5 IBD-Associated Liver Conditions
Here are five liver-related conditions that may develop alongside IBD.
1. Primary Sclerosing Cholangitis
Primary sclerosing cholangitis (PSC) is a form of liver disease associated with IBD. It most commonly occurs with UC, says Donald Jensen, MD, a hepatologist at Rush University Medical Center in Chicago.
According to a systematic review and meta-analysis of 776,700 patients with IBD, 2.16 percent also had PSC.
PSC is characterized by inflammation, thickening, and the formation of fibrous tissue in the bile ducts, which carry bile from the liver to help with the digestion of fats. Eventually, scarring of the liver can develop. Without treatment, people with PSC may ultimately need a liver transplant.
“We don’t know why they’re connected, and there is no effective treatment for PSC,” says Dr. Jensen.
According to a review article, the link between PSC and IBD indicates an emerging concept called the gut-liver axis. In the gut-liver axis, the gut and the liver affect each other in a bidirectional relationship.
Men with ulcerative colitis are more likely than women to develop PSC, with a prevalence of about 60 to 70 percent. The typical age at diagnosis is between 30 and 40 years old, however, it can vary by region.
2. Metabolic Dysfunction–Associated Steatotic Liver Disease
Metabolic dysfunction–associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease, is the most common liver complication of IBD.
MASLD is a condition in which extra fat is deposited in the liver. People with MASLD rarely experience symptoms. In many cases, weight loss and managing blood cholesterol levels and diabetes can reverse the disease.
According to a systematic review and meta-analysis of 89 studies, MASLD occurred in 24.4 percent of people with IBD. Of those, 20.2 percent occurred in people with Crohn’s disease, and 18.5 percent in people with UC.
3. Autoimmune Hepatitis
Autoimmune hepatitis is when your immune system attacks your own liver cells. It is caused by chronic liver inflammation.
There are two main forms of autoimmune hepatitis: type 1 and type 2. Type 1 is the most common form of the disease. About half of people with type 1 also have other autoimmune disorders, such as celiac disease, rheumatoid arthritis, or ulcerative colitis.
Autoimmune hepatitis is typically treated with a high-dose corticosteroid, such as prednisone. The dosage is eventually reduced.
Sometimes, a medication called azathioprine (Imuran) is used as a second line of treatment. Azathioprine is an immunomodulator, meaning it modifies the activity of the immune system, reducing inflammation.
4. Gallstones
The blockage can lead to serious complications. “When gallstones pass from the gallbladder to the bile ducts, it can be associated with infection or pancreatitis,” Jensen says.
Dr. Raffals notes that ulcerative colitis itself does not lead to gallstones, but gallstones are common in older patients with IBD. They’re also more common in patients with Crohn’s disease than those with UC.
According to a meta-analysis of five studies, people with IBD had a significantly higher rate of gallstone disease than the general population. However, most of these cases occurred in people with Crohn’s disease. The authors note that larger-scale studies are needed to confirm those findings.
5. Pancreatitis
Pancreatitis, or inflammation of the pancreas, occurs more often in people with IBD, compared with the general population.
In most cases, pancreatitis with IBD seems to be related to gallstones or medications used to treat IBD. However, some cases may be due to direct damage from the condition. “Pancreatitis and inflammatory bowel diseases often present similarly, so patients may be misdiagnosed,” says Raffals.
Symptoms of pancreatitis may include abdominal pain, vomiting, nausea, and diarrhea.
The Takeaway
- Up to 30 percent of people with inflammatory bowel disease are affected by liver abnormalities.
- IBD itself, as well as certain drugs to treat the disease, can cause liver damage.
- People with IBD should get their liver enzymes checked at least once a year and know the symptoms of liver disease.
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