Patients With Inflammatory Bowel Disease Are at Increased Risk of Interstitial Lung Diseases

INTRODUCTION: Pulmonary manifestations have been postulated in inflammatory bowel disease (IBD), but supporting data are scarce. We examined the risk of interstitial lung diseases (ILD) in IBD and its subtypes (ulcerative colitis, Crohn's disease, and IBD-unclassified). METHODS: We conducted a nationwide cohort study of individuals diagnosed with IBD in Sweden between 1969 and 2019 and followed until 2021. For each patient, we identified up to 5 matched general-population comparators. Through Cox regression, we examined adjusted hazard ratios for ILD as defined by diagnostic codes in the National Patient Register. In a secondary analysis, patients with IBD were compared with their siblings free of IBD. RESULTS: We identified 85,705 patients with IBD and 412,677 general-population comparators. Over a median follow-up of 14 years, 438 patients (0.51%) with IBD and 1,253 comparators (0.30%) were diagnosed with ILD, corresponding to incidence rates of 34 and 20 per 100,000 person-years, respectively. Patients with IBD had a 48% greater relative risk of ILD (95% confidence interval 1.30-1.69). Stratified analyses showed increased risk in both ulcerative colitis and Crohn's disease. Patients with IBD also had a significantly greater risk of developing ILD compared with their siblings (adjusted hazard ratio 1.81, 95% confidence interval 1.43-2.27). DISCUSSION: In this nationwide cohort study of >85,000 patients with incident IBD, we found an increased risk of ILD.