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Abnormal Liver Biochemistry Is Common in Pediatric Inflammatory Bowel Disease: Prevalence and Associations
Pamela L Valentino1, Brian M Feldman, Thomas D Walters
1*Division of Gastroenterology, Hepatology, and Nutrition, The University of Toronto, ON, Canada; †Department of Pediatrics, The University of Toronto, Toronto, ON, Canada; ‡Institute of Health Policy, Management and Evaluation, The University of Toronto, Toronto, ON, Canada; §Child Health Evaluative Sciences, Hospital for Sick Children and The University of Toronto, Toronto, ON, Canada; and ‖Division of Rheumatology, The University of Toronto, Toronto, ON, Canada.
Insights
Abnormal liver enzymes are common in children with inflammatory bowel disease (IBD), often appearing early. Certain medications and conditions like PSC/ASC are linked to these elevations, requiring careful monitoring in pediatric IBD patients.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Inflammatory Bowel Disease Research
Background:
- Liver enzyme abnormalities are understudied in pediatric inflammatory bowel diseases (IBD).
- This study aims to describe the development and associations of abnormal liver enzymes in children with IBD.
Purpose of the Study:
- To investigate the incidence and timing of abnormal liver enzyme development in pediatric IBD.
- To identify clinical factors associated with abnormal liver enzyme levels in this population.
Main Methods:
- Retrospective analysis of a cohort of 300 children with IBD.
- Kaplan-Meier analysis to determine time to abnormal liver enzyme thresholds.
- Association analysis between clinical variables and abnormal liver enzyme development.
Main Results:
- 58.1% probability of abnormal liver enzymes within 150 months post-IBD diagnosis.
- 6% prevalence of primary sclerosing cholangitis (PSC) or autoimmune sclerosing cholangitis (ASC); 93% of these had persistent elevations (>2x ULN).
- Corticosteroids, antibiotics, and exclusive enteral nutrition showed strong associations with abnormal liver enzymes (>ULN) after excluding PSC/ASC.
Conclusions:
- Abnormal liver enzymes are frequent and occur early in pediatric IBD.
- PSC/ASC is linked to persistent, high liver enzyme elevations, with gamma-glutamyl transpeptidase >252 U/L being a key indicator.
- Pediatric IBD patients requiring treatments beyond 5-ASA for remission are at higher risk for elevated liver enzymes.
Background:
Liver enzymes (LEs) abnormalities associated with pediatric inflammatory bowel diseases (IBD) are understudied. We undertook to describe the development and associations of abnormal LEs in pediatric IBD.
Methods:
We ascertained a cohort of 300 children with IBD and collected retrospective data. A Kaplan-Meier analysis determined the time to development of different thresholds of abnormal LEs. Associations between clinical variables and the development of abnormal LEs were determined.
Results:
The probability of developing the first episode of abnormal LEs above the upper limit of normal (ULN) within 150 months was 58.1% (16.3% by 1 mo post-IBD diagnosis). There was a 6% prevalence of primary sclerosing cholangitis (PSC) or autoimmune sclerosing cholangitis (ASC) in this cohort. Of those diagnosed with PSC/ASC, 93% had persistent LE elevations at a threshold of >2× ULN, while those without PSC/ASC had a 4% probability of this abnormality. Elevated gamma glutamyltranspeptidase levels of 252 U/L had a 99% sensitivity and 71% specificity for PSC/ASC in IBD. After exclusion of patients with PSC/ASC, corticosteroids, antibiotics, and exclusive enteral nutrition demonstrated strongly positive associations with the first development of abnormal LEs >ULN (hazard ratio 2.1 [95% confidence interval, 1.3-3.3], hazard ratio 5.6 [95% confidence interval, 3.6-8.9], hazard ratio 4.2 [95% confidence interval, 1.6-11.3], respectively).
Conclusions:
Abnormal LEs are common in pediatric IBD and occur early. PSC/ASC is associated with persistently high LEs and gamma glutamyltranspeptidase levels >252 U/L. Children with IBD are at risk of elevated LEs if they require medications other than 5-ASA to induce IBD remission.
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