Auteur Topic: Liver test abnormalities predict complicated disease behaviour in patients with  (gelezen 470 keer)


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© 2017 Springer International Publishing AG.
International Journal of Colorectal Disease
April 2017, Volume 32, Issue 4,  pp 459–467

Liver test abnormalities predict complicated disease behaviour in patients with newly diagnosed Crohn’s disease

Jessika Barendregt,1 Myrthe de Jong,1 Jeoffrey J. Haans,2 Bart van Hoek,1 James Hardwick,1 Roeland Veenendaal,1 Andrea van der Meulen,1 Nidhi Srivastava,3 Rogier Stuyt,4 and Jeroen Maljaarscorresponding author1
1Department of Gastroenterology-Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
2Department of Gastroenterology-Hepatology, Maastricht University Medical Centre, Maastricht, The Netherlands
3Department of Gastroenterology-Hepatology, Haaglanden Medical Centre, The Hague, The Netherlands
4Department of Gastroenterology-Hepatology, Haga Hospital, The Hague, The Netherlands
Jeroen Maljaars, Phone: +31715297954, Email: ln.cmul@sraajlaM.J.W.P.
corresponding authorCorresponding author.

In coeliac disease, the prevalence of liver test abnormalities (LTAs) is higher in patients with more severe mucosal inflammation. In Crohn’s disease, prognosis is related to the severity of mucosal inflammation.

The aim of this study was to investigate whether the presence of LTA predicts the occurrence of complicated disease behaviour in newly diagnosed Crohn’s disease.


A retrospective cohort study was performed in patients newly diagnosed with Crohn’s disease between 2002 and 2011. The complicated disease was defined as the occurrence of stricturing and/or perforating disease. LTAs were defined as a value of any of alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT), aspartate aminotransferase (AST), or alanine aminotransferase (ALT) over the upper limit of normal.

Three hundred eighty-three patients were included, of whom 34.1% had LTA. LTAs were mostly mild (less than two times the upper limit of normal). During the 5-year follow-up, 33.1% of patients in the group with LTA developed complicated disease behaviour compared to 14.6% in patients without LTA (p < 0.001). The presence of LTA was identified as a risk factor for complicated disease behaviour (HR 2.6, 95% confidence interval (CI) 1.5–4.2, p < 0.0001).

In newly diagnosed Crohn’s disease, the presence of LTA was an independent risk factor for the development of complicated disease behaviour.

Een paar stukjes ivm coeliakie en verhoogde leverwaarden.
b]Study population[/b]
A retrospective study was performed in CD patients newly diagnosed between 1 January 2002 and 31 December 2011 at the Leiden University Medical Centre (Leiden), a tertiary IBD referral centre, and the Haga Hospital (The Hague) and the Haaglanden Medical Centre (The Hague), two large teaching hospitals. Patient charts were obtained from an electronic patient database, using (CD) diagnosis code “601”.

In order to be included, patients had to be newly diagnosed with CD between 1 January 2002 and 31 December 2011, the diagnoses must have been made in one of the three hospitals, and laboratory evaluation including ALT, AST, AP, GGT, and C-reactive protein (CRP) had to be available for analysis.

In coeliac disease, a relationship was found between the presence of liver test abnormalities and disease activity.
For instance, Zanini et al. found a correlation between the degree of mucosal inflammation, graded according to the Marsh-Oberhuber classification, and elevation of AST, ALT, and GGT, whereas AP was not reported in [5].
In our study of patients with active disease, the prevalence of LTA was highest in patients with the highest CRP (48% when CRP >58 mg/L) and this is in line with what is observed in patients with coeliac disease.

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