Low prevalence of pulmonary involvement in children with inflammatory bowel disease

Background: Since extraintestinal sites of inflammation have been demonstrated in patients with Crohn's disease (CD) and ulcerative colitis (UC), both entities are regarded as systemic disorders. There are only scarce data on the prevalence of inflammatory bowel disease (IBD)-associated lung involvement in children. Objectives: The aim of our study was to investigate pulmonary involvement in pediatric patients with IBD. Material and methods: Fifty children with IBD (25 UC and 25 CD, mean age 14.2 +/- 3.2 yrs) and 39 age-matched, healthy, control subjects were included in the study. Pulmonary function testing, methacholine bronchial challenge, fractional exhaled nitric oxide (FeNO) and high resolution computed tomography (HRCT) were used to detect functional and/or structural pulmonary involvement. Results: There were no differences in spirometric parameters, lung volumes or lung diffusion capacity for carbon monoxide between IBD patients and control subjects. Highly significant differences were found in FeNO between CD, UC and control patients (mean 9.3 +/- 3.3, 27.7 +/- 14.8 and 16.6 +/- 9.28, respectively; p = 0.000). Bronchial hyperresponsiveness was diagnosed in six IBD cases (14.6%). HRCT (performed in 32 patients from the study group) revealed mild bilateral bronchiectasis in one patient. Conclusions: The prevalence of pulmonary involvement in children with IBD is low. Screening for pulmonary involvement in children and young adults with IBD may enable early detection of IBD-related pulmonary diseases which, seems to be notably more common in adult patients. Elevated FeN0 could probably be regarded as a marker of airway involvement in nonsmoking UC pediatric patients. This requires further studies. (C) 2012 Elsevier Ltd. All rights reserved.