Hepatobiliary manifestations in inflammatory bowel disease: A practical approach

Table 1 Possible, drug induced liver injury, prevention and what to do

Drug	Prevention	Hepatic injury	Treatment
5-Amino salicilyc acid	Check before start treatment annual check	Drug induced hepatitis; Drug induced cholestasic; Granuloma formation (sulfa)	Stop drug; Follow-up
Tiopurines (azathioprine/6MP)	Check before treatment: TPMT and liver test; Check every week in first month, withing 2 wk in 2nd mo, every 3 mo	Drug induced hepatitis; Drug induced cholestasic; Sinusoidal obstruction syndrome; Nodular regenerative hyperplasia; Peliosis hepatitis	Drug induced hepatitis and cholestasic are idyosincratic reactions; More cases in the first three months of treatment; Stop drug
Methotrexate	Check before start treatment; Check every 2 wk until 2nd mo; Check every 3 mo; Add folic acid	Fibrosis/cirrhosis; Steatohepatitis	Stop MTX if ALT > 3 times; Despite alcohol; Comsume; Fibroscan

6MP: 6-mercapthopurine; MTX: Methotrexate; TPMT: Thiopurine methyltransferase; ALT: Alanino transferase.