Inflammatory Bowel Disease (IBD) and the Liver

Hepatobiliary Diseases (HBDs) accompanies in a 5-10% of patients with Inflammatory Bowel Diseases (IBD). They are either extra-intestinal manifestations or drug side effects. The main extra-intestinal manifestation is Primary Sclerosing Cholangitis (PSC), which as an entity, includes the former "pericholangitis ", now called small duct Primary Sclerosing Cholangitis. It mainly affects young males with ulcerative colitis. It is a chronic cholestatic disease with a broad spectrum of clinical manifestations. The asymptomatic disease has a better prognosis than the symptomatic one. It eventually leads to cirrhosis and is the 4th cause of orthotopic liver transplantation. Cholangiocarcinoma is the most ominous complication and its presence is also accompanied by increased frequency of colon dysplasia or cancer. A less frequent complication is the ascending cholangitis with or without (pigmented) biliary stones. Auto-immune Hepatitis (type-1) is another extra-intestinal manifestation of IBD, but its frequency seems to be very low under the new diagnostic criteria, compared to the frequency reported in previous publications. An overlap syndrome may also occur. Fatty liver is the commonest occurring liver disease, specially in patients with ulcerative colitis and is usually indolent. Uncommon manifestations include granulomas and granulomatous hepatitis, amyloidosis and hepatic abscesses. Biliary stones are often related to Crohn's Disease, probably due to altered bile component balance. Drugs used for the treatment of IBD may cause liver damage, either acute or chronic. Azathioprine and cyclosporine are newly recognized as such dings. Alertness, proper use and serial tests for monitoring the liver function and morphology can minimize their side effects. More sophisticated tests are not yet routine clinical practice.