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Review
. 2023 Oct 9;12(19):6419.
doi: 10.3390/jcm12196419.

Lung Involvement in Inflammatory Bowel Diseases: Shared Pathways and Unwanted Connections

Carolina Aliai Micol Cavalli  1   2 , Roberto Gabbiadini  1 , Arianna Dal Buono  1 , Alessandro Quadarella  1   2 , Alessandro De Marco  1   2 , Alessandro Repici  2   3 , Cristina Bezzio  1   2 , Edoardo Simonetta  4 , Stefano Aliberti  2   4 , Alessandro Armuzzi  1   2
Affiliations
Review

Lung Involvement in Inflammatory Bowel Diseases: Shared Pathways and Unwanted Connections

Carolina Aliai Micol Cavalli et al. J Clin Med. .

Abstract

Inflammatory bowel diseases (IBDs) are chronic, relapsing inflammatory disorders of the gastrointestinal tract, frequently associated with extraintestinal manifestations (EIMs) that can severely affect IBD patients' quality of life, sometimes even becoming life-threatening. Respiratory diseases have always been considered a rare and subsequently neglected extraintestinal manifestations of IBD. However, increasing evidence has demonstrated that respiratory involvement is frequent in IBD patients, even in the absence of respiratory symptoms. Airway inflammation is the most common milieu of IBD-related involvement, with bronchiectasis being the most common manifestation. Furthermore, significant differences in prevalence and types of involvement are present between Crohn's disease and ulcerative colitis. The same embryological origin of respiratory and gastrointestinal tissue, in addition to exposure to common antigens and cytokine networks, may all play a potential role in the respiratory involvement. Furthermore, other causes such as drug-related toxicity and infections must always be considered. This article aims at reviewing the current evidence on the association between IBD and respiratory diseases. The purpose is to raise awareness of respiratory manifestation among IBD specialists and emphasize the need for identifying respiratory diseases in early stages to promptly treat these conditions, avoid worsening morbidity, and prevent lung damage.

Keywords: airway inflammation; drug-induced lung injury; inflammatory bowel disease; lung cancer; lung involvement; pneumonia; respiratory tract infections; treatment.

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Conflict of interest statement

A Armuzzi has received consulting fees from AbbVie, Allergan, Amgen, Arena, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Celltrion, Eli-Lilly, Ferring, Galapagos, Gilead, Janssen, MSD, Mylan, Pfizer, Protagonist Therapeutics, Roche, Samsung Bioepis, Sandoz, and Takeda; speaker’s fees from AbbVie, Amgen, Arena, Biogen, Bristol-Myers Squibb, Eli-Lilly, Ferring, Galapagos, Gilead, Janssen, MSD, Novartis, Pfizer, Roche, Samsung Bioepis, Sandoz, Takeda, and Tigenix; and research support from MSD, Takeda, Pfizer, and Biogen. R Gabbiadini has received speaker’s fees from Pfizer. A Dal Buono has received speaker’s fees from AbbVie. A Repici received consultancy fee from Medtronic and Erbe. CB received lecture fees and served as a consultant for Takeda, MSD, Ferring, Abbvie, Galapagos. and Janssen. S Aliberti has received consulting and speaker’s fees from Insmed incorporated, Insmed Italy, Insmed Ireland Ltd., Chiesi, Fisher & Paykel, McGraw Hill, MSD Italia S.r.l., AstraZeneca UK Limited, AstraZeneca Pharmaceutical LP, CSL Behring GmbH Moderna, Grifols, Fondazione Internazionale MENARINI, Moderna, BRAHMS, Physioassist SAS, GlaxoSmithKline Spa, and Thermo Fisher Scientific, ZAMBON Spa, and GSK. CAM Cavalli, A Quadarella, A De Marco, E Simonetta declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Pathogenesis of respiratory involvement in IBD patients. Gut epithelium (left) and lung epithelium (right). IL, interleukin; IFN-γ, interferon gamma; TNF-α, tumor necrosis factor; VEGF, vascular endothelial growth factor; CCR3, C-C chemokine receptor 3; CXCR5, C-X-C chemokine receptor 5.
Figure 2
Figure 2
A 23-year-old man with Crohn’s disease. Axial HRCT scans (a–d) show scattered bilateral cylindrical bronchiectasis. Findings on ileocolonoscopy (e–g) include multiple ulcerations > 1 cm involving terminal ileum mucosa.
See this image and copyright information in PMC

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