Restellini Sophie, Chazouillères Olivier, Frossard Jean-Louis
Service de Gastroentérologie et Hépatologie, Hôpitaux Universitaires de Genève, Genève, Suisse.
Division d'Hépatologie, Centre de Référence des Maladies Inflammatoires des Voies Biliaires, et Université de Sorbonne, UPMC Univ Paris 06, UMR_S 938, CDR Saint-Antoine, AP-HP, Hôpital Saint-Antoine, Paris, France.
Liver Int. 2017 Apr;37(4):475-489. doi: 10.1111/liv.13265. Epub 2016 Nov 6.
Inflammatory bowel diseases are associated with various hepatobiliary disorders, reported both in Crohn's disease and ulcerative colitis. They may occur at any moment in the natural course of the disease. The prevalence of liver dysfunction rises from 3% to 50% accordingly to definitions used in different studies. Fatty liver is considered as the most common hepatobiliary complication in inflammatory bowel diseases while primary sclerosing cholangitis is the most specific one. Less frequently, inflammatory bowel diseases-associated hepatobiliary disorders include: autoimmune hepatitis/ primary sclerosing cholangitis overlap syndrome, IgG4-associated cholangiopathy, primary biliary cholangitis, hepatic amyloidosis, granulomatous hepatitis, cholelithiasis, portal vein thrombosis and liver abscess. The spectrum of these manifestations varies according to the type of inflammatory bowel diseases. Treatments of inflammatory bowel diseases may cause liver toxicity, although incidence of serious complications remains low. However, early diagnosis of drug-induced liver injury is of major importance as it affects future clinical management. When facing abnormal liver tests, clinicians should undertake a full diagnostic work-up in order to determine whether the hepatic abnormalities are related to the inflammatory bowel diseases or not. Management of hepatic manifestations in inflammatory bowel diseases usually involves both hepatologists and gastroenterologists because of the complexity of some situations.
炎症性肠病与多种肝胆疾病相关，在克罗恩病和溃疡性结肠炎中均有报道。它们可能在疾病的自然病程中的任何时候出现。根据不同研究中使用的定义，肝功能障碍的患病率从3%上升到50%。脂肪肝被认为是炎症性肠病中最常见的肝胆并发症，而原发性硬化性胆管炎是最具特异性的一种。较少见的是，炎症性肠病相关的肝胆疾病包括：自身免疫性肝炎/原发性硬化性胆管炎重叠综合征、IgG4相关性胆管病、原发性胆汁性胆管炎、肝淀粉样变性、肉芽肿性肝炎、胆石症、门静脉血栓形成和肝脓肿。这些表现的范围因炎症性肠病的类型而异。炎症性肠病的治疗可能会导致肝毒性，尽管严重并发症的发生率仍然很低。然而，药物性肝损伤的早期诊断至关重要，因为它会影响未来的临床管理。当面对肝功能检查异常时，临床医生应进行全面的诊断检查，以确定肝脏异常是否与炎症性肠病有关。由于某些情况较为复杂，炎症性肠病肝脏表现的管理通常需要肝病学家和胃肠病学家共同参与。
