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Liver Pathology in Children with Diagnosed Inflammatory Bowel Disease-A Single Center Experience
Urszula Daniluk1, Kamila Kwiatek-Sredzinska1, Piotr Jakimiec1
1Department of Pediatrics, Gastroenterology, Hepatology, Nutrition and Allergology, Medical University of Bialystok, 15-274 Bialystok, Poland.
Insights
Liver pathology affects 18% of children with inflammatory bowel disease (IBD), often appearing after diagnosis. Routine monitoring of liver enzymes is recommended for pediatric IBD patients to detect these conditions early.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Inflammatory Bowel Disease Research
Background:
- Inflammatory bowel disease (IBD) in children is linked to liver issues, ranging from enzyme elevations to specific liver diseases.
- Understanding the prevalence and types of liver pathology in pediatric IBD is crucial for timely management.
Purpose of the Study:
- To determine the prevalence of liver pathology in children diagnosed with IBD.
- To classify the types of liver diseases occurring in pediatric IBD patients within a two-year follow-up period.
Main Methods:
- Retrospective review of medical records for children diagnosed with IBD.
- Liver pathology defined by elevated liver enzymes (ALT, GGT), bilirubin, abnormal imaging (ultrasound, MRCP), or liver histology.
Main Results:
- Liver pathology was found in 18% of 119 children with IBD (17% with Crohn's disease, 18% with ulcerative colitis).
- Common diagnoses included primary sclerosing cholangitis (PSC), non-alcoholic fatty liver disease (NAFLD), and autoimmune hepatitis.
- Most liver pathologies were diagnosed after the IBD diagnosis, with younger patients showing higher ALT and more imaging abnormalities.
Conclusions:
- A significant proportion of children with IBD experience liver pathology.
- Hepatobiliary abnormalities are frequently diagnosed post-IBD diagnosis, underscoring the need for regular liver enzyme monitoring in these patients.
Background:
Inflammatory bowel disease (IBD) in children is frequently associated with liver pathology manifested as transient elevation of liver enzymes or specified liver diseases. The aim of the study was to evaluate the prevalence and the type of liver pathology in children with IBD within 2 years' follow-up after the IBD diagnosis.
Methods:
We retrospectively reviewed records of children with IBD. Liver pathology was defined as elevated activity of liver enzymes (alanine transaminase (ALT) and/or gamma-glutamyl transpeptidase (GGT)) and bilirubin concentration in serum and/or as pathological changes of the organ on imaging tests (abdominal ultrasound and/or magnetic resonance cholangiopancreatography) or on liver histology performed when indicated.
Results:
Liver pathology was detected in 21 from 119 children (18%), including 7 (17%) with Crohn's disease (CD) and 14 (18%) with ulcerative colitis (UC). Specified diagnosis for liver abnormality was found in 14 of 21 children (67%), including primary sclerosing cholangitis (PSC, 19%), non-alcoholic fatty liver disease (NAFLD, 19%), autoimmune sclerosing cholangitis (ASC, 5%), autoimmune hepatitis (AIH, 5%), cholelithiasis (5%), drug-induced liver disease (9%) and viral infection (herpes simplex virus, 5%). Most patients manifested mild IBD or were in clinical remission at the time of liver pathology diagnosis. 14% of patients with liver disease (including only cases with PSC) were diagnosed before IBD, 33% at the same time, and 52% in the later period. Patients with the specified diagnosis of liver pathology were younger, had higher ALT activity and more often demonstrated liver abnormalities on imaging tests. UC patients with idiopathic elevation of liver enzymes had higher pediatric ulcerative colitis activity index scores compared to children with specified liver disease.
Conclusions:
Liver pathology was observed in a significant percentage of children with IBD in our study. The majority of cases of hepatobiliary abnormalities were detected after diagnosis of IBD; therefore, children with IBD should undergo routine monitoring of liver enzymes.
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