Патология печени и желчного пузыря у пациентов с воспалительными заболеваниями кишечника

Abstract

Pathology of the liver and gallbladder is one of the extra-intestinal manifestations of inflammatory bowel diseases (IBD). Targeted examination indicates clinical, laboratory, and structural changes in the liver and gallbladder in 30% of patients with IBD. However, information about the state of the hepatobiliary zone in comparison with the IBD phenotype, the features of the course, and the nature of therapy are few, and their results are contradictory. The aim − to study the frequency of occurrence, to analyze the structural and functional features of the liver and gallbladder in relation to the phenotype, clinical and endoscopic activity of the process, the nature of the course, and the effectiveness of IBD therapy. Material and methods. A simple, open, single-stage, non-randomized study involved 157 patients with ulcerative colitis (UC) and 37 patients with Crohn's disease (CD) who were treated in the Gastroenterology Department of the City Clinical Hospital No. 5 in Saratov in the period of 2016−2019. Complex clinical, biochemical, and instrumental studies were performed (ultrasound examination of the abdominal organs, fibrogastroduodenoscopy and colonoscopy, general morphological examination of colonobioptates). Results. Non-alcoholic fatty liver disease (NAFLD) was verified in 10.8% of patients with UC (3.8% had non-alcoholic steаthohepatitis (NASH), 7% − liver steatosis) and in 27% of patients with CD (NASH – 5.4% of cases, liver steatosis – 21.6%). Dysfunctional disorders and structural changes of the gallbladder were detected in 14.3% of patients with UC and 20.8% with CD. Of these, cholelithiasis was found in 9.5% of patients with UC and 10.8% with CD. When analyzing the association of risk factors for hepatobiliary pathology with a variant of IBD, NAFLD was associated with the type of IBD course (recurrent course for CD), localization of the process (in UC – with left-sided colitis, in CD – with terminal ileitis), an operational history on the intestine in CD, the duration of CD for more than five years, overweight in UC, and the effects of basic therapy (steroid resistance). The pathology of the gallbladder is associated with the duration of IBD for more than three years, the continuous course of UC, and surgical interventions on the intestine in CD. When analyzing laboratory and structural markers of steatosis, it was noted that high values of the steatosis index prevailed in UC (according to J.H. Lee). Abdominal ultrasound revealed mild (41% in UC, 40% in CD) and moderate (47.1% in UC, 50% in CD) liver steatosis more often. When analyzing the clinical features of the hepatobiliary system, it was found that liver pathology was detected by instrumental and laboratory criteria, and gallbladder pathology was characterized clinically by symptoms of biliary dyspepsia in the absence of biliary colic attacks. Conclusion. The features of liver and gallbladder pathology identified during the study can be used to optimize the management of patients with IBD