P0107 Bronchiectasis as an underrecognized extra-intestinal manifestation of Inflammatory Bowel Disease

Abstract Background Inflammatory bowel disease (IBD) often presents with extra-intestinal manifestations (EIMs). Pulmonary involvement is rare and underrecognized, yet it can have major clinical consequences for patients. The most common pulmonary EIM is bronchiectasis (BE). Preliminary evidence suggests that IBD-associated BE (IBD-BE) leads to increased healthcare use and higher mortality compared to IBD alone (1). This study aims to characterize patients with IBD-BE, assess diagnostic trajectories, and evaluate treatment outcomes. Methods We conducted a retrospective cohort study at the Amsterdam University Medical Centre, identifying IBD patients aged ≥ 18 years with a history of IBD-BE between February 2022 and May 2025. Patients were excluded if they had another underlying etiology of BE. Data on patient characteristics, diagnostic work-up, and treatment outcomes were extracted from electronic patient files between May 2025 and August 2025. BE severity was assessed using the Bronchiectasis Severity Index (BSI), and treatment outcomes were evaluated based on respiratory symptoms, pulmonary function tests (PFTs), and high-resolution computed tomography (HRCT) chest scans. Results Eighteen patients were included (mean age: 63 years; 55.6% male), with the majority presenting with ulcerative colitis (94.4%) and a history of IBD-related surgery (61.1%; figure 1). The median time from IBD diagnosis to respiratory symptom onset was 15 years (IQR 9-25). At onset, 88.9% of patients had quiescent disease, and 66.7% did not receive active IBD treatment. The median time from respiratory symptom onset to IBD-BE diagnosis was 4 years (IQR 1-8). All patients had BE on chest HRCT, with the majority showing mild BE (66.7%; BSI score 0-4) and concomitant findings (83.3%). Chronic productive cough was the most common symptom (88.9%). PFTs were near-normal (mean FEV1 83.6%, mean FVC 93.6%). Twelve patients (66.7%) received IBD-BE-specific treatment, including corticosteroids, immunomodulators, or biologicals (figure 2). Nine patients (50.0%) were treated with corticosteroids, of whom six (66.7%) clinically responded. Three patients (16.7%) received immunomodulators or biologicals, with two patients clinically responding. Conclusion This is the first cohort study to assess patient characteristics and treatment outcomes in IBD-BE patients, suggesting that IBD-BE is a distinct disease entity with specific features that may benefit from a treatment approach different from non-IBD-BE, laying the foundation for larger prospective studies. Early diagnosis and timely therapeutic interventions are crucial for improving patient outcomes. Reference: (1)Lee JS, Yang B, Shin HS, Lee H, Chai HG, Choi H, et al. Increased bronchiectasis risk and related risk factors in inflammatory bowel disease: a 10-year Korean national cohort study. ERJ Open Res. 2024;10(4). Conflict of interest: Te Slaa, Lynn: I have no conflicts of interest. Altenburg, Josje: Chiesi Pharmaceuticals - Unrestricted scientific grant Insmed - Participation in advisory board Vertex, Boehringer, Insmed - PI on clinical trials Takeda Nederland, Insmed, Chiesi - Speaker fee Löwenberg, Mark: No relevant CoI to disclose