Introduction Deranged liver function tests (LFTs) are commonly associated with inflammatory bowel disease (IBD). Observational studies suggest prevalence of between 11% to 49%  but factors predicting this abnormality are unclear. It was the aim of this study to investigate its distribution, association, causes and outcome.
Method Patients with IBD were identified using the endoscopy reporting system (endoscribe) over a five year period. Data was then collected from clinic letters, discharge summaries, endoscopy reports, pathology and biochemistry reports utilising the hospital reporting systems which included medisec, endoscribe, and ICE system. Information collected included demographics, disease classification, co-morbidities, pattern of LFTs, medication, surgery, hospital admission and prognosis.
Results Of 201 patients identified, 6 were excluded due to insufficient data. Of the remaining 195 patients identified with IBD, 35% (n=69) developed deranged LFTs with 107 separate episodes documented. The mean age was 48 years, males, 43%. Co-morbidities included cardiovascular disease17%, rheumatoid disease 12%, dermatological disease 11%, cancer 6%, hyperlipidaemia and diabetes 5% each, and alcohol excess and underlying liver disease 3% each. In patients with IBD who had deranged LFTs, 57% had ulcerative colitis (UC), 42% had Crohn’s Disease (CD) and 1% had indeterminate colitis. Of the 107 episodes of deranged LFTs, 50% were associated with an IBD flare whilst 22% with IBD medication. Other associations included recent non-IBD surgery 5%,other medication 5%, cancer 4%, rheumatoid disease 2%, recent IBD surgery 3%, AIH/PSC 2%,miscellaneous (gallstones, ischemia, NAFLD, sepsis, alcoholic hepatitis, pregnancy) 12% and undetermined causes 14%. On logistic regression, continued deteriorating LFTs was associated with AIH/PSC(p=0.001) and cancer(p=0.019). Logistic regression also suggested an association between the cholestatic pattern of LFTs and IBD medication(p=0.001), recent IBD surgery(p=0.015) and cancer(p=0.005). The distribution of LFTs was cholestatic 34%, hepatitic 51% and mixed 15%. 52% of deranged LFTs episodes resolved, 39% remained elevated and 9% continued to deteriorate.
Conclusion Deranged LFTs are a frequently noted in patients with IBD, the most common reasons being IBD flare, surgery and medications. Furthermore, a cholestatic pattern of LFTs were associated with patients who have deranged LFTs secondary to medication. The factors associated with this derangement should be actively sought and managed.
. Liver Function Test Abnormalities in Patients with Inflammatory Bowel Diseases: A Hospital-based Survey.Cappello M, et al. Clin Med Insights Gastroenterol. 2014Jun 17;7:25–31. doi: 10.4137/CGast.S13125. eCollection 2014.
Disclosure of Interest None Declared
- Inflammatory Bowel Disease
- liver function