title: Liver enzyme elevations within 3 months of diagnosis of inflammatory bowel disease and likelihood of liver disease.
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.
authors.affiliation: *Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA †Connecticut Children's Medical Center, Hartford ‡Hasbro Children's Hospital, Providence, RI §I.W.K. Health Center, Halifax, Nova Scotia, Canada ||Hospital for Sick Children, Toronto, Ontario, Canada ¶Goryeb Children's Hospital, Morristown, NJ #Children's Hospital of Wisconsin, Milwaukee **Johns Hopkins Hospital, Baltimore, MD ††Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada ‡‡Children's Medical Center, Dayton, OH §§Riley Hospital for Children, Indianapolis, IN ||||Nationwide Children's Hospital, Columbus, OH ¶¶Children's Hospital of Philadelphia, Philadelphia, PA ##Russell Children's Hospital, Birmingham, AB ***University of Minnesota, Minneapolis †††University of North Carolina, Chapel Hill ‡‡‡Cincinnati Children's Medical Center, Cincinnati, OH §§§Mayo Clinic, Rochester, MN ||||||Penn State Hershey Children's Hospital, Hershey, PA ¶¶¶Cohen Children's Medical Center, New Hyde Park, NY.
authors.forename: Alka
authors.initials: A
authors.lastname: Goyal
authors.forename: Jeffery S
authors.initials: JS
authors.lastname: Hyams
authors.forename: Trudy
authors.initials: T
authors.lastname: Lerer
authors.forename: Neal S
authors.initials: NS
authors.lastname: Leleiko
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Otley
authors.forename: Anne M
authors.initials: AM
authors.lastname: Griffiths
authors.forename: Joel R
authors.initials: JR
authors.lastname: Rosh
authors.forename: Jose M
authors.initials: JM
authors.lastname: Cabrera
authors.forename: Maria M
authors.initials: MM
authors.lastname: Oliva-Hemker
authors.forename: David R
authors.initials: DR
authors.lastname: Mack
authors.forename: James N
authors.initials: JN
authors.lastname: Rick
authors.forename: Marian D
authors.initials: MD
authors.lastname: Pfefferkorn
authors.forename: Ryan
authors.initials: R
authors.lastname: Carvalho
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Grossman
authors.forename: Meredith C
authors.initials: MC
authors.lastname: Hitch
authors.forename: Boris
authors.initials: B
authors.lastname: Sudel
authors.forename: Michael D
authors.initials: MD
authors.lastname: Kappelman
authors.forename: Shehzad A
authors.initials: SA
authors.lastname: Saeed
authors.forename: William A
authors.initials: WA
authors.lastname: Faubion
authors.forename: Marc E
authors.initials: ME
authors.lastname: Schaefer
authors.forename: James F
authors.initials: JF
authors.lastname: Markowitz
authors.forename: David J
authors.initials: DJ
authors.lastname: Keljo
mesh_terms: D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood*; D002648:Child; D015209:Cholangitis, Sclerosing / Q000097:blood / Q000201:enzymology* / Q000453:epidemiology; D003093:Colitis, Ulcerative / Q000097:blood / Q000201:enzymology*; D003424:Crohn Disease / Q000097:blood / Q000201:enzymology*; D005260:Female; D005500:Follow-Up Studies; D019693:Hepatitis, Autoimmune / Q000097:blood / Q000201:enzymology* / Q000453:epidemiology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013997:Time Factors; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase