Published online Apr 16, 2018. doi: 10.12998/wjcc.v6.i4.44
Peer-review started: January 9, 2018
First decision: January 29, 2018
Revised: February 6, 2018
Accepted: March 7, 2018
Article in press: March 7, 2018
Published online: April 16, 2018
To investigate the prevalence and causes of cholestasis in patients with inflammatory bowel diseases in the Swiss Inflammatory Bowel Diseases Cohort.
A retrospective cohort study was performed of all the patients in the Swiss Inflammatory bowel disease Cohort. Total bile acid was measured for all patients and cholestasis was defined as a concentration > 8 μmol/L. The characteristics of patients with or without cholestasis were compared. Bile acid profiles were then determined for 80 patients with high total bile acid and 80 matched patients with low total bile acid. Bile acid profiles were compared for smokers vs nonsmokers, ileal vs colonic disease, and inflammatory vs non inflammatory diseases.
Ninety-six patients had more than 8 μmol/L total bile acid, giving a prevalence of 7.15%. Patients with an obvious cause of cholestasis, such as primary sclerosing cholangitis, were then excluded, leaving 1190 participants with total bile acid < 8 μmol/L and 80 with total bile acid > 8 μmol/L. In multivariate analysis, calcium supplementation was significantly associated with cholestasis (odds ratio, 2.36, 95%CI: 1.00-5.21, P = 0.040) whereas current smoking significantly reduced the risk of cholestasis (odds ratio, 0.42, 95%CI: 0.17-0.91, P = 0.041). Levels of all conjugated bile acids were higher in the cholestasis group than in the control group. When we compared patients with ileal vs colonic disease, the former had higher levels of primary, secondary, and tertiary bile acids whereas patients with colonic disease had higher levels of conjugated bile acids.
Prevalence of cholestasis is high. Smoking appears to reduce cholestasis. Conjugated bile acids are higher in cholestasis and in colonic disease whereas unconjugated in ileal disease.
Core tip: Inflammatory bowel diseases (IBDs) are often associated with cholestasis. This study shows that the prevalence of cholestasis in IBD patients is high at 7%. Current smoking seems to be a protective factor against cholestasis, maybe reflecting a different gut function than in nonsmokers. Ileal disease was more often associated with elevated non conjugated bile acids levels. Colonic disease was characterized by higher conjugated bile acids levels.