Liver involvement in inflammatory bowel disease: What should the clinician know?

Abstract

Inflammatory bowel disease (IBD) may show a wide range of extraintestinal manifestations. In this context, liver involvement is a focal point for both an adequate management of the disease and its prognosis, due to possible serious comorbidity. The association between IBD and primary sclerosing cholangitis is the most known example. This association is relevant because it implies an increased risk of both colorectal cancer and cholangiocarcinoma. Additionally, drugs such as thiopurines or biologic agents can cause drug-induced liver damage; therefore, this event should be considered when planning IBD treatment. Additionally, particular consideration should be given to the evidence that IBD patients may have concomitant chronic viral hepatitis, such as hepatitis B and hepatitis C. Chronic immunosuppressive regimens may cause a hepatitis flare or reactivation of a healthy carrier state, therefore careful monitoring of these patients is necessary. Finally, the spread of obesity has involved even IBD patients, thus increasing the risk of non-alcoholic fatty liver disease, which has already proven to be more common in IBD patients than in the non-IBD population. This phenomenon is considered an emerging issue, as it will become the leading cause of liver cirrhosis.

Keywords: Inflammatory bowel disease; Liver; Primary sclerosing cholangitis; Viral hepatitis; Immunosuppression; Non-alcoholic fatty liver disease

Core Tip: In the present article, several aspects of liver involvement of inflammatory bowel disease (IBD) have been highlighted. Co-occurrence of primary sclerosing cholangitis is one of the most well-known comorbidities and deserves more attention by the clinician. Liver damage due to drugs used to cure IBD is also a relevant issue. Finally, some emerging topics such as the spread of liver steatosis or the implications of chronic viral hepatitis have been analyzed.