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Characterization of hepatic abnormalities in children with inflammatory bowel disease
J Hyams1, J Markowitz, W Treem
1*Department of Pediatrics, Hartford Hospital, Hartford, Connecticut; and †Department of Pediatrics, North Shore University Hospital, Manhasset, New York, U.S.A.
Insights
Most children with inflammatory bowel disease (IBD) experience transient liver enzyme elevations, often linked to medications or disease activity. Persistent elevations may indicate serious conditions like sclerosing cholangitis or autoimmune hepatitis, requiring further investigation.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Inflammatory Bowel Disease Research
Background:
- Liver disease is a potential complication in pediatric inflammatory bowel disease (IBD).
- Understanding the spectrum of liver abnormalities in children with IBD is crucial for appropriate management.
Purpose of the Study:
- To characterize the incidence, nature, and clinical course of liver disease in pediatric patients with Crohn's disease (CD) and ulcerative colitis (UC).
Main Methods:
- Retrospective chart review of 555 pediatric IBD patients (318 CD, 237 UC).
- Alanine aminotransferase (ALT) levels ≥80 U/L were used to identify hepatic abnormalities.
- Analysis of persistent ( >6 months) and non-persistent ALT elevations and associated diagnoses.
Main Results:
- 75 patients (13.5%) had at least one elevated ALT level (≥80 U/L).
- Persistent ALT elevation occurred in 14 patients: 10 with sclerosing cholangitis (SC) and 4 with autoimmune chronic active hepatitis (CAH).
- Non-persistent elevations (<250 U/L) in 61 patients were associated with medications, parenteral nutrition, bowel obstruction, and IBD flares.
Conclusions:
- Most ALT elevations in pediatric IBD are transient and related to external factors or disease activity.
- Sclerosing cholangitis occurred in 3.5% of UC and <1% of CD patients; CAH in <1% of both.
- Mild to moderate ALT elevations (80-250 U/L) in pediatric IBD warrant observation unless chronic liver disease is suspected.
Abstract:
: We sought to characterize the incidence, nature, and course of liver disease in children with inflammatory bowel disease (IBD). Chart review identified 555 subjects (318 Crohn's disease [CD], 237 ulcerative colitis [UC]). An alanine aminotransferase measurement of ≥80 U/L was used to identify the presence of a hepatic abnormality. Seventy-five patients (47 CD, 28 UC) had at least one ALT level ≥80 U/L. Persistent ALT elevation (>6 months) was found in 14 patients: 10 with sclerosing cholangitis (SC) (eight UC, two CD) and four with autoimmune chronic active hepatitis (CAH) (one UC, three CD). One patient with SC has had hepatic transplantation, and one other has end-stage liver disease. The remainder are clinically well. Two patients with CAH have developed cirrhosis. Nonpersisting ALT elevations (<250 U/L) were noted during disease course in 61 patients and were associated with medications, parenteral nutrition, bowel obstruction, and flare-ups of disease. Most ALT elevations in children with IBD are transient and appear to relate to medications or disease activity. Sclerosing cholangitis was noted in 3.5% of UC patients and <1% of CD patients, while CAH was found in <1% of UC or CD patients. Unless evidence of chronic liver disease is present, the initial finding of mild to moderate ALT elevation (80-250 U/L) should prompt observation before extensive evaluation.
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