From Villi to Alveoli: Lung Involvement in Celiac Disease - A Narrative Review.

Abstract

Background: Celiac disease (CD) is a chronic, immune-mediated enteropathy triggered by gluten that affects about 1% of the population and may present with extraintestinal manifestations. Pulmonary complications are considered rare and are poorly characterized. Lane-Hamilton syndrome is the best described lung manifestation, but data suggests a broader spectrum of respiratory involvement.

Methods: We performed a narrative review with structured search strategy of PubMed and Embase (January 1, 1970-December 1, 2025) using the terms celiac/coeliac and lung, pulmonary, respiratory, hemoptysis, hemosiderosis, alveolar hemorrhage, interstitial lung disease, alveolitis, bronchiectasis, bronchiolitis, asthma, pneumonia, pneumococcal, sarcoidosis and histiocytosis. We analyzed all available data describing patients with CD and respiratory disorders.

Results: Pulmonary involvement in CD appears to represent one of its extraintestinal manifestations, alongside hematologic, dermatologic, neurologic, hepatic, and skeletal. LHS is well defined: several systematic reviews identified dozens of pediatric and adult cases. Increased risk of pneumonia (especially pneumococcal) is demonstrated in observational studies and described in systematic reviews. Moreover, CD has been associated with interstitial lung disease, bronchiectasis, asthma, chronic obstructive pulmonary disease, and chronic cough.

Conclusions: Pulmonary involvement in CD is uncommon but clinically important. For hospital internists, a bidirectional approach is suggested: to screen for CD in selected pulmonary presentations, and to systematically assess respiratory symptoms in patients with CD.