Hepatobiliary disease in inflammatory bowel disease

There are a number of hepatobiliary diseases seen in IBD. PSC is the most common, occurring in up to 7.5% of patients with ulcerative colitis. The etiology of PSC is not well understood but appears to occur on the background of genetic susceptibility, sharing some immunological abnormalities with ulcerative colitis. A characteristic cholangiogram in a patient with abnormal liver injury tests usually establishes the diagnosis. Liver biopsy is not essential but can help make the diagnosis of small duct PSC in patients with a normal cholangiogram. There are no medications that effectively treat PSC. Endoscopic dilation of dominant strictures reduces the frequency of cholangitis and may improve survival. OLT remains the only proven treatment of advanced PSC. Cholangiocarcinoma is a feared complication of PSC that is difficult to diagnose. Cholelithiasis, PBC, portal vein thrombosis, and hepatic abscess are hepatobiliary disorders that occur less frequently in IBD patients.