Hepatobiliary disorders associated with inflammatory bowel disease

Hepatobiliary manifestations are common in inflammatory bowel disease (IBD) frequently manifesting in abnormal hepatic biochemical tests. Of these disorders, Primary Sclerosing Chlangitis (PSC) carries the most significant clinical implications and remains a highly challenging disease to manage. Cholangiocarcioma is a potential risk in PSC and has a poor prognosis in most cases. The presence of PSC is associated with increased risk of colorectal cancer in patients with ulcerative colitis. Hepatotoxicity can occur with nearly all medications in the treatment of IBD. Discontinuation of drug, or dose reduction in some cases, is indicated when abnormalities are detected. This article reviews the hepatobiliary manifestations of IBD and the hepatotoxic effects of the medications used in its management. The importance of routine monitoring of hepatic biochemical tests and an awareness of the implications and causes of abnormal hepatic biochemical tests in patients with IBD is emphasized.