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
Inflammatory bowel diseases (IBDs) are often associated with cholestasis, which can be caused by inflammation, drugs, or extra-intestinal manifestations. There is a lack of data in the literature on the prevalence and characteristics of cholestasis.
Measuring cholestasis and its prevalence and describing its characteristics and the main associated factors should improve our understanding of its causes and help to prevent or avoid the development of cholestasis in IBD.
The main objective of this study was to establish the prevalence of clinical and biological cholestasis. The secondary objective was then to clarify the causes and characteristics of cholestasis by studying the corresponding bile acid subtypes.
A total of 1342 patients from the Swiss Inflammatory Bowel Disease Cohort were included and cholestasis was measured via their total bile acid levels. Patients with the main well-known causes of cholestasis (such as primary sclerosing cholangitis for example) were then excluded to study less obvious causes. The concentrations of different bile acid subtypes were measured in two groups of patients, either with or without cholestasis. The bile acid profiles of patients in the two groups were compared for different clinical situations, notably ileal vs colonic disease and for smokers vs nonsmokers.
The prevalence of cholestasis was found to be high, at 7.15%. Multivariate analysis showed that calcium supplementation was significantly associated with cholestasis whereas current smoking significantly reduced the risk of cholestasis. Regarding bile acid subtypes, patients in the cholestasis group had higher levels of all conjugated bile acids than those in the control group did. Comparing patients with ileal disease with those with colonic disease, the former had higher levels of unconjugated bile acids while the latter had higher levels of conjugated bile acids. These results highlight the probable role played by gut bacteria and the liver in the different types of cholestasis. What exactly these roles are should now be studied in more detail.
This study found that the prevalence of cholestasis is high in patients with IBD. Different subtypes of bile acid were associated with cholestasis, colonic disease, and ileal disease, indicating probable interactions between the gut microbiota, the liver and the different types of IBD. As expected, ileal or colonic involvement, smoking status and inflammation activity all modified the type of cholestasis presented by patients. A prospective analysis of cholestasis and its characteristics should be performed to improve our understanding of this condition and develop prevention strategies.
Cholestasis is frequent in IBD. The characteristics of cholestasis vary with the type of IBD and inflammatory activity. Cholestasis should now be studied prospectively to better understand how the gut microbiota and the liver are involved.