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Transient hypertransaminasemia in paediatric patients with Crohn disease undergoing initial treatment with enteral

Ellen Schatorjé1, Hans Hoekstra

  • 1Department of Pediatrics, Hieronymus Bosch Hospital, Hertogenbosch, The Netherlands.

Journal of Pediatric Gastroenterology and Nutrition
|July 6, 2010
PubMed

Insights

Total enteral nutrition (TEN) in children with Crohn disease can cause temporary liver enzyme elevations. This transient hypertransaminasemia is linked to insulin resistance and hepatic steatosis, not actual liver disease.

Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Inflammatory Bowel Disease Research

Background:

  • Total enteral nutrition (TEN) is a common monotherapy for pediatric Crohn disease, often used to mitigate steroid toxicity.
  • Liver disease is a recognized complication in inflammatory bowel disease, necessitating regular monitoring of liver enzymes in affected children.

Purpose of the Study:

  • To prospectively evaluate the impact of TEN on liver enzyme levels in pediatric Crohn disease patients.
  • To determine the incidence and pattern of liver enzyme changes during TEN therapy and assess for actual liver disease development.

Main Methods:

  • Prospective follow-up of 11 pediatric patients (ages 7.6-17.1 years) treated with TEN for 6 weeks.
  • Measurement of liver enzymes (ASAT, ALAT, GGT, alkaline phosphatase, bilirubin) at baseline, and at 3, 6, and 12 weeks during and after TEN therapy.

Main Results:

  • Transient elevations in aspartate aminotransferase (ASAT) and alanine aminotransferase (ALAT) were observed in 9 and 10 out of 11 patients, respectively.
  • Peak elevations occurred at 3 weeks of TEN, with values significantly decreasing by 6 and 12 weeks.
  • No patients developed clinically evident liver disease, and 9 achieved prolonged clinical remission.

Conclusions:

  • TEN therapy in children with Crohn disease is associated with transient hypertransaminasemia, likely due to insulin resistance and hepatic steatosis.
  • This elevation in liver enzymes is a benign, transient condition and not indicative of underlying liver disease.
  • Clinicians should be aware of this TEN-associated phenomenon to avoid unnecessary investigations and ensure appropriate patient management.
Abstract

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