Pulmonary Manifestations of Inflammatory Bowel Disease and Treatment Strategies

Ulcerative colitis and Crohn's disease are multisystem illnesses that primarily affect the gut, but present with various extraintestinal manifestations. The pathogenesis behind these clinical features is poorly understood, and pulmonary manifestations of inflammatory bowel disease (IBD) are no exception. Research has suggested an intricate interplay between the mucosal immune system and the microbiotic environment between the gut and the lung, often termed the gut-lung axis. This dysregulated communication is demonstrated in a wide range of pulmonary complications involving the large and small airways, lung parenchyma, serosal tissues, and pulmonary vasculature; fistulous connection between the gastrointestinal tract and thoracic cavity; and drug toxicities. Most of these diseases have been well documented in case reports to respond to corticosteroid treatment regimens. However, a notable lack of treatment recommendations guiding the dosage and duration of steroid use and managing the disease refractory to therapy are available. In addition, the progressive and debilitating disease often remains a therapeutic challenge.

This review sheds light on the different strategies documented to treat the spectrum of pulmonary complications of IBD, including novel therapeutic approaches using immunomodulatory therapy, and summarizes their clinical and radiologic features with pathologic correlation.

Although their existence is well documented, further research is needed to develop evidence-based guidelines for diagnosing, managing, and preventing pulmonary complications of IBD.