Is There a Link Between Crohn’s and Liver Disease?
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Although inflammatory bowel diseases (IBD) — ulcerative colitis (UC) and Crohn’s disease — primarily affect the gut, both have been linked to a host of other issues throughout the body.
“We’re just starting to understand [the association between liver disease and Crohn’s disease],” explains Benjamin Click, MD, the director of the UCHealth Digestive Health Center at the University of Colorado School of Medicine in Aurora. “There may be interactions between the liver and IBD activity, or the microbiome and the medications we use to manage IBD that we don’t fully understand, so it’s important to be aware of the association and to be proactive about minimizing risk factors.”
Risk Factors for Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD)
MASLD is a condition of increased accumulation of fat in the liver from causes other than alcohol consumption. Formerly known as non-alcoholic fatty liver disease, MASLD is associated with metabolic risk factors, such as abdominal obesity, insulin resistance, and hypertension.
“Previously, we’d see IBD patients that were thin and weren’t able to gain weight because of their disease, but now we see people with both obesity and IBD, much more than previously,” says Bincy Abraham, MD, a gastroenterologist in Houston who is affiliated with Houston Methodist Hospital.
But obesity may be less of a risk factor for people with IBD who develop MASLD. The World Journal of Hepatology review found that while people with IBD appear to be at a higher risk for MASLD, the main driver does not appear to be metabolic syndrome — conditions including diabetes and obesity — as is the case in people without IBD.
For people with Crohn’s disease, small bowel surgery, disease activity and duration, parenteral nutrition, and use of high doses of corticosteroids for treatment appear to increase the risk of MASLD more than obesity, the review found.
Common Liver Complications Among People With IBD
Fatty liver disease is commonly associated with IBD, but it isn’t the only liver concern.
According to the Crohn’s & Colitis Foundation, other common complications include:
- Autoimmune hepatitis, which is inflammation in the liver that occurs when the immune system attacks liver cells, rather than from a viral infection as with other forms of hepatitis.
- Gallstones, which occur when bile that’s used in digestion and stored in the gallbladder hardens and forms stones that can’t pass. “Patients who have Crohn’s disease have a higher risk of gallstones, because Crohn’s causes malabsorption of nutrients in the small intestine,” says Dr. Abraham.
- Primary sclerosing cholangitis (PSC), or inflammation of the bile ducts in the liver. This inflammation, which affects about 3 percent of people with UC and even fewer patients with Crohn’s, leads to scarring of the bile ducts and eventually the liver, preventing bile from flowing normally.
“Unfortunately, liver disease is often asymptomatic until there has been a significant degree of damage to the liver, so addressing risk factors is critical to avoiding liver disease in the first place,” says Click.
How to Prevent Liver Disease When You Have Crohn’s
Although other factors in people with IBD appear to be in play, the best way to lower your risk of liver disease is still to maintain a healthy weight through diet and exercise, advises Abraham. An active lifestyle that can be modified during a flare-up is key for people who suffer from Crohn’s. “It all comes down to what the patient enjoys, so they will keep it up,” she says. “Do something routinely and keep it as a habit — even if it’s exercising for 5 to 10 minutes each day, that’s better than nothing at all.”
How Often to Get Screened for Liver Disease
Since liver disease usually only shows symptoms during the very advanced stages, such as cirrhosis or liver failure, it’s crucial to identify the disease while it’s still in the early stages in order to treat or perhaps reverse it. Regular monitoring of liver enzymes — which can be an indication of liver disease — is a key step in early detection.
“[If a patient has Crohn’s disease, their physician] should be doing annual labs at a minimum,” says Abraham. “If there is a family history of liver disease, they can be evaluated early or more frequently.” She suggests that people who have an increased risk of liver disease — either due to family history or an underlying condition such as obesity or diabetes — should talk to their doctor about getting tested every six months.
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