title: Systematic review: The epidemiology of the hepatobiliary manifestations in patients with inflammatory bowel disease.
abstract: BACKGROUND
  Extraintestinal manifestations are frequent in inflammatory bowel diseases (IBD). Most studies published so far focused on viral hepatitis and liver toxicity of IBD-related drugs.
  
  
  OBJECTIVE
  To conduct a systematic review of hepatobiliary manifestations associated with IBD. We excluded viral hepatitis and liver toxicity of IBD-related drugs.
  
  
  METHODS
  Studies were identified through the electronic database of MEDLINE, EMBASE and the annual meetings of Digestive Disease Week, the American College of Gastroenterology, the United European Gastroenterology Week and the European Crohn's and Colitis Organization.
  
  
  RESULTS
  One hundred and forty six articles were included in this systematic review. Cholelithiasis is more frequent in Crohn's disease (CD) than in general population. Prevalence of cholelithiasis in CD ranged from 11% to 34%, whereas it ranges from 5.5% to 15% in non-IBD patients. PSC is more frequent in UC than in CD. Prevalence of PSC ranges from 0.76% to 5.4% in UC and from 1.2% to 3.4% in CD. There is a male predominance when PSC is associated with UC, with a male/female ratio ranging from 65/35 to 70/30. No conclusion can be made on a possible increased risk of gall-bladder carcinoma. Mean prevalence of fatty liver is 23% (range, 1.5-55%). Hepatic amyloidosis occurs in less than 1% of IBD. Liver abscess is encountered mainly in CD. Portal vein thrombosis occurs in 39% to 45% of IBD patients undergoing proctocolectomy.
  
  
  CONCLUSIONS
  Hepatobiliary manifestations associated with inflammatory bowel diseases are frequent and probably underdiagnosed.
authors.affiliation: Inserm U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy-Brabois, Université de Lorraine, Vandoeuvre-lès-Nancy, France.
authors.forename: E
authors.initials: E
authors.lastname: Gizard
authors.forename: A C
authors.initials: AC
authors.lastname: Ford
authors.forename: J-P
authors.initials: JP
authors.lastname: Bronowicki
authors.forename: L
authors.initials: L
authors.lastname: Peyrin-Biroulet
mesh_terms: D001660:Biliary Tract Diseases / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D003093:Colitis, Ulcerative / Q000150:complications*; D003424:Crohn Disease / Q000150:complications*; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D015995:Prevalence; D012306:Risk; D012737:Sex Factors