Abnormal Liver Biochemistry Is Common in Pediatric Inflammatory Bowel Disease: Prevalence and Associations

Inflamm Bowel Dis. 2015 Dec;21(12):2848-56. doi: 10.1097/MIB.0000000000000558.


Background: Liver enzymes (LEs) abnormalities associated with pediatric inflammatory bowel diseases (IBD) are understudied. We undertook to describe the development and associations of abnormal LEs in pediatric IBD.

Methods: We ascertained a cohort of 300 children with IBD and collected retrospective data. A Kaplan-Meier analysis determined the time to development of different thresholds of abnormal LEs. Associations between clinical variables and the development of abnormal LEs were determined.

Results: The probability of developing the first episode of abnormal LEs above the upper limit of normal (ULN) within 150 months was 58.1% (16.3% by 1 mo post-IBD diagnosis). There was a 6% prevalence of primary sclerosing cholangitis (PSC) or autoimmune sclerosing cholangitis (ASC) in this cohort. Of those diagnosed with PSC/ASC, 93% had persistent LE elevations at a threshold of >2× ULN, while those without PSC/ASC had a 4% probability of this abnormality. Elevated gamma glutamyltranspeptidase levels of 252 U/L had a 99% sensitivity and 71% specificity for PSC/ASC in IBD. After exclusion of patients with PSC/ASC, corticosteroids, antibiotics, and exclusive enteral nutrition demonstrated strongly positive associations with the first development of abnormal LEs >ULN (hazard ratio 2.1 [95% confidence interval, 1.3-3.3], hazard ratio 5.6 [95% confidence interval, 3.6-8.9], hazard ratio 4.2 [95% confidence interval, 1.6-11.3], respectively).

Conclusions: Abnormal LEs are common in pediatric IBD and occur early. PSC/ASC is associated with persistently high LEs and gamma glutamyltranspeptidase levels >252 U/L. Children with IBD are at risk of elevated LEs if they require medications other than 5-ASA to induce IBD remission.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Cholangitis, Sclerosing / blood
  • Cholangitis, Sclerosing / epidemiology
  • Cholangitis, Sclerosing / etiology
  • Colitis, Ulcerative / complications
  • Colitis, Ulcerative / enzymology*
  • Crohn Disease / complications
  • Crohn Disease / enzymology*
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Liver / enzymology*
  • Liver Function Tests
  • Male
  • Prevalence
  • Proportional Hazards Models
  • Reference Values
  • Retrospective Studies
  • Risk Factors
  • Sensitivity and Specificity
  • gamma-Glutamyltransferase / blood


  • gamma-Glutamyltransferase

Supplementary concepts

  • Pediatric Crohn's disease
  • Pediatric ulcerative colitis