Hepatobiliary involvement in inflammatory bowel disease

Background and aims: Hepatobiliary disease screening is important in patients with inflammatory bowel disease, because approximately 5% of adults develop liver disease in the future. Hepatobiliary disease can occur at any moment in the natural course of the disease. Due to the wide spectrum of hepatobiliary diseases in IBD, the prevalence of abnormal liver function tests reported in the literature varies widely. Actually, when the transient elevations in liver function tests are considered, the prevalence increases from 3% to 50%. Early diagnosis and treatment of patients are important since Hepatobiliary disease in IBD affects patients' survival. In this study, we aimed to investigate the hepatobiliary involvement of patients diagnosed with IBD in Dokuz Eylul University Medical Faculty Hospital and to compare the data with the data in the literature. Methods: In this study, between January 2015 and December 2017 in Dokuz Eylul University Faculty of Medicine Hospital Gastroenterology Clinic, 465 patients aged 18 years and older followed for diagnosis of IBD (260 males, 210 females, mean age: 44.45 ± 12.71, 264 CH, 201 UC) data were evaluated retrospectively. Results: Abnormal liver function tests were detected in 80 (17.5%) of 458 patients whose LFT's were examined. There was no difference between the two types of IBD (UC; 13.6%, CH; 20.4%, p = 0.060) for the prevalence of abnormal LFT. In our study, 75.3% of patients with abnormal liver function tests and 57.9% of patients with normal liver function tests had liver disease. Of the 369 patients with abdominal imaging from 465 IBD patients, 225 (61%) had a finding and / or disease of the hepatobiliary system. Hepatobiliary involvement was higher in Crohn's patients (65.9%) than UC patients (52.6%) (p = 0.011). In our study, there was a significant difference between normal and high CRP values and normal and high LFT values (p = 0.000). In our study, the prevalence of abnormal LFT was higher in active IBD patients compared to IBD patients with remission (24.4% vs 10.8%, p = 0.000). The prevalence of abnormal LFT was less in patients with 5-ASA components and MTX users (16.4% vs 10%) compared to non-user patients (27% vs 17.8%). There was no difference in the prevalence of normal and abnormal liver function tests in patients using drugs such as corticosteroids, immunosuppressive, antibiotics and TNF-antagonists. Unlike the literature in patients with IBD, we found no difference between CH and UC in terms of cholelithiasis (10.8% vs 8.8%, p = 0.539). The incidence of hepatosteatosis in the general population is 14-30%. Hepatosteatosis was detected in 38% of IBD patients and no significant difference was found between CH and UC in terms of hepatostetosis (38.5% vs 38.5%, p = 0.845). There was no significant difference between CH and UC in terms of HM (32.2% vs 30.1%). PSC was detected in 5 patients (3 UC, 2 CH). İn one patient with CH, OİH was detected. Conclusions: Our data suggest that liver function tests should be followed in patients with IBD, given the high incidence of abnormal liver function tests, even in the absence of symptoms. Key Words: Hepatobiliary disease; inflammatory bowel disease; abnormal liver function test