Liver test abnormalities predict complicated disease behaviour in patients with newly diagnosed Crohn’s disease

Abstract

BackgroundsIn coeliac disease, the prevalence of liver test abnormalities (LTAs) is higher in patients with more severe mucosal inflammation. In Crohn’s disease, prognosis is related to the severity of mucosal inflammation.AimThe aim of this study was to investigate whether the presence of LTA predicts the occurrence of complicated disease behaviour in newly diagnosed Crohn’s disease.MethodsA retrospective cohort study was performed in patients newly diagnosed with Crohn’s disease between 2002 and 2011. The complicated disease was defined as the occurrence of stricturing and/or perforating disease. LTAs were defined as a value of any of alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT), aspartate aminotransferase (AST), or alanine aminotransferase (ALT) over the upper limit of normal.ResultsThree hundred eighty-three patients were included, of whom 34.1% had LTA. LTAs were mostly mild (less than two times the upper limit of normal). During the 5-year follow-up, 33.1% of patients in the group with LTA developed complicated disease behaviour compared to 14.6% in patients without LTA (p < 0.001). The presence of LTA was identified as a risk factor for complicated disease behaviour (HR 2.6, 95% confidence interval (CI) 1.5–4.2, p < 0.0001).ConclusionsIn newly diagnosed Crohn’s disease, the presence of LTA was an independent risk factor for the development of complicated disease behaviour.Electronic supplementary materialThe online version of this article (doi:10.1007/s00384-016-2706-3) contains supplementary material, which is available to authorized users.

The role of hepatic enzymes in Crohn’s disease

“…One patient with chronic liver disease (small duct PSC) was excluded. Of the 383 patients included in this study, 131 had liver test abnormalities (34.1%), but liver diseases were not found, apart from liver steatosis in 6% of patients [3] (versus 29% in the previous study [2]).…”

“…In the more recent study [3], however, the authors found that, patients with liver test abnormalities, without an hepatic disease, more often developed complicated CD behaviour and more often needed hospitalization or surgery within 5 years of diagnosis than patients without liver test abnormalities. Patients with a C-reactive protein (CRP) <16 mg/L but with liver test abnormalities had a higher risk of developing complicated disease compared to those without liver test abnormalities.…”

“…The two studies [2,3] agree that, considering the cost/benefit ratio, patients with CD should be considered as healthy from the liver perspective, without the need for additional biochemical and instrumental examinations than the general population, unless the presence of clinical or biochemical suspicion of liver disease.…”

“…This demonstrates that the presence of liver test abnormalities does not merely reflect a higher CRP concentration, but may be a more sensitive indicator of an increased risk of complicated disease behaviour than CRP. At multivariate analysis, the presence of liver test abnormalities was independent risk factors for complicated disease behaviour; additionally, the presence of liver test abnormalities 4 was independently associated with an increased risk of hospitalizations (HR 1.7, p = 0.023) as well as surgery (HR 2.3, p = 0.015) [3][ ] .…”

Welch-weighted Egger regression reduces false positives due to correlated pleiotropy in Mendelian randomization

“…Eosinophils are known to play an important role in the pathogenesis of asthma [29], with well-established genetic evidence indicating a protective effect of lower eosinophil count on asthma risk [30]. Liver test abnormalities are frequently observed in patients with inflammatory bowl diseases [31] and appear to be an risk factor for complications in patients with Crohn's disease [32]. Blood glucose has been observed to be elevated in patients experiencing chronic obstructive pulmonary disease (COPD) exacerbations [33].…”