Hepatobiliary abnormalities in inflammatory bowel disease

Hepatobiliary abnormalities are among the most frequent extraintestinal manifestations of inflammatory bowel disease. Hepatic amyloidosis and granulomas may be found in patients with Crohn's ileitis. Clinical problems are generally absent. This also applies to fatty infiltration of the liver. The prevalence of gallstones is increased in patients with extensive ileitis. Primary sclerosing cholangitis occurs in about 5% of patients with ulcerative and Crohn's colitis. Serious complications such as bacterial cholangitis and bile duct carcinoma may develop. Because of increased awareness of primary sclerosing cholangitis complicating inflammatory bowel disease and widespread availability of endoscopic cholangiography, asymptomatic patients are now often detected Although controversial, the prognosis of these patients may be better than previously thought. Therefore, endoscopic cholangiography should probably be deferred until symptoms develop in order to avoid the risk of procedure-related cholangitis. Although a liver biopsy is not as diagnostic as cholangiography, it may have prognostic relevance. Recent preliminary results of immunosuppressive and anti-fibrogenic therapies and treatment with urodeoxycholic acid for primary sclerosing cholangitis are promising, but should be confirmed in prospective controlled trials.