Diagnosis of liver fibrosis by transient elastography (FibroScan) and non-invasive methods in Crohn's disease patients treated with methotrexate.
BACKGROUND
Methotrexate is an effective treatment in Crohn's disease, which may induce liver fibrosis with high cumulative doses. Transient elastography (FibroScan, Echosens, Paris, France) is a new non-invasive rapid, allowing assessment of liver fibrosis by measurement of liver stiffness.


OBJECTIVE
A prospective study to evaluate liver fibrosis with FibroScan and non-invasive biochemical methods in Crohn's disease patients treated with methotrexate.


METHODS
Consecutive Crohn's disease patients had evaluation of liver fibrosis with non-invasive methods. Two subgroups of patients were compared: cumulative dose of methotrexate of more than 1500 mg (group 1) and naive for methotrexate (group 2). Liver biopsy was performed in patients with persistent liver enzyme abnormalities or FibroScan value >8.7 kPa.


RESULTS
Fifty-four consecutive Crohn's disease patients were fully investigated (45 females, mean age 41 +/- 14 years). Median FibroScan values were similar in group 1 (n = 21) and in group 2 (n = 33), 5.5 and 4.5 kPa, respectively. FibroScan values were not correlated with the cumulative dose of methotrexate.


CONCLUSIONS
In Crohn's disease patients treated with a high dose of methotrexate, significant liver fibrosis is rare and not accurately detected with liver enzymes abnormalities. FibroScan could be recommended and liver biopsy could be performed only with patients with high values and/or with chronic liver enzymes abnormalities.
Laharie
D
D
Gastroenterology and Hepatology Unit, Haut-Lévêque Hospital, Pessac, France.
Zerbib
F
F
Adhoute
X
X
Boué-Lahorgue
X
X
Foucher
J
J
Castéra
L
L
Rullier
A
A
Bertet
J
J
Couzigou
P
P
Amouretti
M
M
de Lédinghen
V
V
D000328:Adult; D001706:Biopsy / Q000379:methods; D003424:Crohn Disease / Q000188:drug therapy*; D003938:Diagnostic Techniques, Digestive System / Q000295:instrumentation*; D004548:Elasticity; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000139:chemically induced / Q000175:diagnosis*; D008297:Male; D008727:Methotrexate / Q000009:adverse effects*; D008875:Middle Aged; D011446:Prospective Studies
D008727:Methotrexate