Suruchi Ramanujan, MD1, Tatini Mal-Sarkar, MD2, Varisha Essani, MD3, Joseph Sleiman, MD4, Suha Abushamma, MD4, Taha Qazi, MD4, Florian Rieder, MD4, Katherine Falloon, MD4 1University of California San Diego, San Diego, CA; 2Cleveland Clinic Foundation, Cleveland Heights, OH; 3University of Toledo Medical Center, Toledo, OH; 4Cleveland Clinic Foundation, Cleveland, OH Introduction: Approximately half of patients with inflammatory bowel disease (IBD) experience extraintestinal manifestations (EIMs). However, pulmonary EIMs are relatively underexplored in the literature. This study aims to identify the frequency of respiratory symptoms among patients with IBD and explore the relationship between disease activity and respiratory symptoms. Methods: We performed a systematic review of studies reporting on respiratory symptoms in adult patients with IBD. Cohort, randomized control trial, case-control, and cross-sectional study designs were eligible for inclusion. Sixteen studies were included, specifically nine cohort studies, five case-control studies, and two cross-sectional studies. The primary outcome was the total number of patients with respiratory symptoms including cough (nonproductive and productive), wheezing, and dyspnea. Chi-square tests were utilized to analyze differences in prevalence of symptoms. As many studies reported only one symptom, percentages were calculated out of the total number of patients in studies that reported each symptom. Results: This study included 8132 total patients with IBD, including 487 (6%) patients with active disease, 540 (6.6%) patients with inactive disease, 7105 (87.4%) patients with no disease activity reported (Table 1). Because controls were selected for their healthiness, they were not included in this analysis. Over 37 percent of patients with active disease endorsed respiratory symptoms, compared to only 18.7 percent of patients with inactive disease (p = 0.0003). Patients with active IBD were more likely to report all forms of cough than patients with inactive disease (all cough: 19 (18.3%) vs 11 (6.2%), p = 0.0016; non-productive cough: 13 (12.5%) vs 9 (5.1%), p = 0.0255; productive cough: 6 (5.8%) vs 2 (1.1%), p = 0.024). There was no significant difference in dyspnea between patients with active disease and patients with inactive disease (22 (21.2%) vs 27 (13.6%), p = 0.0922). No study reported wheezing in patients with active disease, so comparison of rates of wheezing could not be drawn. Discussion: We found patients with active IBD to be at greater risk of experiencing respiratory symptoms, particularly cough compared to patients with inactive disease. Clinicians taking care of patients with IBD should be mindful of possible increased risk of pulmonary extraintestinal manifestations with active disease and consider additional monitoring and work-up during flares.
Figure: Title: Table 1: Summary of Respiratory Symptoms in IBD Patients and Controls By Disease Activity Caption: CD: Crohn’s Disease; IBD: Inflammatory Bowel Disease; NA: Not Applicable; NR: Not Reported; UC: Ulcerative Colitis. *p < 0.05 compared between active disease and inactive disease, ⁺no study reported on wheezing in patients with active IBD
