P319 The etiological profile of chronic disturbances of the liver balance during chronic inflammatory bowel diseases

Abstract

<h3>Introduction</h3> The discovery of chronic liver abnormalities during the diagnosis or follow-up of chronic inflammatory bowel disease (IBD) is a frequent occurrence. Screening is based on simple liver biology tests, and it is important to identify the causes of these abnormalities. It is important to distinguish between transient and chronic liver test abnormalities. The aim of our work is to determine the prevalence and etiological profile of liver test abnormalities in patients being monitored for IBD. <h3>Methods</h3> This was a single-center descriptive retrospective study including 1732 of the patients followed up for IBD (1154 Crohn’s disease (CD) and 578 hemorrhagic rectocolitis (UC). <h3>Results</h3> Of the 1732 IBD patients, 3.06% (n=53) presented with disturbances of the liver balance defined by an increase in the activity of alkaline phosphatases, GGT, conjugated bilirubin or transaminases above the normal range; 47 of these patients were followed up for CD (4.07%), and 7 patients were followed up for UC (1.2%). CD was ileocolic in 18 cases, with an elevated location in one case, colonic in 13 cases, ileal in 12 cases and greglio-colic in 4 cases. It was luminal in 30 cases, fistulising in 10 and stenosing in 7. And UC was pancolic in 5 patients and left-sided in 2. The mean age was 44 years, with extremes ranging from 16–66 years. The sex ratio F/M was 1.3. Functionally, all patients were asymptomatic. Liver function tests showed isolated cytolysis in 62.3% of cases, isolated anicteric cholestasis in 35.8% and combined cytolysis-cholestasis in 20.7%. Imaging showed a normal liver in 35.8%, steatosis in 7.5%, homogeneous hepatomegaly in 1.9%, signs of PH in 13.2% and the typical appearance of primary sclerosing cholangitis (CSP) in 9.4%. Liver biopsy was performed in 13 (24.5%) patients and the profile was as follows: steatohepatitis (grade 1) in 17% patients, in favor of autoimmune hepatitis (HAI) in one patient (1.9%) and normal liver parenchyma in 7.5%. Evaluation of hepatic fibrosis showed F0 in 3.8%, F1 in 11.3%, F2 in 9.4% and F3 in 5.6%. The etiological approach to these hepatic anomalies revealed 30.2% cases of steatosis, 17% cases of CSP, 11.3% cases of HVB, 7.5% cases of HAI, one of which was induced by infliximab, respectively in 5.6% of cases HVC and CBP, 15. 1% cases of drug-induced hepatotoxicity including 3 cases on methotrexate, respectively in 2 cases on azathioprine et anti TNF, 1 case on aminosalicylates, respectively in 1.9% of cases haemochromatosis and a PAL-dependent cholestasis related to osteoporosis and the etiology was undetermined in 2 cases. <h3>Conclusions</h3> The prevalence of various hepatobiliary abnormalities associated with IBD is 3.06%. The most common is steatosis and the most specific is primary sclerosing cholangitis, but there is also a cause independent of IBD, notably drug-induced hepatotoxicity.