Clinical and radiological characteristics of lung disease in inflammatory bowel disease

The pulmonary associations of inflammatory bowel disease (IBD) are poorly c haracterized. The clinical, physiological and high-resolution computed tomo graphic thorax characteristics of the lung disease in patients with IBD pre senting with respiratory symptoms are described. Detailed clinical information was obtained and standard pulmonary physiolog ical tests and thorax high-resolution computed tomography performed on 14 p atients with ulcerative colitis (UC) and three with Crohn's disease (CD), 1 0 male, aged 38-83 yrs. Respiratory symptoms had been present for 2-50 yrs and extraintestinal mani festations were present in three (17.6%). Normal pulmonary physiology (six patients) was associated with the high resolution computed tomographic chan ges of bronchiectasis, mosaic perfusion and air trapping suggestive of obli terative bronchiolitis and a pattern of centrilobular nodules and branching linear opacities ("tree in bud" appearance) suggestive of either cellular bronchiolitis or bronchiolectasis with mucoid secretions. Bronchiectasis wa s found in 13 patients (11 UC, 2 CD), 11 had air trapping and five had a "t ree in bud" appearance on computed tomography. One patient had a predominan tly peripheral reticular pattern at the lung bases similar to that found in cryptogenic fibrosing alveolitis and one patient had a mixed reticular and ground-glass pattern in the midzones with a patchy distribution in the cen tral and peripheral portions of the lungs with air trapping. Eleven patient s (three with alveolitis) exhibited a clinical and/or physiological respons e to steroids. Pulmonary abnormalities in ulcerative colitis and Crohn's disease can prese nt years after the onset of the bowel disease and can affect any part of th e lungs. Early recognition is important as they can be strikingly steroid-r esponsive.