• Crohn’s disease
• HRCT
• bronchiectasis
• inflammatory bowel disease
• prevalence
• ulcerative colitis

• alanyl-glutamine (Ala-Gln)
• colitis
• gut microbiota
• pulmonary injury
• signaling pathways

• Airway
• Crohn disease
• Inflammatory bowel disease
• Prevalence
• Pulmonary
• Respiratory
• Ulcerative colitis

• airways
• children
• gut–lung axis
• immunity
• inflammation
• molecular
• pulmonary function tests

• Child
• Humans
• Inflammatory Bowel Diseases/complications
• Inflammatory Bowel Diseases/diagnosis
• Infliximab/therapeutic use
• Lung
• Mesalamine
• Proline

The prevalence of inflammatory bowel disease (IBD) has increased over the past 20 years. Pulmonary involvement in paediatric IBD is rare but may be missed since the spectrum of symptoms is broad and mimics other diseases. The most important differential diagnoses of pulmonary manifestations of IBD are infections and therapy-related side-effects. There is no gold standard to diagnose respiratory manifestations in children with IBD. Diagnostic tests should be chosen according to history and clinical presentation. Treatment of respiratory manifestations of IBD includes inhaled or oral corticosteroids and initiation or step-up of immunomodulatory IBD therapies.

Pulmonary involvement in paediatric IBD is rare but may be underdiagnosed. The spectrum of symptoms is broad and mimics other diseases. The differentiation between IBD-related and drug-induced pulmonary manifestation can be challenging.https://bit.ly/3uZBvpA

• extraintestinal manifestations
• inflammatory bowel disease
• respiratory tract manifestations

• Extraintestinal manifestation
• Occult pulmonary disease
• Pulmonary involvement
• Restrictive pattern
• Ulcerative colitis

Necrobiotic pulmonary nodules are an exceptionally rare extraintestinal manifestation of inflammatory bowel disease. Recognition is imperative because it may mimic other autoimmune pathologies such as granulomatosis with polyangiitis or sarcoidosis. We describe a 19-year-old man with a known history of ulcerative colitis who was found to possess bilateral pulmonary nodules on computed tomography imaging. Investigations that included an extensive autoimmune and infectious workup were inconclusive. Biopsy of the nodules revealed fibrinous exudate and palisading histiocytes that confirmed the diagnosis. He was started on prednisone therapy. A follow-up computed tomography a month later revealed near complete resolution.

• inflammatory bowel disease
• pulmonary nodules
• ulcerative colitis

We report a unique case of ulcerative colitis-associated bronchiectasis in a pediatric patient 6 years after colectomy. The patient presented with a chronic cough and had a computed tomography demonstrating bronchiectasis. She was treated with sputum expectoration (airway clearance) via chest physiotherapy and pulse-dose steroids with a prolonged oral taper. Her initial response was excellent; however, she experienced a recurrence of symptoms with de-escalation of airway clearance. Pulmonary extraintestinal manifestations of inflammatory bowel disease are most often diagnosed later in life. Both the severity of this patient's presentation and her age are unique to this case.

Inflammatory bowel disease (IBD) is an umbrella term encompassing intestinal conditions Crohn's disease and ulcerative colitis (UC), characterized by inflammation of intestinal wall, differing in location, depth, pathophysiology, and sequela. Extraintestinal manifestations (EIM) of IBD commonly affect the skin, joints, eyes, and in rare instances, the lungs. Pulmonary involvement affects the large and small airways, serosal surface, and vasculature leading to a range of pathology, including bronchiectasis, pleural effusions, and necrobiotic nodules. The presence of EIM is uncommon at the diagnosis, particularly in regard to pulmonary EIM, most commonly seen years later. We present the case of a 22-year-old African American female who was discovered to have pulmonary involvement of her UC at the time of her diagnosis complicating management of her appendicitis.

A 22-year-old female with a history of UC was transferred from an outside hospital for the management of her appendicitis after imaging revealed numerous pulmonary nodules. The presence of multiple cavitary pulmonary nodules delayed surgical intervention leading to a ruptured appendix. The patient had no cardiopulmonary complaints, and review of prior imaging studies showed these nodules to be present six weeks prior, the time of her diagnosis with UC. After antibiotic management failed, the patient required a laparotomy appendectomy with omentectomy due to resulting appendiceal abscess and phlegmon. The nodules were determined to be EIM of UC after sarcoidosis, infectious, and malignant etiologies were ruled out. For the pulmonary nodules, she is following at an outside hospital for the management of her UC as treatment of her underlying UC will result in a decrease or resolution of the EIM.

EIM of IBD may present in patients at any time, even before their initial diagnosis of an IBD. While pulmonary manifestations are rare EIM, the presence of pulmonary nodules at the time of initial diagnosis is exceedingly uncommon. Evaluation and management of these nodules, even if asymptomatic in nature, requires diligence and thorough documentation regarding their onset and etiology. In the event of a medical emergency, such as in the case of our patient with appendicitis, a lack of thorough documentation and evaluation of the nodules may result in unnecessary medical testing, invasive procedures, and delay in treatment of their current medical illness.

• appendicitis
• extraintestinal manifestations
• inflammatory bowel disease
• pulmonary nodules
• ulcerative colitis

• Claims data
• Crohn's disease
• Idiopathic pulmonary fibrosis
• Inflammatory bowel disease
• Ulcerative colitis

• Disease activity
• Exhaled nitric oxide
• Inflammatory bowel disease
• Small airway inflammation

• Ankylosing spondylitis
• Axial spondyloarthritis
• Inflammatory bowel disease
• Pulmonary
• Relapsing polychondritis
• Respiratory
• Thoracic

Crohn’s disease (CD) is a granulomatous inflammatory disease that can involve any part of the gastrointestinal tract, from mouth to anus. In most cases, it remits and relapses in the terminal ileum, requiring treatment via steroid boluses. In rare cases, however, CD can involve the pulmonary system presenting as dyspnea on exertion and dry cough. We present a case of a 38-year-old man who developed shortness of breath, cough, and wheezing for one month after a colectomy procedure due to recurrent toxic megacolon. He recovered and tolerated extubation successfully and was prescribed mesalamine as maintenance therapy for CD. His pulmonary symptoms after the colectomy, along with his imaging and pulmonary function tests, indicated pulmonary involvement in the lungs as a progression of the primary inflammatory bowel disease. After confirming this diagnosis, he was treated with oral high-dose steroids after successful diagnosis, and the patient’s symptoms improved dramatically. This case highlights often overlooked CD bronchopulmonary involvement in the postoperative period.

• colectomy
• crohn’s disease
• inflammatory bowel disease
• mesalamine
• relapse
• steroids

Interstitial lung disease is a rare but increasingly recognized extraintestinal manifestation of inflammatory bowel disease that can have devastating consequences if left untreated. We report a case of ulcerative colitis–associated interstitial lung disease presenting with acute hypoxic respiratory failure during an ulcerative colitis flare. Gastroenterologists and pulmonologists should be aware of the numerous bronchopulmonary signs and symptoms that can suggest systemic illness in inflammatory bowel disease.

• Crohn disease
• High-resolution computed tomography
• chest
• inflammatory bowel disease
• ulcerative colitis

Ulcerative colitis can cause inflammation of small and large airways, characterized by mucosal inflammation, tracheobronchial stenosis, bronchiestasis, and bronchiolitis. We present a case of tracheobronchitis and bronchiolitis associated with ulcerative colitis in a 58-year-old nonsmoking man, 17 years after the total colectomy and complete resolution of intestinal findings. Computed tomography demonstrated wall thickening of trachea and left main stem bronchus, and multiple bronchi around the both hilum with mild to moderate stenosis. Fiberoptic bronchial biopsy showed inflammation of the airways, similar to histologic findings of ulcerative colitis within colon.

• Lung
• Trachea
• Ulcerative colitis

• inflammatory bowel disease
• pulmonary function test
• small airways
• spirometer

Crohn disease is an immune-mediated inflammatory condition with gastrointestinal and extraintestinal manifestations in patients. Pulmonary involvement of Crohn disease is one manifestation. There have been case reports which have shown Crohn disease and lung nodules which were noted to be histopathological as cryptogenic organizing pneumonia (COP). In our case, a 22-year-old woman with Crohn disease was seen with complaints of chest pain and cough. Computed tomographic scan of chest showed multiple bilateral lung nodules, for which biopsy was done, which showed COP. The case study is followed by a deeper discussion of COP and the extraintestinal manifestation seen in inflammatory bowel disease.

• COP
• Crohn disease
• lung nodules

• Extraintestinal manifestations
• Inflammatory bowel disease
• Multiple organ systems

• Crohn disease
• Inflammatory bowel diseases
• Tracheobronchial involvement

• Crohn's disease
• inflammatory bowel disease
• pulmonary function tests
• sputum
• ulcerative colitis

• Crohn's disease
• inflammatory bowel disease
• interstitial lung disease
• tracheobronchitis
• ulcerative colitis

• EIM, extra-intestinal manifestations
• IBD, inflammatory bowel disease
• Inflammatory bowel disease
• Infliximab
• Pulmonary extraintestinal manifestations
• TNF, tumor necrosis factor

Systemic involvement is well known in patients with inflammatory bowel diseases (IBD), but there are only few data looking to Crohn’s disease (CD) and ulcerative colitis (UC) separately instead of lumping together both entities to IBD. The frequency of bronchial involvement in UC is not yet exactly analysed but reported to be rare. We asked 100 patients with UC for bronchial complaints, and found in 13 patients a bronchial affection. From reports in the literature it is known that sometimes a bronchial involvement in patients with UC can affect the whole bronchial tree including small bronchi. The involvement of bronchial system in UC is obviously more prominent than previously thought and may fulfil the criteria for a separate syndrome. These relations may have consequences for pathogenetic understanding of UC as well as bronchitis and also consequences for treatment regimes.

• Crohn’s disease
• bronchiectasis
• bronchitis
• inflammatory bowel disease
• ulcerative colitis

Extraintestinal manifestations occur commonly in inflammatory bowel diseases (IBD). Pulmonary manifestations (PM) of IBD may be divided in airway disorders, interstitial lung disorders, serositis, pulmonary vasculitis, necrobiotic nodules, drug-induced lung disease, thromboembolic lung disease and enteropulmonary fistulas. Pulmonary involvement may often be asymptomatic and detected solely on the basis of abnormal screening tests. The common embryonic origin of the intestine and the lungs from the primitive foregut, the co-existence of mucosa associated lymphoid tissue in both organs, autoimmunity, smoking and bacterial translocation from the colon to the lungs may all be involved in the pathogenesis of PM in IBD. PM are mainly detected by pulmonary function tests and high-resolution computed tomography. This review will focus on the involvement of the airways in the context of IBD, especially stenoses of the large airways, tracheobronchitis, bronchiectasis, bronchitis, mucoid impaction, bronchial granulomas, bronchiolitis, bronchiolitis obliterans syndrome and the co-existence of IBD with asthma, chronic obstructive pulmonary disease, sarcoidosis and a1-antitrypsin deficiency.

• Inflammatory bowel diseases
• Airways
• Bronchiolitis

Extraintestinal manifestations of inflammatory bowel disease (IBD) are a systemic illness that may affect up to half of all patients. Among the extraintestinal manifestations of IBD, those involving the lungs are relatively rare and often overlooked. However, there is a wide array of such manifestations, spanning from airway disease to lung parenchymal disease, thromboembolic disease, pleural disease, enteric-pulmonary fistulas, pulmonary function test abnormalities, and adverse drug reactions. The spectrum of IBD manifestations in the chest is broad, and the manifestations may mimic other diseases. Although infrequent, physicians dealing with IBD must be aware of these conditions, which are sometimes life-threatening, to avoid further health impairment of the patients and to alleviate their symptoms by prompt recognition and treatment. Knowledge of these manifestations in conjunction with pertinent clinical data is essential for establishing the correct diagnosis and treatment. The treatment of IBD-related respiratory disorders depends on the specific pattern of involvement, and in most patients, steroids are required in the initial management. Corticosteroids, both systemic and aerosolized, are the mainstay therapeutic approach, while antibiotics must also be administered in the case of infectious and suppurative processes, whose sequelae sometimes require surgical intervention.

• Inflammatory bowel diseases
• Crohn’s disease
• Ulcerative colitis
• Lung diseases

• Anti-Inflammatory Agents/adverse effects
• Biological Products/adverse effects
• Gastrointestinal Agents/adverse effects
• Humans
• Inflammatory Bowel Diseases/complications
• Inflammatory Bowel Diseases/diagnosis
• Inflammatory Bowel Diseases/drug therapy
• Lung Diseases/chemically induced
• Lung Diseases/diagnosis
• Lung Diseases/etiology
• Lung Diseases/therapy
• Predictive Value of Tests
• Risk Factors
• Treatment Outcome

• Adolescent
• Adult
• Bronchiolitis/complications
• Bronchiolitis/diagnosis
• Bronchiolitis/pathology
• Colitis, Ulcerative/complications
• Colitis, Ulcerative/drug therapy
• Crohn Disease/complications
• Crohn Disease/drug therapy
• Cryptogenic Organizing Pneumonia/complications
• Cryptogenic Organizing Pneumonia/diagnosis
• Cryptogenic Organizing Pneumonia/pathology
• Female
• Histiocytosis, Langerhans-Cell/complications
• Histiocytosis, Langerhans-Cell/diagnosis
• Histiocytosis, Langerhans-Cell/pathology
• Humans
• Inflammatory Bowel Diseases/complications
• Inflammatory Bowel Diseases/drug therapy
• Lung/pathology
• Lung Diseases/chemically induced
• Lung Diseases/complications
• Lung Diseases/etiology
• Lung Diseases, Interstitial/complications
• Lung Diseases, Interstitial/diagnosis
• Lung Diseases, Interstitial/pathology
• Male
• Middle Aged
• Multiple Pulmonary Nodules/complications
• Multiple Pulmonary Nodules/diagnosis
• Multiple Pulmonary Nodules/pathology
• Young Adult

Inflammatory bowel diseases (IBD) include ulcerative colitis (UC) and Crohn's disease (CD) and are due to a dysregulation of the antimicrobial defense normally provided by the intestinal mucosa. This inflammatory process may extend outside the bowel to many organs and also to the respiratory tract. The respiratory involvement in IBD may be completely asymptomatic and detected only at lung function assessment, or it may present as bronchial disease or lung parenchymal alterations. Corticosteroids, both systemic and aerosolized, are the mainstay of the therapeutical approach, while antibiotics must be also administered in the case of infectious and suppurative processes, whose sequels sometimes require surgical intervention. The relatively high incidence of bronchopulmonary complications in IBD suggests the need for a careful investigation of these patients in order to detect a possible respiratory involvement, even when they are asymptomatic.

Inflammatory bowel disease (IBD) has been associated with either clinical or subclinical airway and parenchymal lung involvement and interstitial lung complications. Several studies have reported that atopy has a high prevalence in IBD patients. Overlapping allergic disorders seem to be present in both the respiratory and gastrointestinal systems. The purpose of this review is to update clinicians on recent available literature and to discuss the need for a highly suspicious approach by clinicians.

• Atopy
• Inflammatory bowel disease
• Pulmonary involvement

• Bronchitis/complications
• Bronchitis/diagnosis
• Crohn Disease/complications
• Crohn Disease/diagnosis
• Humans
• Male
• Tracheitis/complications
• Tracheitis/diagnosis
• Young Adult

• Adult
• Anti-Inflammatory Agents/therapeutic use
• Anti-Inflammatory Agents, Non-Steroidal/adverse effects
• Bronchopneumonia/chemically induced
• Bronchopneumonia/diagnosis
• Bronchopneumonia/drug therapy
• Female
• Humans
• Mesalamine/adverse effects
• Methylprednisolone/therapeutic use