The importance of the height of alt and GGT during the diagnosis in children in determining liver disease associated with inflammatory bowel disease

Introduction and Objective: We aimed to investigate the role of ALT and/or GGT elevation at the time of diagnosis and first year of follow-up in determination of associated liver disease in inflammatory bowel disease (IBD). Materials and Methods: 90 children and adolescents were included in this study. Which are diagnosed with ulcerative colitis (UC), Crohn's disease (CD), or indeterminate colitis (IC) and followed up at Dokuz Eylul University School of Medicine Department of Pediatric Gastroenterology Hepatology and Nutrition, Dr. Behçet Uz Children's Diseases and Surgery Training and Research Hospital, Izmir Tepecik Training and Research Hospital. Medical records of the patients were analyzed for age of diagnosis, ALT and/or GGT, gender, type of IBD, pediatric ulcerative colitis activity index / Crohn's disease activity index, follow up duration, nutrition status, perinuclear anti-nuclear cytoplasmic antibody and anti-saccharomyces cerevisisa antibodies at the time of diagnosis and first year routine check were analyzed retrospectively. Results: 90 patients were included in our study. 52 patients (57.8%) were diagnosed with UC, 20 (22.2%) patients were diagnosed with CD, and 18 (20%) were IC cases. Of 90 patients in our study group; 42 were female (46.7%), and 48 (53.3%) were male. The mean age at diagnosis was 10.5 ± 4.3 (0.8-17) years. The mean follow-up duration was 29.4 ± 19.3 (2-92) months. At the time of diagnosis 27 (30%) patients had malnutrition. Out of 90 patients 14 (15.6%) had significantly high ALT values at the time of diagnosis. In the first year three patients (3.3%) had elevated ALT levels at least in three times of first-year follow-up. Of these three patients, two (66.7%) had malnutrition at the time of diagnosis. 21 patients (23.3%) had elevated GGT levels at the time of diagnosis; 14 out of 21 (66.7%) had malnutrition. In the first year follow-up 9 patients (10%) had elevated GGT levels at least in three times. Of these 9 patients, 6 (66.7%) had malnutrition at the time of diagnosis. Patients who had elevated ALT levels at the time of diagnosis were found to have higher frequency of malnutrition (p=0.016). Patients who had elevated GGT levels at the time of diagnosis were found to have higher frequency of malnutrition (p <0.001). Patients who had elevated ALT and GGT levels at the time of diagnosis were found to have higher frequency of malnutrition (p=0.004). We did not find liver disease associated with IBD in our patients. Conclusion: We did not find any relationship between having elevated ALT and/or GGT and liver disease in children with IBD. This might be due to small sample size or short follow up time after diagnosis. However, we found that elevated ALT and GGT levels were associated with malnutrition in pediatric IBD patients. Therefore elevated ALT and GGT levels should be alarming for malnutrition in patients with IBD. Key words: Ulcerative Colitis; Crohn's Disease; ALT; GGT; Liver disease; Inflammatory Bowel Disease; Malnutrition; Nutrition; Growth retardation