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A4943 - Pulmonary Manifestations in Children with Inflammatory Bowel Disease
Author Block: S. M. Pillai1, F. Deshmukh2, J. Lentine2, R. E. Sockolow2, P. J. Christos3, Y. Lao3, G. M. Loughlin1, E. Barfield2; 1Pediatric Pulmonology Allergy and Immunology, Weill Cornell Medicine, NY, NY, United States, 2Pediatric Gastroenterology and Nutrition, Weill Cornell Medicine, NY, NY, United States, 3Department of Biostatistics and Epidemiology, Weill Cornell Medicine, NY, NY, United States.
Background: Over 80,000 children in the U.S. have inflammatory bowel disease (IBD). Extra-intestinal symptoms are a common feature in IBD. Although infrequent, patients report pulmonary symptoms such as cough, wheeze and dyspnea. The spectrum of lung involvement is broad and the diagnosis challenging. Available literature on pulmonary disease in pediatric IBD is limited to case series and reports. The goals of this study were to determine the prevalence of pulmonary manifestations in an urban pediatric IBD cohort and evaluate the impact of these symptoms on patients’ overall health and daily lives. Methods: The study was approved by the Weill Cornell Medicine IRB. Ninety-two IBD patients ages 12-22 years completed St. George’s Respiratory Questionnaire (SGRQ), a validated measure of pulmonary quality of life and overall health. The questionnaire addresses frequency of respiratory symptoms such as cough, wheeze, sputum production and exertional dyspnea, disturbances to physical activity and impairment of psycho-social functioning in the last 3 months. SGRQ ≥ 25 was considered indicative of having respiratory problems. Chart review provided demographic information. Disease activity score (Pediatric Crohn’s disease Activity Index [PCDAI] or Pediatric Ulcerative Colitis Activity Index [PDCAI]) was recorded from day of enrollment. REDCap™ was used for data collection. The prevalence of pulmonary manifestations was calculated and compared to the expected prevalence of asthma in children globally using a one-sample test. The relationship between SGRQ and PCDAI/PUCAI was evaluated using Pearson coefficient. All p-values were two-sided with statistical significance of p ≤ 0.05 alpha. Results: The median age of diagnosis of IBD in this cohort of children was 13 years (range 3 to 18) and 58% were males (n=92); 77 % of children with Crohn’s disease (CD); 17% had Ulcerative colitis (UC) and 5% had Indeterminate colitis). The prevalence of pulmonary symptoms with IBD was 10.9% (95% CI: 5.3% to 19.1%), compared to approximately 14% in children with asthma (p=0.45). There was a positive and significant association observed between SGRQ score and PCDAI score (n = 74, r=0.21, p=0.0002). Females had higher mean SGRQ scores compared to males (regression coefficient = 0.6, p=0.006). This finding was maintained when a cutoff of >=25 was applied (adjusted odds ratio = 4.1; p=0.07; non-significant trend). Conclusion: Our study suggests that pulmonary manifestations are common in pediatric IBD. Providers should routinely inquire about pulmonary symptoms in children with IBD. Early recognition of pulmonary symptoms and initiation of therapy may improve long term patient outcomes