Inflammatory Bowel Disease (IBD), which includes Crohn’s disease and ulcerative colitis, is primarily known for affecting the gastrointestinal tract. However, emerging research confirms that a significant extraintestinal complication of IBD has liver involvement.

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How Common Are Liver Problems in IBD?

Liver and biliary tract diseases are common extraintestinal manifestations of IBD, affecting up to 50% of patients at some point, though clinically significant liver disease occurs in about 5% of cases. These liver issues can range from mild, asymptomatic changes in liver tests to life-threatening complications and may occur independently of bowel disease activity.

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Types of Liver Disease Seen in IBD

• Fatty Liver Disease (Hepatic Steatosis): The most frequent liver complication in IBD, fatty liver involves the accumulation of fat in liver cells. It is often benign and reversible, especially as IBD is brought under control and nutritional status improves. However, it can be influenced by disease severity, malnutrition, and corticosteroid use.

• Primary Sclerosing Cholangitis (PSC): PSC is a chronic, progressive disease causing inflammation and scarring of the bile ducts. It is strongly associated with IBD, particularly ulcerative colitis, and can eventually lead to liver failure. There is currently no cure for PSC except liver transplantation.

• Other Hepatobiliary Manifestations: These include autoimmune hepatitis, cholelithiasis (gallstones), granulomatous hepatitis, portal vein thrombosis, pyogenic liver abscesses, and, rarely, conditions like hepatic amyloidosis and primary biliary cholangitis.

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Why Does IBD Affect the Liver?

The connection between IBD and liver disease is complex. Both IBD and several liver diseases (like PSC and autoimmune hepatitis) may share autoimmune mechanisms.

Persistent inflammation in the gut can affect the liver via the portal vein, leading to complications like portal vein thrombosis or liver abscesses. Also, drugs used to treat IBD-including methotrexate, azathioprine, and biologics-can sometimes cause liver toxicity or reactivate dormant hepatitis viruses.

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Symptoms and Diagnosis

Many patients with IBD-related liver disease have no symptoms, but possible signs include fatigue, upper right abdominal pain, jaundice, itching, easy bruising, and fluid retention. Diagnosis typically involves blood tests, imaging (ultrasound, CT, MRI), and sometimes liver biopsy or endoscopic procedures. 

While all the above are invasive, at Fibronostics, our AI-powered diagnostics, like LIVERFASt, offer a non-invasive, accessible, and clinically validated solution to detect liver health issues early, even in hypertensive patients.