Bronchiectasis as an Underrecognized Extraintestinal Manifestation of Inflammatory Bowel Disease
Lynn te Slaa, Josje Altenburg, Mark LöwenbergABSTRACT
Introduction
Inflammatory bowel diseases (IBD) are chronic inflammatory diseases of the gastrointestinal tract, often presenting with extraintestinal manifestations (EIMs). The most prevalent pulmonary EIM is IBD‐associated bronchiectasis (IBD‐BE), which is often overlooked. This study aimed to characterize the clinical phenotype of IBD‐BE, including diagnostic and therapeutic management.
Methods
We conducted a retrospective cohort study at Amsterdam UMC. Adult patients with IBD (≥ 18 years) with symptomatic BE confirmed on chest high‐resolution computed tomography (HRCT) were identified between February 2022 and May 2025. Data on patient characteristics and diagnostic and therapeutic management were extracted from electronic patient files. BE severity was assessed using the Bronchiectasis Severity Index (BSI score 0–4: mild; 5–8: moderate; ≥ 9: severe).
Results
In total, 18 patients with IBD‐BE were included (mean age: 63 years; 55.6% male; 94.4% ulcerative colitis). Eleven out of 18 patients (61.1%) had therapy‐refractory IBD, and 8/18 (44.4%) had ≥ 1 other EIM. The median time from IBD diagnosis to respiratory symptom onset was 15 years (IQR 9–25). Concomitant bronchiolitis and/or consolidations were found on chest HRCT in 83.3% of patients. Sputum cultures were negative in 16/17 patients (94.1%), and 12/18 (66.7%) had mild BE based on the BSI. Twelve out of 18 patients (66.7%) received IBD‐BE‐specific treatments, including corticosteroids, immunomodulators, or biologics; of these, 9/12 received corticosteroids, of whom 6 showed symptomatic improvement, and 3 showed improved pulmonary function tests.
Conclusion
Our findings suggest that IBD‐BE may represent a distinct phenotype of BE with patients facing a significant diagnostic delay. Compared to BE due to other etiologies, IBD‐BE may require a different treatment approach.