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.

中文翻译：

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炎症性肠病患者肝血检查异常的调查


肝脏血液检查 (LBT) 异常在炎症性肠病 (IBD) 患者中很常见。大多数是自限性的，只有 5% 患有有临床意义的肝病。最常与 IBD 相关的肝脏疾病包括原发性硬化性胆管炎、代谢功能障碍相关的脂肪肝病和药物性肝损伤 (DILI)。结合临床评估、血液检测和影像学检查，可帮助确定 IBD 患者异常 LBT 的因果关系和严重程度。 IBD 免疫调节疗法的使用增加了异常 LBT 的发生率。大多数病例是自限性的，临床上严重的损伤很少见，特别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 来识别 DILI 时，明确的药物起始或剂量递增时间表至关重要。严重肝功能障碍的迹象应促使立即停药。否则，在决定药物改变时需要采取以患者为中心的方法，包括评估治疗效果和替代治疗方案的可用性。