Respiratory involvement in inflammatory bowel disease in children: a case-based narrative review

ABSTRACT

Pediatric Inflammatory Bowel Disease (IBD) is increasingly recognized as a systemic disorder, yet its respiratory implications remain frequently overlooked. While clinical data suggests a lung involvement rate below 1%, subclinical anomalies may affect up to 40% of young patients. We present the case of a 15-year-old boy with Crohn’s disease and chronic tracheobronchitis to highlight the diagnostic challenges in distinguishing primary extraintestinal manifestations from treatment-related toxicity or opportunistic infections. We analyze the spectrum of pediatric pulmonary involvement, where airway disease and interstitial lung disease often fluctuate independently of intestinal activity. Our synthesis suggests that tools such as impulse oscillometry and diffusing capacity of the lung for carbon monoxide (DLCO) are more sensitive than standard spirometry for early detection. A multidisciplinary approach and structured follow-up are essential to ensure early recognition, individualized management, and the prevention of long-term pulmonary sequelae.

IMPACT STATEMENT

Although pulmonary involvement in pediatric IBD is often considered rare, it is frequently underdiagnosed and can lead to irreversible lung damage. This perspective highlights the “gut-lung axis” and the critical role of early diagnostic tools, such as DLCO and impulse oscillometry, in identifying subclinical respiratory manifestations. Our work emphasizes that a high index of clinical suspicion and a multidisciplinary approach are essential for the timely recognition and management of these systemic complications in children and adolescents.

KEY WORDS

Pediatric inflammatory bowel disease; extraintestinal manifestations in pediatric IBD; pulmonary involvement in pediatric IBD; gut-lung axis; pulmonary function tests.