Incidence, Characteristics, Clinical Course, and Risk Factors of Ulcerative Colitis-related Lung Diseases

Mitsuhiro Moda; Miyuri Suga; Shogo Kasai; Yasumi Okochi; Naoki Yoshimura; Masayuki Fukata; Hitoshi Tokuda

doi:10.1016/j.chest.2022.05.037

Incidence, Characteristics, Clinical Course, and Risk Factors of Ulcerative Colitis-related Lung Diseases

Chest. 2022 Dec;162(6):1310-1323. doi: 10.1016/j.chest.2022.05.037. Epub 2022 Jun 9.

Authors

Mitsuhiro Moda¹, Miyuri Suga², Shogo Kasai³, Yasumi Okochi³, Naoki Yoshimura⁴, Masayuki Fukata⁴, Hitoshi Tokuda³

Affiliations

¹ Department of Respiratory Medicine, National Hospital Organization Kinki-chuo Chest Medical Center, Osaka, Japan; Department of Respiratory Medicine, Japan Community Health Care Organization Tokyo Yamate Medical Center, Tokyo, Japan. Electronic address: mitsuhiromoda@yahoo.co.jp.
² Department of Respiratory Medicine, Japan Community Health Care Organization Tokyo Yamate Medical Center, Tokyo, Japan; Department of Respiratory Medicine, Graduate School of Medicine Nippon Medical School, Tokyo, Japan.
³ Department of Respiratory Medicine, Japan Community Health Care Organization Tokyo Yamate Medical Center, Tokyo, Japan.
⁴ Center for Inflammatory Bowel Disease, Division of Gastroenterology, Department of Internal Medicine, Japan Community Health Care Organization Tokyo Yamate Medical Center, Tokyo, Japan.

PMID: 35691329
DOI: 10.1016/j.chest.2022.05.037

Abstract

Background: Ulcerative colitis (UC) is a chronic GI inflammatory disorder involving various extraintestinal organs, including the lungs. Although UC-related lung diseases (UC-LDs) have been widely recognized, much remains unclear.

Research question: What are the incidence, characteristics, clinical course, and risk factors of UC-LD?

Study design and methods: This study retrospectively identified and classified UC-LDs by reviewing the medical records of consecutive patients with UC. The incidence, characteristics, and clinical course of each UC-LD type were investigated, and the clinical characteristics of patients with and without each UC-LD type were compared.

Results: Among 563 patients with UC, 28 (5.0%) developed UC-LD during a mean follow-up period of 77 months. A majority of them displayed airway disease (AD) (n = 13 [2.3%]) or organizing pneumonia (OP) (n = 10 [1.8%]); there were six cases of interstitial pneumonias other than OP (IP) (0.8%) and one of pleuritis (0.2%). All 13 patients with AD responded favorably to inhaled or systemic corticosteroids, although five experienced frequent exacerbations. Older age and a history of colectomy were identified as the risk factors for developing AD. Nine of the 10 cases of OP were possibly due to drug-induced pathogenesis. Only one case showed recurrence, and all cases of OP exhibited a favorable clinical course with discontinuation of the suspicious drug and/or initiation of corticosteroid. The clinical course of IP depended on the existence of fibrosis, and IP with fibrosis was associated with gradual deterioration. Older age was associated with the development of IP.

Interpretation: A nonnegligible number of patients with UC may develop UC-LD. AD, OP, and IP without fibrosis show good prognosis following steroid therapy along with the specific management for each UC-LD type, whereas IP with fibrosis shows gradual deterioration with poor prognosis. Our results provide cues to establish better management of UC-LDs.

Keywords: airway disease; interstitial pneumonia; lung disease; organizing pneumonia; ulcerative colitis.

MeSH terms

Adrenal Cortex Hormones / therapeutic use
Colectomy / methods
Colitis, Ulcerative* / complications
Colitis, Ulcerative* / epidemiology
Colitis, Ulcerative* / therapy
Disease Progression
Fibrosis
Humans
Pneumonia* / drug therapy
Retrospective Studies
Risk Factors

Substances

Adrenal Cortex Hormones