Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 16, 2018; 6(4): 44-53
Published online Apr 16, 2018. doi: 10.12998/wjcc.v6.i4.44
High prevalence of cholestasis, with increased conjugated bile acids in inflammatory bowel diseases patients
Marc Girardin, Antoine Hadengue, Jean-Louis Frossard, the Swiss IBD Cohort Study Group
Marc Girardin, Antoine Hadengue, Jean-Louis Frossard, Service of Gastroenterology and Hepatology, Geneva University Hospital, Geneva 1211, Switzerland
Author contributions: Girardin M performed the research and wrote the manuscript under the supervision of Hadengue A and Frossard JL; Girardin M and Hadengue A conceived the study; the study was reviewed by the Swiss IBD Cohort Study Group, which also provided the patients; all the authors revised the manuscript and approved the final draft.
Institutional review board statement: The study was approved by the ethical review board of Geneva University and by the central ethical review committee of the SIBDC in September 2012.
Informed consent statement: Written, informed consent was obtained from each patient included in the study at inclusion in the SIBDC. The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki as reflected in a prior approval by the institution’s human research committee.
Conflict-of-interest statement: The authors have no potential personal and financial conflicts of interest to declare for this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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:
Correspondence to: Marc Girardin, MD, Attending Doctor, Service of Gastroenterology and Hepatology, Geneva University Hospital, Rue Gabrielle-Perret Gentil 4, Geneva 1211, Switzerland.
Telephone: +41-22-3729340 Fax: +41-22-3729366
Received: January 8, 2018
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.

Keywords: Lipid, Liver, Crohn’s disease, Ulcerative colitis, Cholestasis

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.