Adonis A Protopapas1, Stergios Vradelis2, Theodoros Karampitsakos3, Paschalis Steiropoulos4, Athanasios Chatzimichael3, Emmanouil Paraskakis3. 1. Department of Pediatrics, University Hospital of Alexandroupolis, Democritus University of Thrace, 68100, Alexandroupolis, Greece. adoprot@hotmail.com. 2. Second Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece. 3. Department of Pediatrics, University Hospital of Alexandroupolis, Democritus University of Thrace, 68100, Alexandroupolis, Greece. 4. Department of Pneumonology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
Abstract
INTRODUCTION: Pulmonary manifestations of inflammatory bowel disease (IBD), albeit not rare, are largely overlooked in clinical practice. The role of exhaled nitric oxide (eNO) as an established biological marker of airway inflammation compels us to use it as a tool to investigate the exact nature of these manifestations. METHODS: Fractional eNO (FeNO) was measured in multiple flows, and with the use of a mathematical model, alveolar concentration of NO (CANO) and bronchial flux of NO (JawNO) were assessed in 27 patients with IBD [17 with Crohn's disease (CD) and 10 with ulcerative colitis (UC)] and in 39 healthy controls. Carefully selected criteria were used to exclude patients or healthy controls that presented factors considered to be correlated with eNO measurements. Disease activity was measured in Crohn's patients using the CD activity index (CDAI) score and in UC using the partial Mayo score. RESULTS: CANO was significantly higher in the IBD group, compared to the control group (p < 0.0001). FeNO was significantly increased in patients with IBD (p = 0.023), while there was no statistical significance found regarding levels of JawNO in patients with IBD (p = 0.106), both compared to controls. There was no significant correlation between any eNO component and markers of disease activity. CONCLUSIONS: Alveolar concentration of NO is elevated in patients with IBD, regardless of disease activity. This may suggest that subclinical small airway inflammation is present in patients with IBD, even those with mild or inactive disease.
INTRODUCTION: Pulmonary manifestations of inflammatory bowel disease (IBD), albeit not rare, are largely overlooked in clinical practice. The role of exhaled nitric oxide (eNO) as an established biological marker of airway inflammation compels us to use it as a tool to investigate the exact nature of these manifestations. METHODS: Fractional eNO (FeNO) was measured in multiple flows, and with the use of a mathematical model, alveolar concentration of NO (CANO) and bronchial flux of NO (JawNO) were assessed in 27 patients with IBD [17 with Crohn's disease (CD) and 10 with ulcerative colitis (UC)] and in 39 healthy controls. Carefully selected criteria were used to exclude patients or healthy controls that presented factors considered to be correlated with eNO measurements. Disease activity was measured in Crohn's patients using the CD activity index (CDAI) score and in UC using the partial Mayo score. RESULTS:CANO was significantly higher in the IBD group, compared to the control group (p < 0.0001). FeNO was significantly increased in patients with IBD (p = 0.023), while there was no statistical significance found regarding levels of JawNO in patients with IBD (p = 0.106), both compared to controls. There was no significant correlation between any eNO component and markers of disease activity. CONCLUSIONS: Alveolar concentration of NO is elevated in patients with IBD, regardless of disease activity. This may suggest that subclinical small airway inflammation is present in patients with IBD, even those with mild or inactive disease.
Authors: M Berry; B Hargadon; A Morgan; M Shelley; J Richter; D Shaw; R H Green; C Brightling; A J Wardlaw; I D Pavord Journal: Eur Respir J Date: 2005-06 Impact factor: 16.671
Authors: P-R Burgel; A Bourdin; P Chanez; F Chabot; A Chaouat; T Chinet; J de Blic; P Devillier; A Deschildre; A Didier; G Garcia; G Jebrak; F Laurent; H Morel; T Perez; C Pilette; N Roche; I Tillie-Leblond; S Verbanck; D Dusser Journal: Eur Respir Rev Date: 2011-03
Authors: H Kimura; R Hokari; S Miura; T Shigematsu; M Hirokawa; Y Akiba; I Kurose; H Higuchi; H Fujimori; Y Tsuzuki; H Serizawa; H Ishii Journal: Gut Date: 1998-02 Impact factor: 23.059