Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 27, 2021; 13(12): 1956-1967
Published online Dec 27, 2021. doi: 10.4254/wjh.v13.i12.1956
Liver manifestations and complications in inflammatory bowel disease: A review
Rui Gaspar, Catarina Castelo Branco, Guilherme Macedo
Rui Gaspar, Guilherme Macedo, Department of Gastroenterology and Hepatology, Centro Hospitalar de São João, Porto 4200, Portugal
Catarina Castelo Branco, Internal Medicine Department, Centro Hospitalar e Universitário do Porto, Porto 4200, Portugal
Author contributions: Gaspar R was responsible for acquisition and interpretation of the data and drafting of the manuscript; Branco CC was responsible for critical revision and language correction of the manuscript; Macedo G was responsible for critical revision of the manuscript.
Conflict-of-interest statement: The authors declare no conflict of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Rui Gaspar, MD, Doctor, Department of Gastroenterology and Hepatology, Centro Hospitalar de São João, Alameda Prof Hernani Monteiro, Porto 4200, Portugal.
Received: February 25, 2021
Peer-review started: February 25, 2021
First decision: May 13, 2021
Revised: May 27, 2021
Accepted: November 12, 2021
Article in press: November 12, 2021
Published online: December 27, 2021

Hepatobiliary manifestations are common in inflammatory bowel disease (IBD), with 30% of patients presenting abnormal liver tests and 5% developing chronic liver disease. They range from asymptomatic elevated liver tests to life-threatening disease and usually follow an independent course from IBD. The pathogenesis of liver manifestations or complications and IBD can be closely related by sharing a common auto-immune background (in primary sclerosing cholangitis, IgG4-related cholangitis, and autoimmune hepatitis), intestinal inflammation (in portal vein thrombosis and granulomatous hepatitis), metabolic impairment (in non-alcoholic fatty liver disease or cholelithiasis), or drug toxicity (in drug induced liver injury or hepatitis B virus infection reactivation). Their evaluation should prompt a full diagnostic workup to identify and readily treat all complications, improving management and outcome.

Keywords: Hepatobiliary manifestations, Inflammatory bowel disease, Drug induced liver injury, Primary sclerosing cholangitis, Viral hepatitis, Crohn's disease, Ulcerative colitis

Core Tip: Hepatobiliary manifestations are common in inflammatory bowel disease (IBD), ranging from incidental findings in asymptomatic patients to life-threatening liver failure. Their pathogenesis can be intrinsically linked to IBD (auto-immune background or metabolic abnormalities) or to its medication. Early recognition of these manifestations as well as a full diagnostic workup are mandatory to improve management and prognosis. In this review, we describe all hepatobiliary manifestations in IBD.