Introduction Abnormal liver function tests (LFTs) are present in up to 40% of patients with Inflammatory Bowel Disease (IBD). These abnormalities are often transient. A few studies in the current literature suggest that transient disturbances may be related to disease activity,^1,2whilst others have failed to find a causal association.³The aim of this study is to identify the link between abnormal LFTs and IBD activity.

Method Literature review was performed using Pubmed. For the retrospective study, patients with Ulcerative Colitis (UC) and Crohn’s disease (CD) who were admitted to our institution in 2013 were identified. Patient’s electronic records were used. Exclusion criteria: less than 16 years old, LFTs documented for less than 12 months or on less than 3 occasions. Abnormalites were defined as ’transient’ if at least one of: alanine transaminase, alkaline phosphatase or bilirubin was disturbed for less than 4 weeks or ‘persistent’ if disturbed for more than 4 weeks.

Results 8 studies were included in the literature review. There was significant heterogeneity in the frequency of abnormal LFT (3%⁴to 40%²) due to variations in the definitions used.

Our study included 264 CD patients and 310 UC patients who were followed for a median of 34 months. Abnormal LFTs were found in 242/574 (42%) patients. 66% of abnormalities were transient and 34% were persistent. The causes identified for 192 patients with transient abnormalities were: 70 IBD flare, 52 antibiotics/infection, 3 thiopurine drugs, 59 unknown, 3 fatty liver, 5 other. The causes identified for 99 patients with persistent abnormalities were: 22 IBD flare, 14 infections, 12 PSC, 18 unknown cause, 5 fatty liver, 4 Gilberts, 5 thiopurine drugs, 3 pregnant, 16 other.

Conclusion This study lends support to the notion that an IBD flare can cause deranged LFTs independently of thiopurine drugs. Mild abnormalities during a flare can be monitored. Further investigations are warranted if the bilirubin is raised or if the LFTs are markedly deranged or persist more than 4 weeks after resolution of the flare.

Disclosure of interest None Declared.

References

1. Broome U, Glaumann H, Hellers G, Nilsson B, Sorstad J, Hultcrantz R. Liver disease in ulcerative colitis: an epidemiological and follow up study in the country of Stockholm. Gut. 1994;35(1):84–89

2. Yamamoto-Furusho JK, Sanchez-Osorio M, Uribe M. Prevalence and factors associated with the presence of abnormal liver function tests in patients with ulcerative colitis. Ann Hepatol. 2010;9(4):397–401

3. Mendes FD, Levy C, Enders FB, Loftus EV, Angulo P, Lindor KD. Abnormal hepatic biochemistries in patients with inflammatory bowel disease. Am J Gastroenterol. 2007;102:344–350

4. Shepherd HA, Selby WS, Chapman RW, Nolan D, Barbatis C, McGee JO, Jewell DP. Ulcerative colitis and persistent liver dysfunction. Q J Med.1983;52(208):503–13