bronchial Hyperreactivity and Allergic Status in Inflammatory Bowel Disease

Ceyhan B.B.a · Karakurt S.a · Cevik H.b · Sungur M.a
Departments of aPulmonary Medicine and bGastroenterology, Marmara University School of Medicine, Istanbul, Turkey
email Corresponding Author

Abstract

Background: Despite the known systemic manifestations of inflammatory bowel disease (IBD) and a large number of reports associating lung disease and IBD, the frequency of atopy and bronchial hyperreactivity (BHR) in IBD remains obscure. Objectives: The aim of this study was to investigate the prevalence of abnormal pulmonary function tests, BHR and the atopic status in patients with IBD. Methods: Thirty patients with IBD (19 with ulcerative colitis and 11 with Crohn’s disease; 19 male, 11 female) and 16 controls without any gastrointestinal disease (9 female, 7 male) were included. Patients were questioned with respect to pulmonary and allergic symptoms; subsequently, lung function tests, BHR, skin prick test positivity, peripheral eosinophilia and serum IgE levels were evaluated and compared with those of control subjects. Results: The mean duration of IBD was 5.3 ± 4.8 years. IBD patients had significantly more often respiratory symptoms in comparison with controls (odds ratio, OR: 9.0, p < 0.04). A previous diagnosis of asthma and antiasthmatic drug treatment were noted in 3/30 (10%) IBD patients. Allergic symptoms were more prevalent in IBD patients in comparison with the controls (OR: 13, p < 0.007), particularly in patients with ulcerative colitis (OR: 16, p < 0.004). The mean FEV1 was 3.1 ± 0.9 liters (96 ± 18% predicted), mean methacholine PD20: 14.7 ± 3.6 mg/ml, mean IgE: 190.5 ± 305.6 IU/ml (normal value <94 IU/ml) and the percentage of peripheral eosinophils was 3.1 ± 3.3% in the IBD patients. These values did not result in statistically significant differences in comparison with controls. Furthermore, abnormal lung function and BHR were observed in 8/30 (27%) and 5/30 (17%) IBD patients, respectively. Abnormal lung function tests were more prevalent in the IBD patients than in the controls (OR: 12, p < 0.04). Skin prick tests were positive in 15/30 (50%) IBD patients. The risk of a positive skin prick test increased in the IBD patients in comparison with the controls (OR: 7.0, p < 0.02). Duration and activity of IBD did not influence the prevalence of BHR, allergic and respiratory symptoms, abnormal lung function, high serum IgE levels and skin test positivity. Conclusions: Allergic symptoms, respiratory symptoms, abnormal lung function tests and skin prick test positivity were more common among the IBD patients in comparison with the controls.


 Outline


 goto top of outline Key Words

  • Allergy
  • Atopy
  • Bronchial hyperreactivity
  • Crohn’s disease
  • Inflammatory bowel disease
  • Obstructive airway disease

 goto top of outline Abstract

Background: Despite the known systemic manifestations of inflammatory bowel disease (IBD) and a large number of reports associating lung disease and IBD, the frequency of atopy and bronchial hyperreactivity (BHR) in IBD remains obscure. Objectives: The aim of this study was to investigate the prevalence of abnormal pulmonary function tests, BHR and the atopic status in patients with IBD. Methods: Thirty patients with IBD (19 with ulcerative colitis and 11 with Crohn’s disease; 19 male, 11 female) and 16 controls without any gastrointestinal disease (9 female, 7 male) were included. Patients were questioned with respect to pulmonary and allergic symptoms; subsequently, lung function tests, BHR, skin prick test positivity, peripheral eosinophilia and serum IgE levels were evaluated and compared with those of control subjects. Results: The mean duration of IBD was 5.3 ± 4.8 years. IBD patients had significantly more often respiratory symptoms in comparison with controls (odds ratio, OR: 9.0, p < 0.04). A previous diagnosis of asthma and antiasthmatic drug treatment were noted in 3/30 (10%) IBD patients. Allergic symptoms were more prevalent in IBD patients in comparison with the controls (OR: 13, p < 0.007), particularly in patients with ulcerative colitis (OR: 16, p < 0.004). The mean FEV1 was 3.1 ± 0.9 liters (96 ± 18% predicted), mean methacholine PD20: 14.7 ± 3.6 mg/ml, mean IgE: 190.5 ± 305.6 IU/ml (normal value <94 IU/ml) and the percentage of peripheral eosinophils was 3.1 ± 3.3% in the IBD patients. These values did not result in statistically significant differences in comparison with controls. Furthermore, abnormal lung function and BHR were observed in 8/30 (27%) and 5/30 (17%) IBD patients, respectively. Abnormal lung function tests were more prevalent in the IBD patients than in the controls (OR: 12, p < 0.04). Skin prick tests were positive in 15/30 (50%) IBD patients. The risk of a positive skin prick test increased in the IBD patients in comparison with the controls (OR: 7.0, p < 0.02). Duration and activity of IBD did not influence the prevalence of BHR, allergic and respiratory symptoms, abnormal lung function, high serum IgE levels and skin test positivity. Conclusions: Allergic symptoms, respiratory symptoms, abnormal lung function tests and skin prick test positivity were more common among the IBD patients in comparison with the controls.

Copyright © 2003 S. Karger AG, Basel


goto top of outline Introduction

Following the first recognition by Kraft et al. [1] and many case histories, Camus et al. [2] reported respiratory involvement in inflammatory bowel disease (IBD). The prevalence of lung disease in IBD was found to be 3 in 1,400 cases in one study [3]. It has been shown that the incidence of respiratory changes is higher in patients with ulcerative colitis as opposed to those with Crohn’s disease [1, 2]. Chronic bronchial suppuration, localized upper airway obstruction, diffuse obstructive disease, bronchiectasis, granulomatous lung disease, pulmonary vasculitis and interstitial lung fibrosis were reported in patients with IBD [2, 4, 5]. Little is known about the lung function, atopic status and bronchial hyperreactivity (BHR) in patients with IBD. Camus et al. [2] evaluated pulmonary function tests in 13 patients with IBD and detected a decline in the FEV1/FVC ratio in bronchiectatic patients. BHR to methacholine was examined in only 1 case and was normal [2]. Mansi et al. [6] showed that BHR occurred in a high proportion (71%) of children and adolescents with Crohn’s disease, even in the absence of clinical, radiological and functional evidence of airway disease. Latent pulmonary involvement has also been reported in adult IBD patients recently. BHR was seen in 48% of patients with ulcerative colitis and Crohn’s disease without any bronchopulmonary symptoms and with normal baseline lung function [7]. These findings may indicate that a latent inflammation exists in the airways of IBD patients which is not detectable by routine pulmonary function tests. It is also known that high IgE levels are common in IBD despite the absence of atopic symptoms [8, 9]. These observations suggested the probability of higher prevalence of allergic reactions and BHR in IBD patients in comparison with the normal controls. Furthermore, studies using bronchoalveolar lavage fluid and induced sputum analysis in IBD patients showed higher percentages of lymphocytes, granulocytes and eosinophils in the lung airways [10, 11, 12, 13]. Particularly accumulation of CD4+ T cells in induced sputum samples and increased NO levels in exhaled air suggested a similar pathophysiologic change in asthma and lung involvement in IBD [11, 14]. In addition, it is noteworthy that there are similarities between colonic and bronchial epithelium: both originate from the primitive gut and both are sensitive to inhaled and ingested irritants.

The aim of this study was to investigate whether IBD, which has already been described in patients with asthma, is associated with BHR and atopy and whether there are differences between ulcerative colitis and Crohn’s disease patients. Since ulcerative colitis and Crohn’s disease are clinically and histologically distinct, we assessed these two groups separately.

 

goto top of outline Patients and Methods

Thirty consecutive IBD subjects (11 with Crohn’s disease and 19 with ulcerative colitis) treated at the Gastroenterology Department of the Marmara University Hospital during the study and 16 control subjects, who did not suffer from any gastrointestinal system disease, were recruited for the study. The presence or absence of atopic symptoms and respiratory symptoms was not a determining factor for patient selection for the study. All patients gave written informed consent to participate in the study. The study protocol was approved by the University Hospital Ethics Committee.

IBD characteristics recorded included the date of diagnosis, the presence of histology, the extent of disease and previous treatment. Patients were also questioned with respect to pulmonary symptoms (dyspnea, cough, sputum and wheezing lasting >1 month), allergic symptoms (urticaria, atopic dermatitis, rhinitis, conjunctivitis and asthma), previous history of pulmonary infection, allergy, past history and family history. After a full clinical examination, pulmonary function tests were performed in the sitting position using a spirometer (S3513; Sensormedics, Yorba Linda, Calif., USA). Short- and long-acting β2-agonists were not allowed 8 and 48 h, respectively, before lung function tests. Each data point was the best of at least three reproducible measurements (variability <5%). The values of pulmonary function test indices were expressed as absolute values and the percentage of the normal value for gender, age, weight and height. The predicted values for each subject based on sex, age, weight and height were obtained from standard computerized formulas [15]. Pulmonary function was regarded as normal when FEV1 >75% of the predicted value and FEV1/FVC >75%, and FVC >75% of the predicted value [16]. We could not evaluate lung volumes. Bronchial hyperresponsiveness (PD20, dose of methacholine that caused a 20% fall in FEV1) was measured in the morning with the methacholine challenge test using the dosimeter method in all IBD patients and controls [17]. In all patients and controls, the existence of an atopic state was evaluated by skin prick test using common allergen extracts (grass and tree pollen, house dust mite, molds, cat dog extracts) and reactions >3 mm were regarded as positive (Center Laboratories, Port Washington, N.Y., USA). Histamine was used as a positive control. The percentage of peripheral blood eosinophils and absolute eosinophil count/mm3 were determined, and serum IgE levels were measured using a chemiluminescence assay (PDC, Calif., USA, normal value <94 IU/ml). A radiologist characterized abnormalities on chest X-ray. The severity of the patients’ ulcerative colitis was assessed primarily on the basis of the criteria described by Truelove and Witts [18] and Seo et al. [19]. According to these criteria, the severity of the disease is classified into three stages (mild, moderate and severe). Index values <150, values between 150 and 220, and values >220 nearly corresponded to mild, moderate, and severe disease, respectively. The severity of Crohn’s disease was assessed using Crohn’s disease activity index [20]. Clinical remission in patients with Crohn’s disease was defined as an index score of ≤4, patients who had an Crohn’s disease activity index score >5 were classified as having active disease.

goto top of outline Analysis

Data were expressed as means ± SD. A p value <0.05 was considered statistically significant. The Mann Whitney U test was used to test differences in the results of the pulmonary function test indices, blood eosinophilia, serum IgE levels and PD20 values between IBD patients and normal subjects. The Kruskal-Wallis nonparametric test was applied to compare indices between patients with ulcerative colitis/Crohn’s disease and controls. Spearman’s rank correlation was used to assess the correlation between disease activity or duration of disease and PD20 values, lung function data, eosinophilia and IgE levels. The =χ2 test and Fisher’s exact test were used to assess the risk of IBD patients for impaired pulmonary function, BHR, allergic symptoms, respiratory symptoms, and positive skin prick test.

 

goto top of outline Results

The clinical characteristics of patients are summarized in tables 1 and 2. The mean length of Crohn’s disease at the onset of the study (range: 9 months to 20 years) was 6.1 ± 5.5 years, the mean duration of ulcerative colitis was 4.9 ± 4.4 years (range: 9 months to 15 years). The median disease activity index was 9 (range 0–21) and 158 (range 100–247.6) in patients with Crohn’s disease and ulcerative colitis, respectively. Ten of the 30 (33%) patients had a previous history of extraintestinal manifestations such as arthritis and pyoderma gangrenosum. Fifteen individuals were never smokers, 7 were exsmokers and 8 were current smokers in the IBD group (16.3 ± 15.1 pack-years). Of the 15 subjects who had never smoked, 4 (27%) had pulmonary function test abnormalities. Two patients in the current smoker group (25%) and 2 in the exsmoker group (29%) had pulmonary function test abnormalities. Two of the 30 IBD patients had a past history of tuberculosis. Peripheral eosinophilia, serum IgE levels and lung function test indices were not different between the IBD patients and the normal controls (tables 12). The answers to the questionnaire showed that only 3 IBD patients had previously suffered from asthma treated with antiasthmatic treatment; all of them were atopic and had been using steroid inhalants and bronchodilator drugs. In 1 patient, the diagnosis of asthma predated ulcerative colitis by 6 years; in another patient ulcerative colitis and asthma had been diagnosed concomitantly, and a third patient had developed asthma 10 years after the diagnosis of Crohn’s disease. Respiratory symptoms were significantly more frequent in the IBD patients in comparison with the controls, but there was no difference in respiratory symptoms between patients with ulcerative colitis (8/19, 42%) and Crohn’s disease (7/11, 64%; tables 12). Furthermore, 6 of the 30 (20%) patients had a history of rhinitis and/or sinusitis and 8/30 (27%) had a history of urticaria.

TAB01

Table 1. Clinical characteristics of the IBD patients (means ± SD)

TAB02

Table 2. All clinical parameters of the IBD patients

Allergic symptoms were more prevalent in IBD patients than in controls. This high prevalence was observed in patients with ulcerative colitis (odds ratio, OR: 16, p < 0.004), but not in Crohn’s disease patients. The mean IgE values did not significantly differ between patients and controls and between patients with ulcerative colitis and Crohn’s disease. There was also no difference in the risk of high IgE between IBD patients and controls and also between both subgroups (tables 12). There was an increased risk of positive skin prick test in the IBD patients in comparison with the controls, but no difference was found between both subgroups [7/11 (64%) in patients with Crohn’s disease and 8/19 (42%) in patients with ulcerative colitis (tables 1, 2)]. Excluding 4 patients with a single positive skin prick test, the risk of a positive skin prick test persisted (OR: 8.1, p < 0.04). Furthermore, 7 of 30 (24%) patients had a positive skin prick test and high IgE levels concomitantly.

Although there was no difference in the mean percentage of predicted FEV1, FVC, and FEV1/FVC between IBD patients and controls, an abnormal lung function test (<75% of predicted FEV1, <75% of predicted FVC or <75% of the FEV1/FVC ratio) was more prevalent in IBD patients (OR: 12.0, p < 0.04; tables 1, 2). FVC values of all patients were >75% of predicted. None of the patients had clinical or radiological findings indicating interstitial lung disease. Moreover, there was no difference regarding the risk of an abnormal lung function test and in the mean values of lung function test indices between patients with ulcerative colitis and Crohn’s disease patients (3/11 with Crohn’s disease and 5/19 with ulcerative colitis had abnormal lung function). BHR was determined in 4/30 (13%) patients. In 4 of the 30 IBD patients, the PD20 value of the methacholine challenge test was <16 mg/ml; 1 patient in whom the bronchial challenge test could not be performed because of a low baseline FEV1 value was considered as having BHR. The mean PD20 was 14.7 ± 3.6 mg/ml in the IBD group, and the results of the methacholine challenge tests were negative (PD20 >16 mg/ml) in all control subjects. There was no difference in the risk of BHR between patients and controls, or between patients with Crohn’s disease and patients with ulcerative colitis [2 of 11 (18%) Crohn’s disease patients and 3 of 19 (16%) ulcerative colitis patients had BHR]. When PD20 values were log-transformed, we could not find any significant difference between IBD patients and controls and between both subgroups. In patients with IBD, PD20 was not related to the activity of the disease and the duration of the disease. None of the patients with BHR was treated with oral steroids.

There was no correlation between disease activity and pulmonary symptoms, PD20 values, serum IgE levels, peripheral eosinophilia, and FEV1 predicted. Moreover, no correlation was observed between disease duration and these indices.

Therapy consisted of pharmacological treatment in 29 patients; oral or local 5-ASA and/or oral sulfasalazine in 24 patients, addition of oral methylprednisolone in 4 subjects (daily dose: 33.5 ± 20.5 mg methylprednisolone) and azathioprine in 1 patient. Oral corticosteroids are known to reduce airway responsiveness and might effect skin prick tests. When these 4 patients were excluded from analysis, we did not find any significant difference in the BHR risk between IBD patients and controls, or between both subgroups. Three of these 4 patients had positive skin prick tests, and excluding these patients did not result in any significant change in the increased risk of atopy in the IBD patients. One patient with quiescent disease at the onset of the study had not been treated in the previous 6 months. Two patients had previously undergone total colectomy. Both of them had respiratory symptoms. One of these colectomy patients had a history of smoking, allergic symptoms and abnormal lung function, the other patient had a normal lung function test. Both of these patients had been treated with oral steroids.

 

goto top of outline Discussion

The results of this study show that respiratory and allergic symptoms, skin test positivity and an abnormal lung function test were significantly more prevalent in the IBD patients. However, BHR was not more prevalent in the IBD patients than in the controls. These findings were in agreement with a recent study of Louis et al. [7], who observed a positive skin test in 42% of IBD patients and 21% of controls. In contrast, Troncone et al. [8] found no difference in the prevalence of atopy (assessed by prick testing and serum IgE measurements) and atopic symptoms between 122 patients with IBD and 103 age-matched controls. Younger subjects (<30 years) had a higher prevalence of positive skin tests. In the present study, the prevalence of skin test positivity was increased in the IBD patients, but it was unrelated to younger age. Levo et al. [9] showed that serum IgE concentrations as well as the prevalence of patients with ‘high IgE’ were significantly increased in IBD patients. In our study, high IgE levels were found in 37% of our patients with IBD and in 13% of the controls, even though this did not result in a statistically significant difference.

The true prevalence of airway inflammation and respiratory and atopic symptoms in IBD remains obscure. The findings of this study revealed a significant increase in respiratory and allergic symptoms in comparison with the controls. Three patients with asthma were identified among the 30 IBD patients. Respiratory symptoms were noted in 50% of the patients and rhinitis and sinusitis in 20% of the patients. In accordance with our findings, Douglas et al. [21] reported a history of respiratory symptoms in 21/44 (48%) and asthma in 4/44 (10%) of IBD patients. In another study, 2 of 14 patients with Crohn’s disease (14% in total) were observed to suffer from asthma. Both of these patients were also atopic, but none had rhinitis [6]. These studies suggested a high prevalence of airway involvement in IBD. In the present study, there was no difference between ulcerative colitis and Crohn’s disease with respect to respiratory symptoms, lung function changes, serum IgE levels and peripheral eosinophilia. However, allergic symptoms were only more prevalent in patients with ulcerative colitis, but not in those with Crohn’s disease. In contrast to our data, it has previously been reported that respiratory symptoms or lung function changes are greater in ulcerative colitis as opposed to Crohn’s disease [1, 2]. However, Tzanakis et al. [22] recently found no significant difference in mean values of spirometric indices, TLCO and arterial blood gas results between ulcerative colitis and Crohn’s disease subgroups, supporting our results.

In support of previous studies which also found changes in pulmonary function tests in IBD patients [23, 24], impaired lung function was found in 27% of our subjects in comparison with none of the controls. This prevalence rate is increased in IBD patients compared to the normal population, since pulmonary function test abnormalities of 3–8% have been reported in population studies from North America [25]. Similarly, in the study by Godet et al. [23], in which pulmonary function test abnormalities were detected in 55% of the patients with ulcerative colitis, 15/66 subjects had an obstructive pattern, 19/66 had abnormal diffusion, 1/66 had a restrictive pattern and 5 subjects had both an obstructive pattern and abnormal diffusion. Abnormal pulmonary function could not be predicted by the current or past smoking status, family history of respiratory diseases, occupational history or current medication. In accordance with our study, they also noted no correlation between medication, smoking, disease activity, duration of disease and lung function test indices. Kullmann et al. [24] supported our results and found changes in pulmonary function in 28% of IBD patients, independent of smoking, inflammatory activity, and duration and therapy of IBD. Interestingly, Munck et al. [26] found no obstructive pattern in children in the active phase and remission of Crohn’s disease. However, we evaluated only adult patients. The study by Douglas et al. [21] showed that FRC and RV were increased in 20% of patients at the initial assessment and that these abnormalities appeared to be associated with active IBD, in contrast to our findings. In a recent study, Tzanakis et al. [27] found small airway dysfunction in patients with Crohn’s disease and ulcerative colitis despite their normal baseline spirometric values, and there was no difference between active and nonactive disease.

Recently, increased BHR has been reported in patients with IBD without bronchopulmonary symptoms and with normal baseline lung function tests [7]. Louis et al. [7] noted more often BHR in IBD patients, even when only nonatopic subjects were considered. The same group also reported a greater decline in FEV1 after methacholine challenge in Crohn’s disease patients without any clinical respiratory involvement [10]. Kullmann et al. [24] recently reported BHR in 20% of patients with Crohn’s disease and 8% of patients with ulcerative colitis, who were asymptomatic with respect to the pulmonary system. The findings of our study showed BHR in 5/30 (17%) IBD patients (18% of patients with Crohn’s disease and 16% of patients with ulcerative colitis) and, in contrast to previous studies, 4/5 (80%) of our BHR patients had respiratory symptoms. This discrepancy may be due to different patient populations, since all IBD patients were included irrespective of respiratory and atopic symptoms. In fact, BHR is frequently observed in IBD patients. The pathogenetic mechanism underlying BHR in IBD has yet to be established. Although it has been postulated that airway inflammation may be responsible for BHR, Louis et al. [10] showed no correlation between BHR and sputum eosinophilia and eosinophil cationic protein levels in IBD patients, in contrast to asthma. Furthermore, neither activity nor duration of the disease affected BHR in our study. Similarly, Mansi et al. [6] reported a significant decline in BHR over a 2-year period in a subgroup of patients with Crohn’s disease unrelated to disease status or treatment. However, definite conclusion regarding the pathogenesis of BHR in IBD patients cannot be drawn at present.

It is important to consider whether therapy with sulfasalazine and mesalazine may have been responsible for the pulmonary disease and atopy. This distinction may be difficult regarding lung involvement due to medications and IBD disease. None of the patients in this study had clinical, functional, or radiological findings indicating interstitial lung disease or bronchiolitis obliterans, known adverse pulmonary reactions of sulfasalazine or mesalazine [28, 29]. In our subjects, the current use of sulfasalazine or 5-ASA and active colitis were not predictive of pulmonary function test abnormalities and atopy. A large proportion of the IBD patients with pulmonary disease was responsive to oral or inhaled steroids [2, 30]. In our 8 patients with abnormal lung function, 4 were on oral or inhaled steroid treatment, and their airway diseases were stable.

In a previous study, a beneficial effect of smoking on ulcerative colitis has been suggested [31]. In our study, 15 individuals were never smokers and 7 were exsmokers, and it was unlikely that smoking contributed to the pulmonary disease since the control group was matched with respect to the smoking habit. Furthermore, 4 of the current or exsmokers and 4 of the nonsmokers had abnormal lung function tests.

In conclusion, our findings provide evidence that in patients with IBD airway dysfunction is accompanied by atopy. The nature and significance of this impaired pulmonary function, BHR and atopy merit further investigation.

 

goto top of outline Acknowledgment

We thank Seval Acar for her help in the laboratory.


 goto top of outline References
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 goto top of outline Author Contacts

Berrin Bagcı Ceyhan, MD
Marmara University Hospital
TR–81190 Altunizade-Istanbul (Turkey)
Tel. +90 216 3262162, Fax +90 216 4280335, E-Mail bbcey@superonline.com


 goto top of outline Article Information

Received: July 27, 2001
Accepted after revision: July 27, 2002
Number of Figures : 0, Number of Tables : 2, Number of References : 31


 goto top of outline Publication Details

Respiration (International Review of Thoracic Diseases)
Founded 1944 as ‘Schweizerische Zeitschrift für Tuberkulose und Pneumonologie’ by E. Bachmann, M. Gilbert, F. Häberlin, W. Löffler, P. Steiner and E. Uehlinger, continued 1962–1967 as ‘Medicina Thoracalis’ as of 1968 as ‘Respiration’, H. Herzog (1962–1997)
Official Journal of the European Association for Bronchology and Interventional Pulmonology

Vol. 70, No. 1, Year 2003 (Cover Date: January-February 2003)

Journal Editor: C.T. Bolliger, Cape Town
ISSN: 0025–7931 (print), 1423–0356 (Online)

For additional information: http://www.karger.com/journals/res


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Abstract

Background: Despite the known systemic manifestations of inflammatory bowel disease (IBD) and a large number of reports associating lung disease and IBD, the frequency of atopy and bronchial hyperreactivity (BHR) in IBD remains obscure. Objectives: The aim of this study was to investigate the prevalence of abnormal pulmonary function tests, BHR and the atopic status in patients with IBD. Methods: Thirty patients with IBD (19 with ulcerative colitis and 11 with Crohn’s disease; 19 male, 11 female) and 16 controls without any gastrointestinal disease (9 female, 7 male) were included. Patients were questioned with respect to pulmonary and allergic symptoms; subsequently, lung function tests, BHR, skin prick test positivity, peripheral eosinophilia and serum IgE levels were evaluated and compared with those of control subjects. Results: The mean duration of IBD was 5.3 ± 4.8 years. IBD patients had significantly more often respiratory symptoms in comparison with controls (odds ratio, OR: 9.0, p < 0.04). A previous diagnosis of asthma and antiasthmatic drug treatment were noted in 3/30 (10%) IBD patients. Allergic symptoms were more prevalent in IBD patients in comparison with the controls (OR: 13, p < 0.007), particularly in patients with ulcerative colitis (OR: 16, p < 0.004). The mean FEV1 was 3.1 ± 0.9 liters (96 ± 18% predicted), mean methacholine PD20: 14.7 ± 3.6 mg/ml, mean IgE: 190.5 ± 305.6 IU/ml (normal value <94 IU/ml) and the percentage of peripheral eosinophils was 3.1 ± 3.3% in the IBD patients. These values did not result in statistically significant differences in comparison with controls. Furthermore, abnormal lung function and BHR were observed in 8/30 (27%) and 5/30 (17%) IBD patients, respectively. Abnormal lung function tests were more prevalent in the IBD patients than in the controls (OR: 12, p < 0.04). Skin prick tests were positive in 15/30 (50%) IBD patients. The risk of a positive skin prick test increased in the IBD patients in comparison with the controls (OR: 7.0, p < 0.02). Duration and activity of IBD did not influence the prevalence of BHR, allergic and respiratory symptoms, abnormal lung function, high serum IgE levels and skin test positivity. Conclusions: Allergic symptoms, respiratory symptoms, abnormal lung function tests and skin prick test positivity were more common among the IBD patients in comparison with the controls.



 goto top of outline Author Contacts

Berrin Bagcı Ceyhan, MD
Marmara University Hospital
TR–81190 Altunizade-Istanbul (Turkey)
Tel. +90 216 3262162, Fax +90 216 4280335, E-Mail bbcey@superonline.com


 goto top of outline Article Information

Received: July 27, 2001
Accepted after revision: July 27, 2002
Number of Figures : 0, Number of Tables : 2, Number of References : 31


 goto top of outline Publication Details

Respiration (International Review of Thoracic Diseases)
Founded 1944 as ‘Schweizerische Zeitschrift für Tuberkulose und Pneumonologie’ by E. Bachmann, M. Gilbert, F. Häberlin, W. Löffler, P. Steiner and E. Uehlinger, continued 1962–1967 as ‘Medicina Thoracalis’ as of 1968 as ‘Respiration’, H. Herzog (1962–1997)
Official Journal of the European Association for Bronchology and Interventional Pulmonology

Vol. 70, No. 1, Year 2003 (Cover Date: January-February 2003)

Journal Editor: C.T. Bolliger, Cape Town
ISSN: 0025–7931 (print), 1423–0356 (Online)

For additional information: http://www.karger.com/journals/res


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

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