Hepatobiliary Manifestations and Complications in Inflammatory Bowel Disease: A Review

Abstract

Liver and biliary track diseases are common extraintestinal manifestations of inflammatory bowel disease (IBD), reported both in Crohn’s disease and ulcerative colitis, and may occur at any time during the natural course of the disease. Their etiology is mainly related to pathophysiological changes induced by IBD, and secondary, due to drugs used in IBD. Fatty liver is considered as the most frequent hepatobiliary manifestation in IBD, while primary sclerosing cholangitis (PSC) is the most correlated hepatobiliary disorder and is more prevalent in patients with ulcerative colitis. PSC can cause serious complications from the liver, biliary tree, and gallbladder and can lead to liver failure. Less frequently, IBD-associated hepatobiliary manifestations include cholelithiasis, granulomatous hepatitis, portal vein thrombosis, IgG4-related cholangiopathy, pyogenic liver abscess, hepatic amyloidosis and primary biliary cirrhosis. Most of the drugs used for IBD treatment may cause liver toxicity. Methotrexate and thiopurines carry the higher risk for hepatotoxicity, and in many cases, dose adjustment may normalize the liver biochemical tests. Reactivation of hepatitis B and C virus during immunosuppressive use, especially during use of biological agents, is a major concern, and adequate screening, vaccination and prophylactic treatment is warranted.

The difference in extraintestinal manifestations of inflammatory bowel disease for children and adults

“…Transl Pediatr 2019;8(1):4-15 tp.amegroups.com granulomatous), hepatic abscess, hepatic cirrhosis, bile duct carcinoma, fatty liver, and cholelithiasis (89)(90)(91). Among them, PSC is the most common and serious complication in adult or pediatric patients and is more common in patients with UC than in those with CD with a prevalence of 2.4-7.5% in patients with UC (92-94).…”

The Antioxidant and Anti-Inflammatory Effects of Quercus brantii Extract on TNBS-Induced Ulcerative Colitis in Rats

“…IBD patients are prone to acute and chronic complications, such as bleeding, toxic megacolon, primary sclerosing cholangitis (PSC), and colorectal cancer (CRC). Moreover, IBD has a significant impact on the quality of life with direct or indirect health care costs [ 3 – 5 ]. As a main subgroup of IBD, UC affects the large bowel of the gastrointestinal (GI) tract with a broad spectrum of acute and chronic clinical presentations.…”

​Treating pyogenic liver abscesses secondary to diverticulitis in a patient using immunosuppressants for Crohn’s disease by performing a sigmoid colectomy

“…Predisposing factors for the development of PLA are thought to be intra-abdominal abscess formation, fistulas, mucosal ulceration, perforating disease, long-term treatment with steroids, diabetes mellitus and malnutrition. The precise pathophysiology is not known 1 2. However, the PLAs in the presented case are thought to be secondary to intra-abdominal abscess formation around the sigmoid due to diverticulitis, without evidence for an exacerbation of CD.…”

“…The most prevalent complication is the formation of intra-abdominal abscesses due to perforating intestinal lesions. Moreover, hepatobiliary complications like primary sclerosing cholangitis, cholelithiasis and liver steatosis are well-studied manifestations of CD 1. A more rare infectious complication is the development of a pyogenic liver abscess (PLA), only documented in several case studies 2–11…”