Publication: İnflamatuvar bağırsak hastalığı ve akciğer tutulumu
Abstract
Ülseratif kolit ve Crohn hastalığı bağırsak dışı çeşitli organ tutulumları göstermektedir. Akciğer tutulumuna ise daha az sıklıkta rastlanılmaktadır ve bu konuda 400’ü aşan sayıda olgu yayınlanmıştır. Akciğer ve bağırsaklar, her iki organ da primitif guttan köken almaktadır ve hastalarda benzer patogenetik değişimler göstermektedirler. İnflamatuvar bağırsak hastalığı (İBH)’nda sıklıkla plörit, hava yolu hastalığı, interstisyel akciğer hastalığı, nekrobiyotik nodüller, pulmoner eozinofili, tromboembolik hastalık, vaskülit, granülomatöz hastalık vs. gibi akciğer tutulumları tanımlanmıştır. Kolektomi bazı olgularda akciğer hastalığını alevlendirebilmektedir. Sülfasalazin, mesalamin, metotreksat, anti-TNF-α alanlarda ilaca bağlı akciğer sorunları da akla getirilmelidir. Hava yolu semptomları olmasa da bazı hastalarda solunum fonksiyon testlerinde, bronkoalveolar lavaj veya indüklenmiş balgam örneklerinde latent akciğer tutulumu tanımlanmıştır. İBH hastalarında akciğere yönelik tedavi akciğer tutulumunun paternine bağlıdır ve özellikle hava yolu hastalarında tedavide gecikme hava yollarında kalıcı hasarlara yol açmaktadır. Hastaların erken teşhis alması için bu bağırsak hastalığında yakın takip ve akciğer kontrolü önemlidir.
Ulcerative colitis and Crohn’s disease are associated with a variety of systemic manifestations. Pulmonary disease has been described much less frequently than other organ systems, yet more than 400 cases have been reported. Lung and gastrointestinal system are originated from primitiv gut and they have same pathogenetic changes in these patients. Major patterns of pulmonary disease associated with inflammatory bowel disease (IBD) are pleuritis, airway disease, interstitial lung disease, necrobiotic nodules, pulmonary eosinophilia, thromboembolic disease, vasculitis, granulomatous lung disease, etc. Colectomy may aggrevate respiratory symptoms. Drug induced disease must be kept in mind in patients taking sulfasalazine, mesalamine, methodrexate, and anti-TNF-α. Latent pulmonary abnormalities are evident either at pulmonary function tests or induced sputum or bronchoalveolar lavage, have been also reported in patients with inflammatory bowel disease in the absence of clinical evidence of airway disease. The treatment of IBD related respiratory involvement depends on the specific pattern of involvement, if left untreated, especially in airway disease, puts the patient at risk of developing irreversible destruction of the air passage. A high degree of suspicion is necessary to detect early the repiratory disease in association with any form of bowel disease.
Ulcerative colitis and Crohn’s disease are associated with a variety of systemic manifestations. Pulmonary disease has been described much less frequently than other organ systems, yet more than 400 cases have been reported. Lung and gastrointestinal system are originated from primitiv gut and they have same pathogenetic changes in these patients. Major patterns of pulmonary disease associated with inflammatory bowel disease (IBD) are pleuritis, airway disease, interstitial lung disease, necrobiotic nodules, pulmonary eosinophilia, thromboembolic disease, vasculitis, granulomatous lung disease, etc. Colectomy may aggrevate respiratory symptoms. Drug induced disease must be kept in mind in patients taking sulfasalazine, mesalamine, methodrexate, and anti-TNF-α. Latent pulmonary abnormalities are evident either at pulmonary function tests or induced sputum or bronchoalveolar lavage, have been also reported in patients with inflammatory bowel disease in the absence of clinical evidence of airway disease. The treatment of IBD related respiratory involvement depends on the specific pattern of involvement, if left untreated, especially in airway disease, puts the patient at risk of developing irreversible destruction of the air passage. A high degree of suspicion is necessary to detect early the repiratory disease in association with any form of bowel disease.