IBD and Liver Disease

Inflammatory bowel disease (IBD) affects the digestive tract, but it can also affect other parts of the body as well. People with Crohn's disease and ulcerative colitis may also be at risk for developing liver problems. Some of the liver problems that are associated with IBD are primary sclerosing cholangitis, autoimmune hepatitis, and primary biliary cirrhosis.

What Is the Liver?

The liver, which is the largest organ in the body, provides several important functions without which the body can not survive. The liver removes impurities and foreign bodies from the blood, makes the proteins that help blood clot, and produces bile. When disease interferes with the functioning of the liver, it can cause significant medical problems.

Causes of Cirrhosis of the Liver

In people with IBD, cirrhosis could be caused by autoimmune hepatitis or primary biliary cirrhosis. Autoimmune hepatitis is associated with a dysfunctional immune system. Primary biliary cirrhosis is an inflammation of the bile ducts that can inhibit bile from leaving the liver and going to the small intestine. When the bile gets backed up it can cause further damage to liver tissues. Primary sclerosing cholangitis, which is largely associated with ulcerative colitis, can also overlap with autoimmune hepatitis (sometimes called "overlap syndrome").

Symptoms of Liver Disease

One of the biggest concerns about liver disease is that in its earliest stages, there may be no symptoms at all. Some people may have liver disease, and yet show no signs of it either in their symptoms or via liver tests. When cirrhosis does start to cause symptoms, they can include:

• Exhaustion
• Fatigue
• Loss of appetite
• Nausea
• Weakness
• Weight loss

Complications of Liver Disease

In some cases, liver disease is first discovered when it starts to cause complications, such as:

• Fluid buildup in the legs (edema) or the abdomen (ascites)
• Excessive bruising and bleeding
• Jaundice, which is yellowing of the eyes and skin caused by the buildup of bilirubin
• Itching, which is caused by a buildup of bile in the skin
• Gallstones, which develop when bile is blocked from entering the gallbladder
• Toxin buildup in the blood and the brain
• Medication sensitivity caused by the inability of the liver to process drugs
• Portal hypertension, which is an increase in blood pressure in a vein called the portal vein
• Varices, which are enlarged blood vessels caused by the slow blood flow through the portal vein
• Various other complications such as immune system dysfunctions, infections, and kidney problems

How Is Liver Disease Diagnosed?

Some of the tests used to diagnose liver disease include:

• Blood tests
• Computerized axial tomography (CAT) scan
• Liver biopsy
• Liver scan with a radioisotope or a laparoscope
• Medical history
• Physical exam
• Symptoms
• Ultrasound

Is Liver Disease Permanent?

Liver damage isn't reversible, but when liver disease is present, further damage can be prevented. Getting proper treatment, eating a healthy diet, and avoiding alcoholic beverages are all important to halting the progression of liver disease. Any complications from the liver disease must also be treated, to avoid further damage to other body systems from toxins building up in the brain and the blood. Medications might also be used to manage portal hypertensions and varices.

What About Transplants?

In some cases, the liver becomes too damaged and a liver transplant is needed. The transplant is from a donor, and with improved technology, it is increasingly successful.

Monitoring For Liver Disease

People with IBD who have concerns about developing liver disease should ask their gastroenterologist about how often they should have liver testing. Some medications can also be associated with liver disease, and regular monitoring is recommended.