Investigation of abnormal liver blood tests in patients with inflammatory bowel disease

IF 2.4 Q3 GASTROENTEROLOGY & HEPATOLOGY
Jennifer Amy Scott, Christopher Mysko, Huw Purssell, Varinder S Athwal
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引用次数: 0

Abstract

Liver blood test (LBT) abnormalities are common in people with inflammatory bowel disease (IBD). The majority are self-limiting, with only 5% having clinically significant liver disease. Liver conditions most frequently associated with IBD include primary sclerosing cholangitis, metabolic dysfunction-associated steatotic liver disease and drug-induced liver injury (DILI). A combination of clinical assessment, blood tests and imaging can be used to help establish the causality and severity of abnormal LBTs in people with IBD. The use of immunomodulatory therapies for IBD has increased the incidence of abnormal LBTs. Most cases are self-limiting and clinically significant injury is rare, particularly with the newer therapeutic agents. Azathioprine and antitumour necrosis factor-α therapies have the greatest risk of liver injury. A clear timeline of drug initiation or dose escalation is essential when interpreting abnormal LBTs to identify DILI. Signs of serious liver dysfunction should prompt immediate cessation of the drug. Otherwise, a patient-centred approach is required when deciding on drug alteration, including the assessment of therapeutic efficacy and the availability of alternative treatment options.
对炎症性肠病患者肝脏血液检测异常的调查
肝脏血液检测(LBT)异常在炎症性肠病(IBD)患者中很常见。大多数患者的肝病都是自限性的,只有 5%的患者会出现有临床意义的肝病。最常与 IBD 相关的肝病包括原发性硬化性胆管炎、代谢功能障碍相关性脂肪肝和药物性肝损伤 (DILI)。临床评估、血液化验和影像学检查相结合,有助于确定 IBD 患者肝功能异常的因果关系和严重程度。使用免疫调节疗法治疗 IBD 增加了异常 LBT 的发病率。大多数病例是自限性的,临床上重大的损伤非常罕见,尤其是使用较新的治疗药物时。硫唑嘌呤和抗肿瘤坏死因子-α疗法造成肝损伤的风险最大。在解释异常 LBT 以识别 DILI 时,明确的用药或剂量递增时间表至关重要。出现严重肝功能异常迹象时,应立即停药。否则,在决定是否换药时,需要采取以患者为中心的方法,包括评估疗效和是否有替代治疗方案。
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来源期刊
Frontline Gastroenterology
Frontline Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
4.70
自引率
11.50%
发文量
93
期刊介绍: Frontline Gastroenterology publishes articles that accelerate adoption of innovative and best practice in the fields of gastroenterology and hepatology. Frontline Gastroenterology is especially interested in articles on multidisciplinary research and care, focusing on both retrospective assessments of novel models of care as well as putative future directions of best practice. Specifically Frontline Gastroenterology publishes articles in the domains of clinical quality, patient experience, service provision and medical education.
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