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Liver damage in juvenile inflammatory bowel disease
A Nemeth1, J Ejderhamn, H Glaumann
1Department of Paediatrics, Karolinska Institutet, Huddinge University Hospital, Sweden.
Insights
Pediatric inflammatory bowel disease (IBD) frequently causes liver damage, particularly in ulcerative colitis patients. Severe liver issues often appear at diagnosis, highlighting the need for early monitoring.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Inflammatory Bowel Disease Research
Background:
- Inflammatory bowel disease (IBD) encompasses ulcerative colitis (UC) and Crohn's disease (CD).
- Liver involvement in pediatric IBD is a recognized complication, but its frequency and characteristics require further elucidation.
- Early identification of liver dysfunction is crucial for managing IBD in children and adolescents.
Purpose of the Study:
- To investigate the prevalence and nature of liver function abnormalities in children and adolescents diagnosed with IBD.
- To determine the association between liver damage and specific IBD types (UC vs. CD), disease extent, and duration.
- To characterize the histological findings and clinical presentation of liver disease in this cohort.
Main Methods:
- A longitudinal study followed 46 children and adolescents with IBD for a mean of 5.2 years.
- Regular biochemical liver function tests were performed from diagnosis.
- Liver biopsies and ERCP were utilized for detailed assessment in selected cases; electron microscopy was used for morphometric analysis.
Main Results:
- Sixty percent of ulcerative colitis patients (20/34) exhibited abnormal liver function tests, with 9 showing severe disturbances often at diagnosis.
- Liver damage was most common in total colitis and included pericholangitis, fibrosis, and cirrhosis.
- Electron microscopy revealed increased lysosomes and dilated rough endoplasmic reticulum cisternae; primary sclerosing cholangitis was confirmed in one patient.
- Four of 12 Crohn's disease patients had mildly abnormal liver tests, with no correlation to disease extent, duration, or treatment.
Conclusions:
- Liver damage is a frequent complication in juvenile IBD, predominantly observed in ulcerative colitis.
- Severe liver dysfunction in pediatric IBD often presents at the time of diagnosis, particularly in cases of total colitis.
- Histopathological findings suggest significant cellular changes in the liver, underscoring the systemic impact of IBD.
Abstract:
During a 12-year period, 46 children and adolescents with inflammatory bowel disease were followed from the time of diagnosis with regular biochemical tests of liver function. Thirty-four patients had ulcerative colitis and 12 had Crohn's disease. Mean age at the time of diagnosis was 10.2 years (range 7 months-17 years) and the mean follow-up period was 5.2 years (range 1-11 years). Pathological liver function tests were found in 60% of the 34 patients with ulcerative colitis: 9 of these 20 patients demonstrated more severe disturbance, usually at the time of diagnosis. Liver damage was most frequent in patients with total colitis. Liver biopsy was performed in eight patients, demonstrating "pericholangitis", fibrosis and in one case cirrhosis. Morphometry of electron microscopical pictures revealed a significantly increased number of lysosomes and dilated cisternae of the rough endoplasmic reticulum. ERCP was performed in two patients, verifying primary sclerosing cholangitis in one. Four of the 12 patients with Crohn's disease had mildly pathological liver function tests. No correlation was found to the extent, duration or treatment of bowel disease. In our series of juvenile inflammatory bowel disease, liver damage occurred frequently, especially in ulcerative colitis. The more severe changes tended to coincide with the onset of bowel disease.