Abstract
Abstract Background Abnormal hepatobiliary biochemistry is frequently observed in patients with inflammatory bowel diseases (IBD), encompassing ulcerative colitis (UC) and Crohn’s disease (CD). However, its prevalence and clinical implications in IBD remain unclear. We aimed to determine the occurrence and clinical impact of abnormal hepatobiliary biochemistry in patients with newly diagnosed IBD. Methods Between May 1, 2021, and April 30, 2023, all adult and pediatric patients with incident IBD within a catchment area covering 20% of Denmark were enrolled in the prospective, population-based Copenhagen IBD Inception Cohort.1 Herein, all adult patients underwent hepatobiliary blood tests (alanine aminotransferase (ALT), alkaline phosphatase (ALP), bilirubin, and INR) at IBD diagnosis. Multivariate Cox proportional hazard analyses adjusting for age, sex, smoking, and disease phenotype were performed (adjusted HR, aHR, 95% confidence interval). Results A total of 527 patients (UC: 326; CD: 201) were included in the cohort, with 290 (89.0%) and 189 (94.0%) undergoing blood tests, respectively, within a median of two days (interquartile range: -14 - 6) before IBD diagnosis. No demographic or clinical phenotypical differences were observed between patients who underwent blood test and those untested. Abnormal hepatobiliary biochemistry was found in 49 (16.7%) and 46 (24.3%, p<0.01) patients with UC and CD, respectively, primarily driven by higher median ALP levels in CD (80 U/L [IQR 69-97]) versus UC (74 U/L [IQR 61-90], p<0.01). No associations were observed between abnormal hepatobiliary biochemistry and sex, age, initial extent or location of IBD, or disease activity (Table 1). However, stricturing or penetrating CD was significantly associated with abnormal hepatobiliary biochemistry (adjusted OR = 4.62 [1.70; 12.54]). During a follow-up of 2.1 years (IQR 1.6-2.6), abnormal hepatobiliary biochemistry was not associated with the initial course of UC; however, an increased risk of requiring resective surgery for CD was observed (aHR= 3.27 [1.04-10.24], Table 2). Conclusion In this prospective, population-based cohort, abnormal hepatobiliary biochemistry was present in approximately one in six patients with UC and one in four patients with CD at diagnosis, with no association with IBD disease activity. Although it did not correlate with the initial course of UC, these findings underscore the need for increased attention to hepatobiliary biochemistry in patients with CD.
Published Version
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