BRONCHOPULMONARY MANIFESTATIONS OF GASTRO ENTEROLOGIC AND HEPATIC DISEASES

Topics of this review are the bronchopulmonary manifestations of gastr oesophageal reflux disease, cirrhosis of the liver and chronic inflamm atory bowel diseases. About 20% patients with chronic obstructive airw ay disease show evidence tf gastroesophageal reflux disease. Reflex br onchoconstriction seems to be of greater importance than microaspirati on. First studies show the positive effects of acid inhibition by prot on pump inhibitors on pulmonary symptoms. Hepatorenal syndrome is char acterized by arterial hypoxemia with p(a)O(2)-values <70 mm Hg. Differ ent mediators (endotoxins, amines, polypeptides or allergens) are disc ussed. Furthermore, elevated levels of prostacycline, atrial natriuret ic factor and platelet activating factor have been described. Recently published studies focused on the role of nitric oxide (NO). Patients with cirrhosis of the liver show a higher rate of a pathologically ele vated airway resistance which might be induced by a reduced histamine clearance. Ascites leads to reversible restrictive airway disease. Bro nchopulmonary manifestations in chronic inflammatory bowel diseases in clude obstructive and restrictive airway diseases, vascular or serosal changes and show low clinical evidence. In contrast, pathological cha nges of the common function tests were found in 30 to 50%. These findi ngs may be induced by circulating immune complexes, vasculitis, increa sed permeability or a combined immune reaction of both, the bronchial and intestinal mucosa. Undesired effects of salicylates should be take n into account. This review shows that bronchopulmonary manifestations in diseases of the G1-tract or the liver are more common than usually known and should be taken into clinical consideration.