HEPATOBILIARY MANIFESTATIONS OF INFLAMMATORY BOWEL DISEASE (original) (raw)
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Hepatopancreatobiliary manifestations of inflammatory bowel disease
Clinical Journal of Gastroenterology, 2012
Inflammatory bowel disease (IBD) is frequently associated with extraintestinal manifestations such as hepatopancreatobiliary manifestations (HPBMs), which include primary sclerosing cholangitis (PSC), pancreatitis, and cholelithiasis. PSC is correlated with IBD, particularly ulcerative colitis (UC); 70-80% of PSC patients in Western countries and 20-30% in Japan have comorbid UC. Therefore, patients diagnosed with PSC should be screened for UC by total colonoscopy. While symptoms of PSC-associated UC are usually milder than PSC-negative UC, these patients have a higher risk of colorectal cancer, particularly in the proximal colon. Therefore, regular colonoscopy surveillance is required regardless of UC symptoms. Administration of 5-aminosalicylic acid or ursodeoxycholic acid may prevent colorectal cancer and cholangiocarcinoma. While PSC is diagnosed by diffuse multifocal strictures on cholangiography, it must be carefully differentiated from immunoglobulin G4 (IgG4)-associated cholangitis, which shows a similar cholangiogram but requires different treatment. When PSC is suspected despite a normal cholangiogram, the patient may have small-duct PSC, which requires a liver biopsy. IBD patients have a high incidence of acute and chronic pancreatitis. Most cases are induced by cholelithiasis or medication, although some patients may have autoimmune pancreatitis (AIP), most commonly type 2 without elevation of serum IgG4. AIP should be accurately identified based on characteristic image findings, because AIP responds well to corticosteroids. Crohn's disease is frequently associated with gallstones, and several risk factors are indicated. HPBMs may influence the management of IBD, therefore, accurate diagnosis and an appropriate therapeutic strategy are important, as treatment depends upon the type of HPBM.
Specific Features of Patients With Inflammatory Bowel Disease and Primary Sclerosing Cholangitis
Journal of Clinical Medicine Research, 2019
Primary sclerosing cholangitis (PSC) is a chronic and progressive disease of the biliary tract. PSC is strongly associated with inflammatory bowel disease (IBD), mainly with ulcerative colitis, and most PSC patients have underlying IBD. The pathophysiological interactions between IBD and PSC are unclear, although it seems that the patients with IBD and PSC have a distinct phenotype. IBD with coexisting PSC is more extensive and is characterized by milder activity compared to IBD alone. The coexistence of PSC increases the risk for colorectal cancer in IBD patients and lifelong annual surveillance colonoscopy is recommended. Also, liver transplantation (LT) for PSC may affect the course of IBD. In addition, the management of IBD after LT includes many specific problems. On the other hand, the effect of IBD on the natural history of PSC appears to be milder. However, IBD may increase the risk of postsurgical complications after LT and is a risk factor for recurrent PSC after LT. Overall, the coexistence of IBD with PSC changes the management, natural history and prognosis of both diseases.
Transplantation, 2012
Introduction: Previous studies have shown a quite variable course of inflammatory bowel disease (IBD) after liver transplantation (Ltx) in patients with primary sclerosing cholangitis (PSC). We aimed to describe the natural history of IBD in liver transplanted PSC patients and to identify potential risk factors for increased disease activity. Methods: In a multicenter study within the Nordic Liver Transplant Group we compared the IBD activity before and after Ltx by a longitudinal follow-up of the patient cohort. Results: Among the 439 PSC patients included, 353 (80%) had IBD at the time of Ltx. The median duration of IBD was 15 (0-50) years at the time of Ltx and follow-up after Ltx was 5 (0.3-20) years. Macroscopic colonic inflammation was more frequent after compared to before Ltx (124 vs. 153 of 218 patients, p < 0.001). After Ltx, the degree of inflammation was improved in 37 (17%), unchanged in 93 (43%) and deteriorated in 88 (40%) patients. The relapse rate (number of relapses/ person years) after Ltx was higher than that before (p < 0.001). By an evaluation of the clinical activity in the total course of IBD, more patients had active disease after compared to before Ltx (p < 0.001). The cumulative risk of colectomy due to active IBD was increased compared to the corresponding risk before Ltx but without reaching statistical significance (HR 1.4, 95% CI 0.4-1.2, p = 0.22). Multivariate Cox regression analysis identified low age at diagnosis of IBD and dual treatment with tacrolimus and mycophenolate mofetil as significant risk factors for worsened IBD-activity post Ltx, whereas combination treatment with ciclosporine A and azathioprine showed a protective effect. Conclusions: IBD-activity in PSC-IBD patients increases after Ltx and is related to the type of immunotherapy. Ciclosporine A and azathioprine should be considered an alternative maintenance treatment in liver transplanted PSC patients.
Are Hepatobiliary Manifestations Related to the Site of Involvement in Inflammatory Bowel Disease?
2022
Objective: This study was carried out to reveal the factors affecting the hepatobiliary manifestations in inflammatory bowel disease. Methods: Inflammatory bowel disease patients followed in our gastroenterology outpatient clinic between 1999 and 2009 were included in the study retrospectively. The demographic and clinical characteristics of the patients were evaluated. In order to reveal hepatobiliary involvement, all patients were evaluated with clinical, laboratory, imaging examinations, and liver biopsy in some necessary patients. Results: A total of 504 inflammatory bowel disease patients (48.2% female) (of whom 39.1% had Crohn's disease, 57.5% had ulcerative colitis, and 3.4% had indeterminate colitis) were enrolled in this study. The mean age of patients was 38.7 ± 13 years. The mean duration of disease was 80 ± 59 months, and the mean follow-up period was 32 ± 3 months. The proportion of patients with hepatobiliary involvement was 4.8% (33.3% Crohn's disease, 66.7% ulcerative colitis). In terms of liver findings, the rate of primary sclerosing cholangitis was 50%, and the rate of hepatosteatosis was 50%. In this group, 58.3% of them were male, and the mean duration of disease was 32 ± 3 months (2-96 months). All of the patients with diagnosis of primary sclerosing cholangitis received ursodeoxycholic acid (UDCA) (15 mg/kg), with a median of 84 months. The mean GGT (87 ± 92 IU/L vs. 68 ± 84 IU/L) and ALP (397 ± 507 IU/L vs. 271 ± 255 IU/L) levels were significantly decreased after UDCA treatment (P < .05). There was a positive correlation between duration of disease and hepatobiliary manifestation (r = 0.1, P = .025). Ileocolonic involvement and pancolitis were independent risk factors for the development of hepatobiliary manifestations in Crohn's disease and ulcerative colitis, respectively (P = .005). Hepatic failure was not observed in any patient during the follow-up period. Conclusion: Hepatobiliary involvement is more common in inflammatory bowel disease patients with colonic involvement.
BioMed Research International, 2019
Background. In inflammatory bowel disease (IBD) patients there are reports of the occurrence of hepatobiliary manifestations, so the aim of this study was to evaluate the hepatobiliary manifestations in patients with Crohn’s disease (CD) and ulcerative colitis (UC) from an IBD reference center. Methods. Cross-sectional study in an IBD reference center, with interviews and review of medical charts, between July 2015 and August 2016. A questionnaire addressing epidemiological and clinical characteristics was used. Results. We interviewed 306 patients, and the majority had UC (53.9%) and were female (61.8%). Hepatobiliary manifestations were observed in 60 (19.6%) patients with IBD. In the greater part of the patients (56.7%) hepatobiliary disorders were detected after the diagnosis of IBD. In UC (18.2%) patients, the hepatobiliary disorders identified were 11 (6.7%) non-alcoholic fatty liver disease, 9 (5.5%) cholelithiasis, 6 (3.6%) primary sclerosing cholangitis (PSC), 3 (1.8%) hepa...