Here are five conditions that may develop alongside IBD, including liver disease.
1. Primary Sclerosing Cholangitis
Primary sclerosing cholangitis (PSC) is a form of liver disease associated with IBD, most commonly UC, says Donald Jensen, MD, a hepatologist at Rush University Medical Center in Chicago. In a systematic review and meta-analysis of 776,700 patients with IBD, pooled prevalence of PSC in IBD was 2.16 percent.
PSC is characterized by inflammation, thickening, and abnormal formation of fibrous tissue in the bile ducts, which carry bile from the liver to help with the digestion of fats. Scarring of the liver can eventually develop, and many 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 close relationship between PSC and IBD points to the emerging concept of the gut-liver axis, in which the gut and the liver have a bidirectional relationship.
While PSC was once thought to affect middle-aged men, according to a European study published in the Spanish medical journal Gastroenterología y Hepatología, nearly half of the participants with PSC were women.
Metabolic dysfunction–associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is the most common liver complication of IBD.
A systematic review and meta-analysis of 89 studies found the overall prevalence of MASLD was 24.4 percent in IBD, 20.2 percent in Crohn’s disease, and 18.5 percent in UC.
MASLD occurs when extra fat gets deposited in the liver, but it rarely causes any symptoms. In many cases, weight loss along with control of blood cholesterol levels and diabetes if present can reverse the disease.
3. Autoimmune Hepatitis
Autoimmune hepatitis is caused by chronic inflammation of the liver when your immune system attacks the cells in your own liver, notes the Mayo Clinic. There are two main forms of autoimmune hepatitis: type 1 and type 2. Type 1 is the most common form of the disease, and about half of the people who have it have other autoimmune disorders, such as celiac disease, rheumatoid arthritis, or ulcerative colitis.
Autoimmune hepatitis is usually first treated with a high-dose corticosteroid such as prednisone, which is eventually reduced. Sometimes a second medicine, called azathioprine (Imuran), is used. Azathioprine is an immunomodulator, meaning it modifies the activity of the immune system, reducing inflammation.
4. Gallstones
Gallstones form when bile, produced by the liver and stored in the gallbladder, hardens into small, stonelike pieces. If one or more stones block the ducts of the gallbladder, you may experience pain, nausea, and vomiting.
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 prevalence of gallstone disease, but the significantly higher prevalence occurred in Crohn’s disease, not ulcerative colitis. However, the authors note that larger-scale studies are needed.
The incidence of gallstones is higher in people with IBD who have undergone resection of the last part of their small bowel, the ileum.
5. Pancreatitis
An increased incidence of acute or chronic pancreatitis, or inflammation of the pancreas, is associated with IBD compared with the general population. In most cases, pancreatitis seems to be related to gallstones or the drugs used to treat IBD, but some cases suggest direct damage to the pancreas in IBD. “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. If your doctor determines that medication is the cause, you’ll most likely need to stop taking it to resolve the inflammation. But don’t stop taking any medications without first getting your doctor’s approval.
