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Re: Herrlinger et al.—pulmonary function abnormalities in inflammatory bowel disease
THE AMERICAN JOURNAL OF GASTROENTEROLOGY © 2002 by Am. Coll. of Gastroenterology Published by Elsevier Science Inc.
Vol. 97, No. 11, 2002 ISSN 0002-9270/02/$22.00
LETTERS TO THE EDITOR Re: Herrlinger et al.—Pulmonary Function Abnormalities in Inflammatory Bowel Disease TO THE EDITOR: We read with interest the recent article by Herrlinger et al. (1). The authors have demonstrated significant alterations in forced expiratory volume in 1 second (FEV1), inspiratory vital capacity, Tiffeneau value, and lung carbon monoxide transfer capacity in patients with inflammatory bowel disease compared with healthy controls. Variability of the results both in favor (2, 3) and against (4, 5) such association reported in previous trials may be related to the presence of multiple confounding factors. Nutritional status has been shown to have significant influence on the overall pulmonary function in otherwise healthy individuals and in patients with inflammatory bowel disease (6 – 8). In a previous study, Christie and Hill (7) demonstrated a 35% loss of body protein stores and associated 20 – 40% physiological impairment in patients with acute exacerbations of Crohn’s disease compared with controls. The associated reduction reported for FEV1, vital capacity, and maximal voluntary ventilation was in the range of 25– 40%. There was significant immediate and delayed improvement of these parameters after 2 wk of nutritional supplementation and further improvement on restoration of body proteins during convalescence. In our opinion, the significant alterations in FEV1 and inspiratory vital capacity reported by Herrlinger et al. (1) cannot be entirely ascribed to disease process or activity alone. Additional information on the nutritional status of the study population should have been included to fully clarify the reported association. Similarly, previous controversial results showing lung carbon monoxide transfer capacity alteration in inflammatory bowel disease patients demand carefully designed future prospective studies, considering all possible confounding factors including nutritional status of the study population. Asghar Qasim, M.R.C.P.I. Ramona McLoughlin, M.R.C.P.I. Martin Buckley, F.R.C.P.I. Colm O’Morain, M.D., D.Sc., F.R.C.P.I., F.E.B.G., F.A.C.G., F.R.C.P. (U.K.) Department of Gastroenterology Trinity College/Adelaide and Meath Hospital Dublin, Ireland
REFERENCES 1. Herrlinger KR, Noftz MK, Dalhoff K, et al. Alterations in pulmonary function in inflammatory bowel disease are frequent
2. 3. 4. 5.
6. 7. 8.
and persist during remission. Am J Gastroenterol 2002;97:377– 81. Tzanakis N, Samiou M, Bouros D, et al. Small airways function in patients with inflammatory bowel disease. Am J Respir Cirt Care Med 1998;157:382– 6. Munck A, Murciano D, Pariente R, et al. Latent pulmonary function abnormalities in children with Crohn’s disease. Eur Respir J 1995;8:377– 80. Eade OE, Smith CL, Alexander JR, et al. Pulmonary function in patients with inflammatory bowel disease. Am J Gastroenterol 1980;73:154 – 6. Bonniere P, Wallaert B, Cortot A, et al. Latent pulmonary involvement in Crohn’s disease: Biological, functional, bronchoalveolar lavage and scintigraphic studies. Gut 1986;27:919 – 25. Faridi MM, Gupta P, Prakash A. Lung functions in malnourished children aged five to eleven years. Indian Pediatr 1995; 32:35– 42. Christie PM, Hill GL. Effect of intravenous nutrition on nutrition and function in acute attacks of inflammatory bowel disease. Gastroenterology 1990;99:730 – 6. Aroral NS, Rochester DF. Respiratory muscle strength and maximal voluntary ventilation in undernourished patients. Am Rev Respir Dis 1982;126:5– 8.
Reprint requests and correspondence: Asghar Qasim, M.R.C.P.I., Lecturer/Registrar, Clinical Medicine, Trinity College Dublin, Department of Gastroenterology, Adelaide and Meath Hospital, incorporating National Children Hospital, Tallaght, Dublin 24, Ireland. Received Apr. 23, 2002; accepted July 1, 2002.
Response to Drs. Qasim et al.—Lack of Influence of Nutritional Status on Pulmonary Function in Inflammatory Bowel Disease TO THE EDITOR: We appreciate the thoughtful comments from Qasim et al. (1) on our paper on pulmonary dysfunction in inflammatory bowel disease (2). Multiple variables may influence pulmonary function tests especially in patients with inflammatory bowel disease. We were able to rule out several variables, including disease entity and 5-acetylsalicylic acid medication. In their letter, Qasim et al. (1) postulate a strong influence of nutritional status on pulmonary function. Regarding our patients, the majority of patients overlapped the average body weight for age and height (median 0.95 ⫾ 0.19 of average body weight, range 0.62–1.59). To look for an influence of the nutritional status on pulmonary function tests, we correlated the relative average body weight to forced expiratory volume in 1 s, inspiratory vital capacity, and lung carbon monoxide transfer capacity (% predicted). There was a very weak correlation for inspiratory vital capacity (r ⫽ 0.25, p ⬍ 0.05) and
Vol. 97, No. 11, 2002 ISSN 0002-9270/02/$22.00
LETTERS TO THE EDITOR Re: Herrlinger et al.—Pulmonary Function Abnormalities in Inflammatory Bowel Disease TO THE EDITOR: We read with interest the recent article by Herrlinger et al. (1). The authors have demonstrated significant alterations in forced expiratory volume in 1 second (FEV1), inspiratory vital capacity, Tiffeneau value, and lung carbon monoxide transfer capacity in patients with inflammatory bowel disease compared with healthy controls. Variability of the results both in favor (2, 3) and against (4, 5) such association reported in previous trials may be related to the presence of multiple confounding factors. Nutritional status has been shown to have significant influence on the overall pulmonary function in otherwise healthy individuals and in patients with inflammatory bowel disease (6 – 8). In a previous study, Christie and Hill (7) demonstrated a 35% loss of body protein stores and associated 20 – 40% physiological impairment in patients with acute exacerbations of Crohn’s disease compared with controls. The associated reduction reported for FEV1, vital capacity, and maximal voluntary ventilation was in the range of 25– 40%. There was significant immediate and delayed improvement of these parameters after 2 wk of nutritional supplementation and further improvement on restoration of body proteins during convalescence. In our opinion, the significant alterations in FEV1 and inspiratory vital capacity reported by Herrlinger et al. (1) cannot be entirely ascribed to disease process or activity alone. Additional information on the nutritional status of the study population should have been included to fully clarify the reported association. Similarly, previous controversial results showing lung carbon monoxide transfer capacity alteration in inflammatory bowel disease patients demand carefully designed future prospective studies, considering all possible confounding factors including nutritional status of the study population. Asghar Qasim, M.R.C.P.I. Ramona McLoughlin, M.R.C.P.I. Martin Buckley, F.R.C.P.I. Colm O’Morain, M.D., D.Sc., F.R.C.P.I., F.E.B.G., F.A.C.G., F.R.C.P. (U.K.) Department of Gastroenterology Trinity College/Adelaide and Meath Hospital Dublin, Ireland
REFERENCES 1. Herrlinger KR, Noftz MK, Dalhoff K, et al. Alterations in pulmonary function in inflammatory bowel disease are frequent
2. 3. 4. 5.
6. 7. 8.
and persist during remission. Am J Gastroenterol 2002;97:377– 81. Tzanakis N, Samiou M, Bouros D, et al. Small airways function in patients with inflammatory bowel disease. Am J Respir Cirt Care Med 1998;157:382– 6. Munck A, Murciano D, Pariente R, et al. Latent pulmonary function abnormalities in children with Crohn’s disease. Eur Respir J 1995;8:377– 80. Eade OE, Smith CL, Alexander JR, et al. Pulmonary function in patients with inflammatory bowel disease. Am J Gastroenterol 1980;73:154 – 6. Bonniere P, Wallaert B, Cortot A, et al. Latent pulmonary involvement in Crohn’s disease: Biological, functional, bronchoalveolar lavage and scintigraphic studies. Gut 1986;27:919 – 25. Faridi MM, Gupta P, Prakash A. Lung functions in malnourished children aged five to eleven years. Indian Pediatr 1995; 32:35– 42. Christie PM, Hill GL. Effect of intravenous nutrition on nutrition and function in acute attacks of inflammatory bowel disease. Gastroenterology 1990;99:730 – 6. Aroral NS, Rochester DF. Respiratory muscle strength and maximal voluntary ventilation in undernourished patients. Am Rev Respir Dis 1982;126:5– 8.
Reprint requests and correspondence: Asghar Qasim, M.R.C.P.I., Lecturer/Registrar, Clinical Medicine, Trinity College Dublin, Department of Gastroenterology, Adelaide and Meath Hospital, incorporating National Children Hospital, Tallaght, Dublin 24, Ireland. Received Apr. 23, 2002; accepted July 1, 2002.
Response to Drs. Qasim et al.—Lack of Influence of Nutritional Status on Pulmonary Function in Inflammatory Bowel Disease TO THE EDITOR: We appreciate the thoughtful comments from Qasim et al. (1) on our paper on pulmonary dysfunction in inflammatory bowel disease (2). Multiple variables may influence pulmonary function tests especially in patients with inflammatory bowel disease. We were able to rule out several variables, including disease entity and 5-acetylsalicylic acid medication. In their letter, Qasim et al. (1) postulate a strong influence of nutritional status on pulmonary function. Regarding our patients, the majority of patients overlapped the average body weight for age and height (median 0.95 ⫾ 0.19 of average body weight, range 0.62–1.59). To look for an influence of the nutritional status on pulmonary function tests, we correlated the relative average body weight to forced expiratory volume in 1 s, inspiratory vital capacity, and lung carbon monoxide transfer capacity (% predicted). There was a very weak correlation for inspiratory vital capacity (r ⫽ 0.25, p ⬍ 0.05) and