Transient elastography to assess liver stiffness in patients with inflammatory bowel disease

Meijer, Berrie; Everdingen, Charlotte K Van; Ramsoekh, Dewkoemar; Stedman, Catherine A.; Frampton, Christopher; Mulder, Chris J.; Bouma, Gerd; Boer, Nanne K. H. de; Gearry, Richard B.

doi:10.1016/j.dld.2017.09.128

Cited by 10 publications

(12 citation statements)

References 49 publications

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“…[73] Thus, hepatotoxicity has been recognised in as many as 20% of IBD patients treated with azathioprine, 6MP, or methotrexate. [74] Azathioprine is the thiopurine most often associated with NRH, [75] and since most of the 6TG-treated IBD patients have received azathioprine previously, signs of NRH could have been present beforehand. As baseline liver biopsies prior to 6TG treatment were not obtained in any of the studies, some of the reported cases of NRH may likely have been triggered by other factors than 6TG.…”

Section: Discussionmentioning

confidence: 99%

Hepatotoxicity during 6-thioguanine treatment in inflammatory bowel disease and childhood acute lymphoblastic leukaemia: A systematic review

et al. 2019

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Background The recently established association between higher levels of DNA-incorporated thioguanine nucleotides and lower relapse risk in childhood acute lymphoblastic leukaemia (ALL) calls for reassessment of prolonged 6-thioguanine (6TG) treatment, while avoiding the risk of hepatotoxicity. Objectives To assess the incidence of hepatotoxicity in patients treated with 6TG, and to explore if a safe dose of continuous 6TG can be established. Data sources Databases, conference proceedings, and reference lists of included studies were systematically searched for 6TG and synonyms from 1998–2018. Methods We included studies of patients with ALL or inflammatory bowel disorder (IBD) treated with 6TG, excluding studies with 6TG as part of an intensive chemotherapy regimen. We uploaded a protocol to PROSPERO (registration number CRD42018089424). Database and manual searches yielded 1823 unique records. Of these, 395 full-texts were screened for eligibility. Finally, 134 reports representing 42 studies were included. Results and conclusions We included data from 42 studies of ALL and IBD patients; four randomised controlled trials (RCTs) including 3,993 patients, 20 observational studies including 796 patients, and 18 case reports including 60 patients. Hepatotoxicity in the form of sinusoidal obstruction syndrome (SOS) occurred in 9–25% of the ALL patients in two of the four included RCTs using 6TG doses of 40–60 mg/m 2 /day, and long-term hepatotoxicity in the form of nodular regenerative hyperplasia (NRH) was reported in 2.5%. In IBD patients treated with 6TG doses of approximately 23 mg/m 2 /day, NRH occurred in 14% of patients. At a 6TG dose of approximately 12 mg/m 2 /day, NRH was reported in 6% of IBD patients, which is similar to the background incidence. According to this review, doses at or below 12 mg/m 2 /day are rarely associated with notable hepatotoxicity and can probably be considered safe.

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Section: Discussionmentioning

confidence: 99%

Hepatotoxicity during 6-thioguanine treatment in inflammatory bowel disease and childhood acute lymphoblastic leukaemia: A systematic review

et al. 2019

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“…Using transient elastography, researchers found a correlation between higher BMI levels and liver stiffness in those with IBD and NAFLD; interestingly, the use of azathioprine for IBD tended towards improved liver stiffness, though this did not reach significance. This finding may be from efficacy for IBD or a direct effect on the liver [38][39][40][41][42][43][44][45].…”

Section: Clinical Features Of Patients With Nafld and Ibdmentioning

confidence: 99%

“…Biologic therapies are not the index therapy for many patients which potentially leaves those patients at risk for persistent mucosal inflammation and an increased risk of NAFLD. Alternatively, early treatment with biologics may exchange one risk for NAFLD with another, since they will be have better mucosal absorption and possibly develop metabolic risk factors [44].…”

Section: Possible Connections Between Ibd and Nafldmentioning

confidence: 99%

“…By using serial shear wave velocity measurements to assess liver stiffness measurement (LSM) and using a cutoff for LSM of 9.9 kPA, TE performs with 95% sensitivity and 77% specificity for advanced fibrosis on histology [66]. TE has been used to evaluate for liver injury and stiffness in patients with IBD, though widespread screening with the modality is not recommended [44,67]. We recommend that patients with IBD with concerning non-invasive testing see a liver specialist equipped to consider a liver biopsy to formally stage steatohepatitis.…”

Section: Approach To Nafld In Ibdmentioning

confidence: 99%

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Nonalcoholic Fatty Liver Disease and Inflammatory Bowel Disease: Complex Interactions, Evaluations, and Management Decisions

Sadowski¹,

Ordway²,

Bobeck³

et al. 2019

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Diseases of the liver are commonly encountered in patients with inflammatory bowel disease (IBD). While the differential diagnosis for IBD patients with elevated liver associated enzymes is broad, it is similar to that of the general population, including nonalcoholic fatty liver disease (NAFLD): The most common liver disease in North America. When initial workup for elevated liver associated enzymes is negative and patients have steatosis on ultrasound, we counsel IBD patients aggressively about weight loss in order to prevent the progression of liver disease. Here, we describe the association between liver disease and IBD and illustrate an approach to management of elevated liver associated enzymes in this unique patient population.

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“…In 2017, we published a prospective international cohort study measuring the degree of liver fibrosis in a population of 168 IBD patients using TE. 4 Although the major aim of our study was to compare the rate of liver fibrosis between those who were exposed to a thiopurine and those who were not, we focused on the prevalence of both fibrosis and cirrhosis, rather than the degree of steatosis. Moderate fibrosis was found in 4% of the participants, and severe fibrosis was detected in 1 patient.…”

mentioning

confidence: 99%

Transient Elastography in IBD Patients

Everdingen

Meijer

Gearry

2019

Inflammatory Bowel Diseases

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Transient elastography to assess liver stiffness in patients with inflammatory bowel disease

Abstract: Exposure to thiopurine therapy was not associated with higher liver stiffness, although no clinical difference in severity of fibrosis was detected. Further research should robustly determine the accuracy of TE as an evaluation of liver fibrosis in IBD patients.

Cited by 10 publications

References 49 publications

Hepatotoxicity during 6-thioguanine treatment in inflammatory bowel disease and childhood acute lymphoblastic leukaemia: A systematic review

Hepatotoxicity during 6-thioguanine treatment in inflammatory bowel disease and childhood acute lymphoblastic leukaemia: A systematic review

Nonalcoholic Fatty Liver Disease and Inflammatory Bowel Disease: Complex Interactions, Evaluations, and Management Decisions

Transient Elastography in IBD Patients

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