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Poster presentations: Epidemiology 2020

P753 Elevation of liver enzymes in a large cohort of patients with inflammatory bowel disease

O. ATIA1, D. Turner1, A. Mendelovici1, A. Assa2, Y. Mozer-Glassberg2, A. Cahan3, N. Lederman4, E. Matz5, I. Dotan6, E. Shteyer1, Israeli IBD Research Nucleus (IIRN)

1Shaare Zedek Medical Center- The Hebrew University of Jerusalem- Israel., Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, Jerusalem, Israel, 2Schneider Children’s Medical Center, Institute of Gastroenterology- Nutrition- and Liver Diseases., Petah Tikva, Israel, 3Maccabi Health Services, Maccabi Health Services, Tel-Aviv, Israel, 4Meuhedet Sick Fund- Medical Division, Meuhedet Sick Fund- Medical Division, Tel-Aviv, Israel, 5Leumit Health Fund, Leumit Health Fund, Tel Aviv, Israel, 6Sourasky Medical Center- and the Sackler School of Medicine- Tel-Aviv- Israel, IBD Center- Department of Gastroenterology and Liver diseases and the Research Center for Digestive Diseases, Tel-Aviv, Israel

Background

Elevation in liver enzymes (ELE) is often seen in patients with inflammatory bowel disease (IBD). The aim of this study is to assess the incidence, character, chronicity, degree, and etiology of ELE in within the validated epiIIRN cohort which includes all IBD patients in Israel (n = 45,074).

Methods

We current analysis was performed on data from three of four Health Maintenance Organisations (HMOs), covering 48% of the Israeli population. The identification of Crohn’s disease (CD) and ulcerative colitis (UC) utilised previously validated algorithms. Retrieved data included demographics, anthropometric measures, liver enzymes, medications and other diagnoses codes. Mild ELE was defined from upper normal limit (UNL) to X2 UNL, moderate X3 UNL and severe elevation ≥X4 UNL). The pattern of elevation was defined as hepatocellular (isolated elevation of ALT and/or AST), cholestatic (elevated GGT and/or ALK and bilirubin) and mixed pattern. Chronicity of ELE was defined as brief (<30 days) to chronic (>180 days).

Results

The total incidence (ever) of ELE in CD patients was 33% (3098/9421) and 28% in UC (2001/7040); p < 0.001. The mean age at ELE was 29.9 years (IQR 17.2–47.5) in CD and 37.9 years (23.2–53.8) in UC (p < 0.001). Hepatocellular pattern had more commonly in UC (54% vs. 47%, p < 0.001) as mixed pattern (22% vs. 20%, p = 0.01), while cholestatic pattern had more commonly in CD (31% vs. 26%, p < 0.001). The ELE was transient in 609 (9%) patients, while 4054 (62%) had chronic ELE. Mild ELE was recorded in 860 (22%) CD patients and 460 (19%) UC, and severe in 328 (8%) CD and 253 (10%) UC. ELE was recorded during the first three months after initiation of thiopurines in 604 (15%) CD and 201 (8%) UC patients (p < 0.001), after biologics in 346 (9%) CD and 62 (3%) UC (p < 0.001), after steroids in 538 (14%) and 272 (11%), respectively (p = 0.01) and after methotrexate in 76 (2%) and 15 (0.6%), respectively (p = 0.001). The incidence of fatty liver was most common in UC (5% vs. 3%, p = 0.006).

Conclusion

ELE is common complication in IBD patients, more so in UC. When enzymes do increase in CD they tend to reach higher levels. Drug induced liver injury was more common in CD.

This study was supported by a grant from the Leona M. and Harry B. Helmsley Charitable Trust.