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The complex interrelationships between chronic lung and liver disease: a review

The complex interrelationships between chronic lung and liver disease: a review
The complex interrelationships between chronic lung and liver disease: a review
Lung complications may occur as a result of hepatic disease from any cause and represent a highly heterogeneous group of conditions. Early recognition of such complications may be challenging but is crucial both in forming a meaningful differential diagnosis and in avoiding severe sequelae and irreversible damage. Although a number of different pathogenetic mechanisms are likely to be involved, chronic liver dysfunction may cause pulmonary manifestations because of alterations in the production or clearance of circulating cytokines and other mediators. This is likely to be the case in hepatopulmonary syndrome, portopulmonary hypertension and primary biliary cirrhosis, although their pathogenesis remains largely speculative. Moreover, the severity of lung manifestations may or may not correspond to that of liver impairment, making disease outcome often unpredictable. Congenital and inflammatory disorders, however, may primarily affect both the liver and lung. Apart from specific diseases, a number of medications can also result in pulmonary and hepatic toxic effects. This is particularly important with cytokine therapy - used to treat viral hepatitis, among other diseases - because treatment consists of drug discontinuation, which, in turn, may cause reactivation or progression of the underlying disease that the drug was used for. This review summarizes salient diagnostic and therapeutic aspects of these often misdiagnosed conditions and highlights, based on the most recent literature, the need for early referral of such patients to centres with specific expertise in the field. In fact, a multidisciplinary approach involving pulmonologists, hepatologists and, in particularly severe cases, transplant surgeons has been already proven successful.
1352-0504
381-390
Spagnolo, P.
dfc6600e-bbca-4678-abc4-6feb243d4fbb
Zeuzem, S.
4abb9589-3443-4b6e-97fe-4218c0f06aff
Richeldi, L.
47177d9c-731a-49a1-9cc6-4ac8f6bbbf26
du Bois, R.M.
e99dbf8f-b9a7-427b-a425-f44e22ff4c0d
Spagnolo, P.
dfc6600e-bbca-4678-abc4-6feb243d4fbb
Zeuzem, S.
4abb9589-3443-4b6e-97fe-4218c0f06aff
Richeldi, L.
47177d9c-731a-49a1-9cc6-4ac8f6bbbf26
du Bois, R.M.
e99dbf8f-b9a7-427b-a425-f44e22ff4c0d

Spagnolo, P., Zeuzem, S., Richeldi, L. and du Bois, R.M. (2010) The complex interrelationships between chronic lung and liver disease: a review. Journal of Viral Hepatitis, 17 (6), 381-390. (doi:10.1111/j.1365-2893.2010.01307.x). (PMID:20384964)

Record type: Article

Abstract

Lung complications may occur as a result of hepatic disease from any cause and represent a highly heterogeneous group of conditions. Early recognition of such complications may be challenging but is crucial both in forming a meaningful differential diagnosis and in avoiding severe sequelae and irreversible damage. Although a number of different pathogenetic mechanisms are likely to be involved, chronic liver dysfunction may cause pulmonary manifestations because of alterations in the production or clearance of circulating cytokines and other mediators. This is likely to be the case in hepatopulmonary syndrome, portopulmonary hypertension and primary biliary cirrhosis, although their pathogenesis remains largely speculative. Moreover, the severity of lung manifestations may or may not correspond to that of liver impairment, making disease outcome often unpredictable. Congenital and inflammatory disorders, however, may primarily affect both the liver and lung. Apart from specific diseases, a number of medications can also result in pulmonary and hepatic toxic effects. This is particularly important with cytokine therapy - used to treat viral hepatitis, among other diseases - because treatment consists of drug discontinuation, which, in turn, may cause reactivation or progression of the underlying disease that the drug was used for. This review summarizes salient diagnostic and therapeutic aspects of these often misdiagnosed conditions and highlights, based on the most recent literature, the need for early referral of such patients to centres with specific expertise in the field. In fact, a multidisciplinary approach involving pulmonologists, hepatologists and, in particularly severe cases, transplant surgeons has been already proven successful.

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Published date: June 2010
Organisations: Clinical & Experimental Sciences

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Local EPrints ID: 369076
URI: http://eprints.soton.ac.uk/id/eprint/369076
ISSN: 1352-0504
PURE UUID: 49a8e1b7-f3ca-4e2c-a381-66ecf9d1d6a0

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Date deposited: 24 Sep 2014 11:15
Last modified: 14 Mar 2024 17:57

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Contributors

Author: P. Spagnolo
Author: S. Zeuzem
Author: L. Richeldi
Author: R.M. du Bois

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