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Pulmonary Function Test Abnormalities in Pediatric Inflammatory Bowel Disease
Raoul I Furlano1, Pavel Basek, Pascal Müller
1Division of Pediatric Gastroenterology, University of Basel Children's Hospital, Basel, Switzerland.
Insights
Pediatric inflammatory bowel disease (IBD) patients show altered lung function, including reduced carbon monoxide transfer capacity. Pulmonary involvement in children with IBD is variable and its clinical significance requires further investigation.
Area of Science:
- Pediatric Pulmonology
- Gastroenterology
- Inflammatory Bowel Disease Research
Background:
- Pulmonary complications are increasingly recognized in adult inflammatory bowel disease (IBD).
- The prevalence and natural history of lung involvement in pediatric IBD patients remain largely uncharacterized.
- This study addresses the knowledge gap regarding pulmonary function in children with IBD.
Purpose of the Study:
- To assess lung function, including fraction of exhaled nitric oxide (FeNO) and transfer capacity for carbon monoxide (TLCO), in pediatric IBD patients.
- To longitudinally track lung function abnormalities in a subset of these patients.
- To identify potential correlations between lung function and disease characteristics.
Main Methods:
- Pulmonary function tests, including TLCO and FeNO, were performed on 48 pediatric IBD patients (30 Crohn's disease, 18 ulcerative colitis) and 108 controls.
- Patients with abnormal TLCO or elevated residual volume/total lung capacity (RV/TLC) underwent follow-up assessments.
- Statistical analyses included nonparametric tests and ANOVA.
Main Results:
- IBD patients exhibited significantly decreased TLCO compared to controls (88% vs. 99% predicted).
- Mildly elevated RV/TLC ratios were observed in ulcerative colitis patients, and reduced expiratory flows in Crohn's disease patients.
- No consistent correlation was found between FeNO, disease activity, and lung function abnormalities; abnormalities did not consistently persist over follow-up.
Conclusions:
- Pediatric IBD patients demonstrate variable pulmonary involvement, mirroring findings in adults.
- Observed lung function abnormalities fluctuate and may not be persistent.
- The long-term clinical significance of these pulmonary findings in pediatric IBD warrants further research.
Background:
Pulmonary involvement in adult patients with inflammatory bowel disease (IBD) seems more common than previously appreciated. Its prevalence and development over time in pediatric IBD patients are largely unknown.
Objectives:
The aim was to study lung function including fraction of exhaled nitric oxide (FeNO) and transfer capacity for carbon monoxide (TLCO) in pediatric IBD patients and to describe the longitudinal development in a subset of patients with lung function abnormalities.
Methods:
Sixty-six measurements were made in 48 IBD patients (30 patients with Crohn's disease and 18 with ulcerative colitis) and 108 matched controls. Patients with abnormal TLCO or elevated residual volume/total lung capacity (RV/TLC) ratios were invited for a follow-up. Statistical comparisons were made by nonparametric tests and ANOVA.
Results:
TLCO was decreased in IBD patients [median: 88% predicted (interquartile range, IQR, 22) vs. 99% predicted (IQR 19) in controls]. RV/TLC ratios were mildly elevated in patients with ulcerative colitis [32% (IQR 9) vs. 27% (IQR 8) in controls], and maximum expiratory flows at 50 and 25% of vital capacity were mildly reduced in patients with Crohn's disease. FeNO and disease activity did not correlate with lung function abnormalities. Abnormalities did not consistently persist over a median follow-up period of 34 months.
Conclusions:
This study supports evidence that variable and fluctuating pulmonary involvement also occurs in pediatric IBD patients. Its clinical significance is unclear.
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