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P156. Pulmonary involvement in IBD patients and the effect of TNF-alpha inhibitors on pulmonary function

J. Bethge1, M. Ellrichmann1, C. Conrad1, S. Nikolaus1, R. Noth2, D. Schuldt1, S. Zeissig1, S. Schreiber1,2, 1University Medical Center, Schleswig Holstein, Campus Kiel, Medical Department I, Gastroenterology, Kiel, Germany, 2University Medical Center Schleswig Holstein, Campus Kiel, Medical Department I, Pneumology, Kiel, Germany

Background

Extraintestinal manifestations are a frequent complication in patients with Inflammatory Bowel Disease (IBD). Of note, increased mortality from respiratory diseases was observed in patients with ulcerative colitis (UC). This may be due to an overlap between genetic causes in IBD and various chronic inflammatory lung diseases. Therefore, pulmonary involvement may be overlooked in IBD patients. The aim of this prospective study was to assess pulmonary-function-abnormalities in IBD patients in comparison to healthy controls and investigate the effect of TNF-alpha-inhibitors on pulmonary-function-test (PFT).

Methods

90 consecutive patients with IBD (51 Crohn's disease (CD), 39 UC) were included: N = 47 in remission, N = 43 with active disease. Out of these, 25 patients were seen for initiating anti-TNF therapy. 40 matched healthy controls were included. Pulmonary function was evaluated using the Medical Research Council (MRC) dyspnea index and a standardized spirometry. IBD activity was assessed using Harvey–Bradshaw index for CD and partial-Mayo-score for UC. In patients treated with anti-TNF all parameters were reevaluated 6 weeks later. Data are presented as Median/25thpercentile/75thpercentile.

Results

Patients with active IBD showed significantly reduced parameters in their PFT. Tiffeneau index-values (FEV1%) were significantly reduced in IBD patients with active disease (78.9/73.7/85.1) compared to controls (86/81.8/88.3; p = 0.001) and IBD patients in remission (84.5/81.2/89.4; p = 0.0002). No difference was found between IBD patients in remission and controls (p > 0.05). Parameters of peripheral airway obstruction (MEF 75–25%) showed comparable changes (MEF75IBDactive vs. MEF75control p = 0.01; MEF75IBDactive vs. MEF75IBDremission p = 0.002). Clinically significant peripheral airway obstruction was seen in 19.1%, obstructive dysfunction in 12.8% and restrictive dysfunction in 2.1% of IBD patients with an active disease. Patients treated with anti-TNF showed a significant improvement of pulmonary obstruction (p = 0.003 FEV1%) compared to baseline levels.

Conclusion

IBD patients with active disease showed significant abnormalities in their PFT indicating pulmonary obstruction in comparison to healthy controls and IBD patients in remission. Anti-inflammatory therapy with anti-TNF improves obstructive abnormalities. Pulmonary obstruction and chronic broncho-pulmonary inflammation might be the cause of reduced exercise levels during active disease and may be overlooked in the majority of patients. Further studies are necessary to determine whether chronic obstruction should be treated and whether it contributes to the observed mortality from lung problems in IBD.