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Published on: November 27, 2016
Hepatobiliary phenotype of individuals with chronic intestinal disorders
Jessica Voss1, Carolin V Schneider1, Moritz Kleinjans1
1Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
Insights
This study reveals distinct liver disease risks associated with celiac disease (CeD), Crohn´s disease (CD), and ulcerative colitis (UC). Intestinal disorders increase risks for cirrhosis, non-alcoholic steatohepatitis (NASH), and hepatocellular carcinoma (HCC), with surgery impacting outcomes.
Area of Science:
- Gastroenterology and Hepatology
- Clinical Research
- Population Health
Background:
- The gut-liver axis is functionally established, but its clinical implications for specific intestinal disorders remain underexplored.
- Understanding these connections is crucial for managing patients with inflammatory bowel diseases and celiac disease.
Purpose of the Study:
- To investigate the hepatobiliary (liver and bile duct) disease phenotypes associated with celiac disease (CeD), Crohn´s disease (CD), and ulcerative colitis (UC).
- To analyze liver function tests and disease frequencies in large cohorts compared to controls.
Main Methods:
- A population-based cohort study using UK Biobank data, analyzing 2377 CeD, 1738 CD, 3684 UC subjects, and 488,941 controls.
- Adjusted analyses for age, sex, BMI, diabetes, and alcohol consumption to assess associations between intestinal disorders and hepatobiliary outcomes.
Main Results:
- Celiac disease (CeD) showed higher AST/ALT, while Crohn´s disease (CD)/ulcerative colitis (UC) had elevated GGT. All intestinal disorders had increased ALP and gallstones.
- Non-alcoholic steatohepatitis (NASH) and hepatocellular carcinoma (HCC) were more common in CeD and CD. Cholangitis was more frequent in CD/UC.
- Chronic hepatitis, autoimmune hepatitis (AIH), and cirrhosis were prevalent across all intestinal disorders. Intestinal surgery in UC/CD correlated with liver enzyme elevation and gallstones.
Conclusions:
- Distinct intestinal disorders are associated with specific hepatobiliary disease risks.
- Increased prevalence of cirrhosis, NASH, AIH, and HCC in CeD/CD warrants further investigation.
- The impact of intestinal surgery on liver health in UC/CD requires additional study.
Abstract:
Despite the known functional relationship between the gut and the liver, the clinical consequences of this circuit remain unclear. We assessed the hepatobiliary phenotype of cohorts with celiac disease (CeD), Crohn´s disease (CD) and ulcerative colitis (UC). Baseline liver function tests and the frequency of hepatobiliary diseases were analyzed in 2377 CeD, 1738 CD, 3684 UC subjects and 488,941 controls from the population-based UK Biobank cohort. In this cohort study associations were adjusted for age, sex, BMI, diabetes, and alcohol consumption. Compared to controls, cohorts with CeD, but not CD/UC displayed higher AST/ALT values. Subjects with CD/UC but not CeD had increased GGT levels. Elevated ALP and cholelithiasis were significantly more common in all intestinal disorders. Non-alcoholic steatohepatitis and hepatocellular carcinoma (HCC) were enriched in CeD and CD (NASH: taOR = 4.9 [2.2-11.0] in CeD, aOR = 4.2 [1.7-10.3] in CD, HCC: aOR = 4.8 [1.8-13.0] in CeD, aOR = 5.9 [2.2-16.1] in CD), while cholangitis was more common in the CD/UC cohorts (aOR = 11.7 [9.1-15.0] in UC, aOR = 3.5 [1.8-6.8] in CD). Chronic hepatitis, autoimmune hepatitis (AIH) and cirrhosis were more prevalent in all intestinal disorders. In UC/CD, a history of intestinal surgery was associated with elevated liver enzymes and increased occurrence of gallstones (UC: aOR = 2.9 [2.1-4.1], CD: 1.7 [1.2-2.3]). Our data demonstrate that different intestinal disorders predispose to distinct hepatobiliary phenotypes. An increased occurrence of liver cirrhosis, NASH, AIH and HCC and the impact of surgery warrant further exploration.
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