Hepatobiliary phenotype of individuals with chronic intestinal disorders

Voss, Jessica; Schneider, Carolin V.; Kleinjans, Moritz; Bruns, Tony; Strnad, Pavel

doi:10.1038/s41598-021-98843-7

Cited by 9 publications

(10 citation statements)

References 47 publications

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“…In the literature, the prevalence of NAFLD in patients with IBD is variable. Two recent meta-analyses reported a pooled prevalence of NAFLD in IBD of 27.5%[ 75 ] and 32%[ 76 ]; older age, obesity, type 2 diabetes, longer IBD duration and previous surgery were the main risk factors associated with the development of NAFLD[ 77 ]. A further meta-analysis specifically addressing the role of IBD treatment on the risk of NAFLD found no significant association between medications of all types ( i.e.…”

Section: Non-immune-mediated Disordersmentioning

confidence: 99%

Liver-side of inflammatory bowel diseases: Hepatobiliary and drug-induced disorders

Mazza¹,

Soro²,

Verga³

et al. 2021

WJH

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Hepatobiliary disorders are among the most common extraintestinal manifestations in inflammatory bowel diseases (IBD), both in Crohn’s disease and ulcerative colitis (UC), and therefore represent a diagnostic challenge. Immune-mediated conditions include primary sclerosing cholangitis (PSC) as the main form, variant forms of PSC (namely small-duct PSC, PSC-autoimmune hepatitis overlap syndrome and IgG4-related sclerosing cholangitis) and granulomatous hepatitis. PSC is by far the most common, presenting in up to 8% of IBD patients, more frequently in UC. Several genetic foci have been identified, but environmental factors are preponderant on disease pathogenesis. The course of the two diseases is typically independent. PSC diagnosis is based mostly on typical radiological findings and exclusion of secondary cholangiopathies. Risk of cholangiocarcinoma is significantly increased in PSC, as well as the risk of colorectal cancer in patients with PSC and IBD-related colitis. No disease-modifying drugs are approved to date. Thus, PSC management is directed against symptoms and complications and includes medical therapies for pruritus, endoscopic treatment of biliary stenosis and liver transplant for end-stage liver disease. Other non-immune-mediated hepatobiliary disorders are gallstone disease, whose incidence is higher in IBD and reported in up to one third of IBD patients, non-alcoholic fatty liver disease, pyogenic liver abscess and portal vein thrombosis. Drug-induced liver injury (DILI) is an important issue in IBD, since most IBD therapies may cause liver toxicity; however, the incidence of serious adverse events is low. Thiopurines and methotrexate are the most associated with DILI, while the risk related to anti-tumor necrosis factor-α and anti-integrins is low. Data on hepatotoxicity of newer drugs approved for IBD, like anti-interleukin 12/23 and tofacitinib, are still scarce, but the evidence from other rheumatic diseases is reassuring. Hepatitis B reactivation during immunosuppressive therapy is a major concern in IBD, and adequate screening and vaccination is warranted. On the other hand, hepatitis C reactivation does not seem to be a real risk, and hepatitis C antiviral treatment does not influence IBD natural history. The approach to an IBD patient with abnormal liver function tests is complex due to the wide range of differential diagnosis, but it is of paramount importance to make a quick and accurate diagnosis, as it may influence the therapeutic management.

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Section: Non-immune-mediated Disordersmentioning

confidence: 99%

Liver-side of inflammatory bowel diseases: Hepatobiliary and drug-induced disorders

Mazza¹,

Soro²,

Verga³

et al. 2021

WJH

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“…Among 2377 individuals with CD, 6.1% received a diagnosis of cholelithiasis, which was significantly higher than controls (3.9%, p < 0.001); only 1.1% were diagnosed with unspecified cholecystitis. This value was greater than that observed in controls (0.7%), but the difference did not reach the statistical significance ( p = 0.071) [ 68 ]. Therefore, although one may speculate that gallbladder dysfunction may contribute to some dyspeptic complaints in CD patients, there are no clinical studies investigating this specific aspect, and no final conclusion can be made in this regard.…”

Section: Is There Any Clinical Implication Of Gallbladder Dysfunction...mentioning

confidence: 77%

Celiac Disease and Gallbladder: Pathophysiological Aspects and Clinical Issues

et al. 2022

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Background: Celiac Disease (CD) is an immune-mediated disorder which primarily affects the small intestine; however, extra-intestinal organs are often affected by the pathological process, too. As regards the digestive system, liver alterations in CD patients have been widely described, which can also extend to the biliary tract. Notably, gallbladder function can be altered in CD patients. In this review, we specifically analyze and summarize the main pathophysiological aspects and clinical evidence of gallbladder dysfunction in CD patients, in order to discuss the potential medical complications and clinical research gaps. In addition to some perturbations of bile composition, CD patients can develop gallbladder dysmotility, which mainly expresses with an impaired emptying during the digestive phase. The main pathophysiological determinant is a perturbation of cholecystokinin secretion by the specific duodenal enteroendocrine cells in response to the appropriate nutrient stimulation in CD patients. This situation appears to be reversible with a gluten-free diet in most cases. Despite this gallbladder impairment, CD patients do not seem to be more predisposed to gallbladder complications, such as calculous and acalculous cholecystitis. However, very few clinical studies have actively investigated these clinical aspects, which may not be completely evidenced so far; alternatively, the substantial improvements in the last two decades regarding CD diagnosis, which have reduced the diagnostic delay (and related dietary treatment), may have lessened the potential clinical consequences of CD-related gallbladder dysfunction. Specific clinical studies focused on these aspects are needed for a better understanding of the clinical implications of gallbladder alterations in CD patients.

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“…A recent study found that among 3,684 UC patients, the prevalence of AIH was 0.24% ( 5 ). Patients with IBD had a higher prevalence of AIH, with odds ratios of 7.8 and 17.9 for men and women, respectively ( 5 ). These patients are more likely to fail treatment and develop cirrhosis ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

“…Imaging features of the bile duct resemble PSC while the clinical, biochemical, and histological features are consistent with AIH ( 3 ). The incidence of IBD is as high as 40–50% in PSC-AIH overlap syndrome patients ( 4 ); however, PSC-AIH overlap syndrome is rare in IBD patients ( 5 ). Herein, we described a 38-year-old male UC patient, who received a diagnosis of PBC after 2 years because of abnormal liver function.…”

Section: Introductionmentioning

confidence: 99%

Ulcerative colitis complicated by primary sclerosing cholangitis and autoimmune hepatitis overlap syndrome: a case report and literature review

Zhang

Lin

et al. 2023

Front. Immunol.

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Primary sclerosing cholangitis (PSC), autoimmune hepatitis (AIH), and ulcerative colitis (UC) are immune diseases of the digestive system. Some patients develop overlap syndrome, the presentation of two or more of the clinical, biochemical, immunological, and histological features of these conditions simultaneously or sequentially. The incidence of UC in PSC-AIH overlap syndrome is as high as 50%. In contrast, PSC-AIH overlap syndrome is rare in UC patients. However, because it has a low prevalence and has been studied in less detail, PSC is often misdiagnosed as primary biliary cholangitis (PBC) in its early stage. Herein, we reported a case of a 38-year-old male patient who presented to a clinician in 2014 with irregular bowel habits. A colonoscopy suggested UC. In 2016, the patient was found to have abnormal liver function and was diagnosed with PBC by pathology. He was treated with ursodeoxycholic acid (UDCA) but this had no effect on his liver function. Additional liver biopsies in 2018 indicated PBC-AIH overlap syndrome. The patient refused hormone therapy for personal reasons. Following UDCA monotherapy, his liver function remained abnormal. The patient was reexamined after repeated abnormal liver function tests and bowel symptoms. Systematic laboratory testing, imaging diagnosis, colonoscopy, liver biopsy, and various pathological examinations conducted in 2021 were used to diagnose the patient with PSC-AIH-UC overlap syndrome. He was treated with various drugs, including UDCA, methylprednisolone, mycophenolate mofetil, and mesalazine. His liver function improved significantly after treatment and follow-up is ongoing. Our case report highlights the need to raise awareness about rare and difficult-to-diagnose clinical disorders.

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Hepatobiliary phenotype of individuals with chronic intestinal disorders

Cited by 9 publications

References 47 publications

Liver-side of inflammatory bowel diseases: Hepatobiliary and drug-induced disorders

Liver-side of inflammatory bowel diseases: Hepatobiliary and drug-induced disorders

Celiac Disease and Gallbladder: Pathophysiological Aspects and Clinical Issues

Ulcerative colitis complicated by primary sclerosing cholangitis and autoimmune hepatitis overlap syndrome: a case report and literature review

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