Prevalence and prognostic value of hepatic histological alterations in patients with Crohn’s disease

Variable degrees of liver histological changes in patients with Crohn's disease (CD) have been reported. Objective. To evaluate the liver histological alterations and their prognostic significance in patients affected by CD without abnormalities of liver biochemical parameters and ultrasound features. Material and Methods. A prospective, single-blind study, including 35 consecutive patients with CD that underwent bowel resection with a contemporary performance of liver biopsy from 1992 to 2003. Exclusion criteria: the presence of standard causes of liver disease, such as alcohol consumption exceeding 20 g/day, primary sclerosing cholangitis, viral infections, celiac disease, metabolic syndrome and alterations of the metabolism. Patients were followed up with regular evaluation of hepatic cytolysis, cholestasis, synthesis and ultrasound performance. After a mean interval of 14 years (from May to December 2013), liver fibrosis was assessed by Fibroscan (R). Results. Histological alterations were shown in 60% of patients, without serious liver injuries (no case of inflammation or significant fibrosis). Fibroscan (R) was performed in 33 subjects and no significant changes were observed (mean value of liver stiffness: 5.2 +/- 1.2 kPa). The minimal microscopic damage did not evolve either in patients with a normal histology or in those with an altered histology at baseline (p = 0.9). Only patients who took azathioprine had a statistically significant increase of liver stiffness values (5.7 +/- 1.5 kPa vs 4.7 +/- 1.3 kPa, p = 0.017). Conclusions. Patients with CD do not need additional examinations compared to the general population, unless clinical or biochemical abnormalities are found.