Liver enzyme elevations within 3 months of diagnosis of inflammatory bowel disease and likelihood of liver disease

Alka Goyal, Jeffery S. Hyams, Trudy Lerer, Neal S. Leleiko, Anthony R. Otley, Anne M. Griffiths, Joel Rosh, Jose M. Cabrera, Maria M. Oliva-Hemker, David R. Mack, James N. Rick, Marian D. Pfefferkorn, Ryan Carvalho, Andrew B. Grossman, Meredith C. Hitch, Boris Sudel, Michael D. Kappelman, Shehzad A. Saeed, William A. Faubion, Marc E. SchaeferJames F. Markowitz, David J. Keljo

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

BACKGROUND: Inflammatory bowel disease-associated liver diseases (IBD-LDs) include autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), and an overlap syndrome. Prospective unbiased multicenter data regarding the frequency of IBD-LD in patients with pediatric inflammatory bowel disease (IBD) are lacking. We examined early alanine aminotransferase (ALT) and γ-glutamyl transpeptidase (GGT) elevations in children diagnosed as having IBD and assessed the likelihood of IBD-LD. METHODS: Data collected from the prospective observational Pediatric Inflammatory Bowel Disease Collaborative Research Group Registry enrolling children of age <16 years within 30 days of diagnosis. AIH, PSC, and overlap syndrome were diagnosed using local institutional criteria. RESULTS: A total of 1569 subjects had liver enzymes available. Of the total, 757 had both ALT and GGT, 800 had ALT only (no GGT), and 12 had GGT only (no ALT). Overall, 29 of 1569 patients (1.8%) had IBD-LD. IBD-LD was diagnosed in 1 of 661 (0.15%) of patients with both ALT and GGT ≤ 50 IU/L compared with 21 of 42 (50%) of patients with both ALT and GGT > 50 (odds ratio 660, P < 0.0001). Of the 29 patients with IBD-LD, 21 had PSC, 2 had AIH, and 6 had overlap syndrome. IBD-LD was more common in patients with ulcerative colitis and IBD-unclassified (indeterminate colitis) than in those with Crohn disease (4% vs 0.8%, respectively, P < 0.001). CONCLUSIONS: Elevation of both ALT and GGT within 90 days after the diagnosis of IBD is associated with a markedly increased likelihood of IBD-LD. Both ALT and GGT levels should be measured in all of the pediatric patients newly diagnosed as having IBD.

Original languageEnglish (US)
Pages (from-to)321-323
Number of pages3
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume59
Issue number3
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Inflammatory Bowel Diseases
Liver Diseases
Liver
Enzymes
Alanine Transaminase
Autoimmune Hepatitis
Sclerosing Cholangitis
Pediatrics
gamma-Glutamyltransferase
Colitis
Ulcerative Colitis
Crohn Disease
Registries
Odds Ratio

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology

Cite this

Goyal, Alka ; Hyams, Jeffery S. ; Lerer, Trudy ; Leleiko, Neal S. ; Otley, Anthony R. ; Griffiths, Anne M. ; Rosh, Joel ; Cabrera, Jose M. ; Oliva-Hemker, Maria M. ; Mack, David R. ; Rick, James N. ; Pfefferkorn, Marian D. ; Carvalho, Ryan ; Grossman, Andrew B. ; Hitch, Meredith C. ; Sudel, Boris ; Kappelman, Michael D. ; Saeed, Shehzad A. ; Faubion, William A. ; Schaefer, Marc E. ; Markowitz, James F. ; Keljo, David J. / Liver enzyme elevations within 3 months of diagnosis of inflammatory bowel disease and likelihood of liver disease. In: Journal of Pediatric Gastroenterology and Nutrition. 2014 ; Vol. 59, No. 3. pp. 321-323.
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abstract = "BACKGROUND: Inflammatory bowel disease-associated liver diseases (IBD-LDs) include autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), and an overlap syndrome. Prospective unbiased multicenter data regarding the frequency of IBD-LD in patients with pediatric inflammatory bowel disease (IBD) are lacking. We examined early alanine aminotransferase (ALT) and γ-glutamyl transpeptidase (GGT) elevations in children diagnosed as having IBD and assessed the likelihood of IBD-LD. METHODS: Data collected from the prospective observational Pediatric Inflammatory Bowel Disease Collaborative Research Group Registry enrolling children of age <16 years within 30 days of diagnosis. AIH, PSC, and overlap syndrome were diagnosed using local institutional criteria. RESULTS: A total of 1569 subjects had liver enzymes available. Of the total, 757 had both ALT and GGT, 800 had ALT only (no GGT), and 12 had GGT only (no ALT). Overall, 29 of 1569 patients (1.8{\%}) had IBD-LD. IBD-LD was diagnosed in 1 of 661 (0.15{\%}) of patients with both ALT and GGT ≤ 50 IU/L compared with 21 of 42 (50{\%}) of patients with both ALT and GGT > 50 (odds ratio 660, P < 0.0001). Of the 29 patients with IBD-LD, 21 had PSC, 2 had AIH, and 6 had overlap syndrome. IBD-LD was more common in patients with ulcerative colitis and IBD-unclassified (indeterminate colitis) than in those with Crohn disease (4{\%} vs 0.8{\%}, respectively, P < 0.001). CONCLUSIONS: Elevation of both ALT and GGT within 90 days after the diagnosis of IBD is associated with a markedly increased likelihood of IBD-LD. Both ALT and GGT levels should be measured in all of the pediatric patients newly diagnosed as having IBD.",
author = "Alka Goyal and Hyams, {Jeffery S.} and Trudy Lerer and Leleiko, {Neal S.} and Otley, {Anthony R.} and Griffiths, {Anne M.} and Joel Rosh and Cabrera, {Jose M.} and Oliva-Hemker, {Maria M.} and Mack, {David R.} and Rick, {James N.} and Pfefferkorn, {Marian D.} and Ryan Carvalho and Grossman, {Andrew B.} and Hitch, {Meredith C.} and Boris Sudel and Kappelman, {Michael D.} and Saeed, {Shehzad A.} and Faubion, {William A.} and Schaefer, {Marc E.} and Markowitz, {James F.} and Keljo, {David J.}",
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Goyal, A, Hyams, JS, Lerer, T, Leleiko, NS, Otley, AR, Griffiths, AM, Rosh, J, Cabrera, JM, Oliva-Hemker, MM, Mack, DR, Rick, JN, Pfefferkorn, MD, Carvalho, R, Grossman, AB, Hitch, MC, Sudel, B, Kappelman, MD, Saeed, SA, Faubion, WA, Schaefer, ME, Markowitz, JF & Keljo, DJ 2014, 'Liver enzyme elevations within 3 months of diagnosis of inflammatory bowel disease and likelihood of liver disease', Journal of Pediatric Gastroenterology and Nutrition, vol. 59, no. 3, pp. 321-323. https://doi.org/10.1097/MPG.0000000000000409

Liver enzyme elevations within 3 months of diagnosis of inflammatory bowel disease and likelihood of liver disease. / Goyal, Alka; Hyams, Jeffery S.; Lerer, Trudy; Leleiko, Neal S.; Otley, Anthony R.; Griffiths, Anne M.; Rosh, Joel; Cabrera, Jose M.; Oliva-Hemker, Maria M.; Mack, David R.; Rick, James N.; Pfefferkorn, Marian D.; Carvalho, Ryan; Grossman, Andrew B.; Hitch, Meredith C.; Sudel, Boris; Kappelman, Michael D.; Saeed, Shehzad A.; Faubion, William A.; Schaefer, Marc E.; Markowitz, James F.; Keljo, David J.

In: Journal of Pediatric Gastroenterology and Nutrition, Vol. 59, No. 3, 01.01.2014, p. 321-323.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Liver enzyme elevations within 3 months of diagnosis of inflammatory bowel disease and likelihood of liver disease

AU - Goyal, Alka

AU - Hyams, Jeffery S.

AU - Lerer, Trudy

AU - Leleiko, Neal S.

AU - Otley, Anthony R.

AU - Griffiths, Anne M.

AU - Rosh, Joel

AU - Cabrera, Jose M.

AU - Oliva-Hemker, Maria M.

AU - Mack, David R.

AU - Rick, James N.

AU - Pfefferkorn, Marian D.

AU - Carvalho, Ryan

AU - Grossman, Andrew B.

AU - Hitch, Meredith C.

AU - Sudel, Boris

AU - Kappelman, Michael D.

AU - Saeed, Shehzad A.

AU - Faubion, William A.

AU - Schaefer, Marc E.

AU - Markowitz, James F.

AU - Keljo, David J.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - BACKGROUND: Inflammatory bowel disease-associated liver diseases (IBD-LDs) include autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), and an overlap syndrome. Prospective unbiased multicenter data regarding the frequency of IBD-LD in patients with pediatric inflammatory bowel disease (IBD) are lacking. We examined early alanine aminotransferase (ALT) and γ-glutamyl transpeptidase (GGT) elevations in children diagnosed as having IBD and assessed the likelihood of IBD-LD. METHODS: Data collected from the prospective observational Pediatric Inflammatory Bowel Disease Collaborative Research Group Registry enrolling children of age <16 years within 30 days of diagnosis. AIH, PSC, and overlap syndrome were diagnosed using local institutional criteria. RESULTS: A total of 1569 subjects had liver enzymes available. Of the total, 757 had both ALT and GGT, 800 had ALT only (no GGT), and 12 had GGT only (no ALT). Overall, 29 of 1569 patients (1.8%) had IBD-LD. IBD-LD was diagnosed in 1 of 661 (0.15%) of patients with both ALT and GGT ≤ 50 IU/L compared with 21 of 42 (50%) of patients with both ALT and GGT > 50 (odds ratio 660, P < 0.0001). Of the 29 patients with IBD-LD, 21 had PSC, 2 had AIH, and 6 had overlap syndrome. IBD-LD was more common in patients with ulcerative colitis and IBD-unclassified (indeterminate colitis) than in those with Crohn disease (4% vs 0.8%, respectively, P < 0.001). CONCLUSIONS: Elevation of both ALT and GGT within 90 days after the diagnosis of IBD is associated with a markedly increased likelihood of IBD-LD. Both ALT and GGT levels should be measured in all of the pediatric patients newly diagnosed as having IBD.

AB - BACKGROUND: Inflammatory bowel disease-associated liver diseases (IBD-LDs) include autoimmune hepatitis (AIH), primary sclerosing cholangitis (PSC), and an overlap syndrome. Prospective unbiased multicenter data regarding the frequency of IBD-LD in patients with pediatric inflammatory bowel disease (IBD) are lacking. We examined early alanine aminotransferase (ALT) and γ-glutamyl transpeptidase (GGT) elevations in children diagnosed as having IBD and assessed the likelihood of IBD-LD. METHODS: Data collected from the prospective observational Pediatric Inflammatory Bowel Disease Collaborative Research Group Registry enrolling children of age <16 years within 30 days of diagnosis. AIH, PSC, and overlap syndrome were diagnosed using local institutional criteria. RESULTS: A total of 1569 subjects had liver enzymes available. Of the total, 757 had both ALT and GGT, 800 had ALT only (no GGT), and 12 had GGT only (no ALT). Overall, 29 of 1569 patients (1.8%) had IBD-LD. IBD-LD was diagnosed in 1 of 661 (0.15%) of patients with both ALT and GGT ≤ 50 IU/L compared with 21 of 42 (50%) of patients with both ALT and GGT > 50 (odds ratio 660, P < 0.0001). Of the 29 patients with IBD-LD, 21 had PSC, 2 had AIH, and 6 had overlap syndrome. IBD-LD was more common in patients with ulcerative colitis and IBD-unclassified (indeterminate colitis) than in those with Crohn disease (4% vs 0.8%, respectively, P < 0.001). CONCLUSIONS: Elevation of both ALT and GGT within 90 days after the diagnosis of IBD is associated with a markedly increased likelihood of IBD-LD. Both ALT and GGT levels should be measured in all of the pediatric patients newly diagnosed as having IBD.

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