Frequency of Hepatobiliary Manifestations and Concomitant Liver Disease in Inflammatory Bowel Disease Patients (original) (raw)
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Journal of gastroenterology and hepatology, 2015
To prospectively follow the evolution of hepatobiliary diseases in a population based cohort of patients with inflammatory bowel diseases. Between 2005 and 2009, 790 incident cases of ulcerative colitis and Crohn's disease was registered in Uppsala Health Region, corresponding to an average incidence of 20.0 and 9.9 new cases/100 000 inhabitants/year, respectively. Liver function tests were analysed in 97.1% and the results of ensuing investigations were summarised. Seventeen patients with primary sclerosing cholangitis were diagnosed corresponding to an overall prevalence of 2.2 % (ulcerative colitis 1.7% and Crohn's disease 3.0%, respectively). The median age at diagnosis was 25 years (IQR: 17.0-34.0). Among the 92 patients below 17 years of age, three had autoimmune hepatitis and three primary sclerosing cholangitis, summing up to a prevalence of 6.5% immune mediated hepatobiliary diseases among the paediatric patients. Three patients have undergone liver transplantation ...
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.
Hepatobiliary Manifestations of Inflammatory Bowel Disease
Hpb Surgery, 2000
Hepatobiliary manifestations occur quite frequently in patients suffering from chronic ulcerative colitis and Crohn's disease and carry with them considerable morbidity and mortality. Although the true incidence is difficult to determine, clinically significant hepatobiliary disease occurs in 5%-10% of patients. At the present moment, the aetiology and pathogenesis of inflammatory bowel disease and its systemic manifestations remains speculative. For those hepatobiliary manifestations that respond to therapy of the underlying bowel disease, medical and/or surgical therapy must be aggressively pursued. More urgent research is required towards understanding the underlying cause(s) of the primary bowel disease and its systemic manifestations in order to improve the overall management of this condition.
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.
Journal of pediatric gastroenterology and nutrition, 2017
Hepatobiliary disorders are common in patients with inflammatory bowel disease (IBD), and persistent abnormal liver function tests are found in approximately 20% to 30% of individuals with IBD. In most cases, the cause of these elevations will fall into 1 of 3 main categories. They can be as a result of extraintestinal manifestations of the disease process, related to medication toxicity, or the result of an underlying primary hepatic disorder unrelated to IBD. This latter possibility is beyond the scope of this review article, but does need to be considered in anyone with elevated liver function tests. This review is provided as a clinical summary of some of the major hepatic issues that may occur in patients with IBD.
Hepatobiliary Alterations in Ulcerative Colitis: A Report from a Tertiary Care Centre in Odisha
Journal of Clinical and Experimental Hepatology, 2016
Background and Aim: Hepatobiliary manifestations are amongst the most important extra intestinal manifestations in chronic ulcerative colitis patients. There is paucity of data on hepatobiliary alterations in ulcerative colitis patients from India. The study was carried out to evaluate the hepatobiliary alterations in ulcerative colitis patients admitted to a tertiary care center in Odisha. Methods: Consecutive patients of Ulcerative colitis admitted to Gastroenterology Department SCB Medical College, Cuttack from 0ct 2013 to April 2015 were included in the study. Patients with history of liver diseases were excluded. All patients were subjected to clinical examination, liver function tests and ultrasonography for evaluation of hepatobiliary alterations. MRCP was performed in selected patients. Controls were recruited from healthy subjects (n=100). Results: A total of 112 patients [73(65.1 %%) male; 39(34.9%) female] with ulcerative colitis were included. The mean age and BMI were 40.2±14.01years and 21.3±3.5kg/m2 respectively. Patients with mild, moderate and severe disease activity were 22(19.6%), 67(59.8%) and 23(20.5%) respectively. The median duration of illness was 24 months (IQR: 6.5-48). Extra intestinal manifestations were found in 68 patients (60.7%). 40(35.7%) patients had arthralgia, 6(5.3%) had arthritis, 13(11.6%) had episcleritis, 2(1.7%) had stomatitis, 3(2.6%) had Erythematic Nodosum, 1(0.9%) had pyoderma Gangrenosum. 60(53.8%) patients developed hepatobiliary alterations. 2(1.7%) had jaundice, pruritus and clay colored stool in whom MRCP revealed primary sclerosing cholangitis. 22(19.6%) had hepatic steatosis, 42(37.5%) had asymptomatic transaminitis, 17(15.1%) had elevated alkaline phosphatase and 67(60%) had hypoalbuminmia. In control groups 17(17%) had hepatic steatosis, 28(28%) had transaminitis, 8(8%) had elevated alkaline phosphatase.
Intestinal Research
Background/Aims: Primary sclerosing cholangitis (PSC) represents the most common hepatobiliary extraintestinal manifestation of inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD). Limited data exist on PSC in patients with IBD from India. We aimed to assess the prevalence and disease spectrum of PSC in Indian patients with IBD. Methods: Database of IBD patients at 5 tertiary care IBD centers in India were analyzed retrospectively. Data were extracted and the prevalence of PSC-IBD was calculated. Results: Forty-eight patients out of 12,216 patients with IBD (9,231 UC, 2,939 CD, and 46 IBD unclassified) were identified to have PSC, resulting in a prevalence of 0.39%. The UC to CD ratio was 7:1. Male sex and pancolitis (UC) or colonic CD were more commonly associated with PSC-IBD. The diagnosis of IBD preceded the diagnosis of PSC in most of the patients. Majority of the patients were symptomatic for liver disease at diagnosis. Eight patients (...