Liver Dysfunction in Patients with Inflammatory Bowel Disease

Abstract

Purpose: The prevalence of liver dysfunction in inflammatory bowel disease (IBD) varies across studies. Little is known about the relationship between liver dysfunction and IBD activity. In IBD patients we sought to 1) determine the prevalence of liver dysfunction, defined by abnormal serum levels of aspartate aminotransferase, alanine aminotransferase and/or alkaline phosphatase; 2) determine the prevalence of chronic liver disease; and 3) clinically compare patients with and without liver dysfunction. Methods: IBD patients seen for the first time at Mayo Clinic Rochester from 1/1/00 to 12/31/00 were identified. Medical records were abstracted for gender, age, IBD subtype, extent and activity, medications, history of liver disease, and liver biochemistries. Chi-square, student t-test or rank tests were used as appropriate. Results: We identified 544 patients with available hepatic biochemistries. Abnormal liver tests were found in 159 (29%), of whom 81% had no specific diagnosis. Primary sclerosing cholangitis (PSC) was present in 4% of all patients, and in 14% of those with liver dysfunction. Other liver diseases were autoimmune hepatitis (n = 2), fatty liver (n = 1), hepatitis C (n = 1), portal or hepatic vein thrombosis (n = 2) and metastatic cancer (n = 1). The prevalence of liver dysfunction was 27% for those with active IBD and 36% for those in remission (p = 0.06). Patients with and without liver dysfunction did not differ with regards to gender, age or subtype of IBD, but were less likely to be on oral 5-aminosalicylate (5-ASA) agents (35% vs. 51%, p < 0.001). 5-ASA did not modify or confound the effect of IBD activity in liver dysfunction. The use of other medications did not differ between groups. Follow-up liver tests were obtained in 118 patients (74%) with liver dysfunction. Abnormalities persisted in 39 (32%), with PSC being diagnosed in 15 (38%). Conclusions: Liver dysfunction was detected in 29% of IBD patients. Surprisingly, we found no association between liver dysfunction and IBD activity. Patients with liver dysfunction were less likely to be on 5-ASA. One-third of those with abnormal liver tests had persitent abnormalities, and PSC was present in a significant proportion of them. Abnormal liver tests should not be attributed to active IBD. Rather, they should be monitored and work-up should be undertaken if liver dysfunction persists, even if IBD is active.