Cholestasis associated with mesalazine therapy in a patient with Crohn's disease

Stoschus, Bodo; Meybehm, M.; Spengler, Ulrich; Scheurlen, C; Sauerbruch, Tilman

doi:10.1016/s0168-8278(97)80061-x

Cited by 35 publications

(16 citation statements)

References 23 publications

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“…In a randomized trial of coated mesalazine versus sulfasalazine, the total incidence of hepatitis was almost as frequent. 198 Mesalazine-induced acute and chronic hepatitis has been reported [199][200][201] and its hepatotoxicity occurs from as early as 6 days to 1 year after initiation of the therapy. 202 Hepatotoxicity from 5-ASAs can also manifest either with elevated aminotransferases and/or a cholestatic pattern of liver enzyme elevation.…”

Section: Sulfasalazinementioning

confidence: 99%

“…202 Hepatotoxicity from 5-ASAs can also manifest either with elevated aminotransferases and/or a cholestatic pattern of liver enzyme elevation. [199][200][201] Cyclosporine Cyclosporine can cause hepatotoxicity in a dose-dependent manner. Unlike hepatotoxicity associated with other medications used in IBD, it manifests predominantly as a cholestastic pattern, which may be partially due to its effect on inhibition of bile acid excretion.…”

Section: Sulfasalazinementioning

confidence: 99%

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Hepatopancreatobiliary manifestations and complications associated with inflammatory bowel disease

Navaneethan¹,

Shen²

2010

Inflammatory Bowel Diseases

179

127

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Diseases involving the hepatopancreatobiliary (HPB) system are frequently encountered in patients with inflammatory bowel disease (IBD). Hepatobiliary manifestations constitute some of the most common extraintestinal manifestations of IBD. They appear to occur with similar frequency in patients with Crohn's disease or ulcerative colitis. HPB manifestations may occur in following settings: 1) disease possibly associated with a shared pathogenetic mechanism with IBD including primary sclerosing cholangitis (PSC), small-duct PSC/pericholangitis and PSC/autoimmune hepatitis overlap, acute and chronic pancreatitis related to IBD; 2) diseases which parallel structural and physiological changes seen with IBD, including cholelithiasis, portal vein thrombosis, and hepatic abscess; and 3) diseases related to adverse effects associated with treatment of IBD, including drug-induced hepatitis, pancreatitis (purine-based agents), or liver cirrhosis (methotrexate), and reactivation of hepatitis B, and biologic agent-associated hepatosplenic lymphoma. Less common HPB manifestations that have been described in association with IBD include autoimmune pancreatitis (AIP), IgG4-associated cholangitis (IAC), primary biliary cirrhosis (PBC), fatty liver, granulomatous hepatitis, and amyloidosis. PSC is the most significant hepatobiliary manifestation associated with IBD and poses substantial challenges in management requiring a multidisciplinary approach. The natural disease course of PSC may progress to cirrhosis and ultimately require liver transplantation in spite of total proctocolectomy with ileal-pouch anal anastomosis. The association between AIP, IAC, and elevated serum IgG4 in patients with PSC is intriguing. The recently reported association between IAC and IBD may open the door to investigate these complex disorders. Further studies are warranted to help understand the pathogenesis of HPB manifestations associated with IBD, which would help clinicians better manage these patients. An interdisciplinary approach, involving gastroenterologists, hepatologists, and, in advanced cases, general, colorectal, and transplant surgeons is advocated.

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Section: Sulfasalazinementioning

confidence: 99%

Section: Sulfasalazinementioning

confidence: 99%

Hepatopancreatobiliary manifestations and complications associated with inflammatory bowel disease

Navaneethan¹,

Shen²

2010

Inflammatory Bowel Diseases

179

127

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“…A recent audit from the UK reported an incidence of 3.2 cases per million prescriptions [24] . Cholestatic injury has been reported, both with and without immunoallergic features [25,26] . An apparent cross-reactive hypersensitivity reaction with mesalamine after a prior hypersensitivity reaction to sulfasalazine has been reported [27] .…”

Section: Drug-induced Liver Injury Due To Agents Used Tomentioning

confidence: 99%

Hepatotoxicity of Agents Used in the Management of Inflammatory Bowel Disease

Khokhar

Lewis²

2010

Dig Dis

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Patients with inflammatory bowel disease (IBD) are at risk for hepatobiliary disease and toxicity, and the diagnosis of drug-induced liver disease in patients being treated for IBD can represent a clinical challenge. There are a number of disease states associated with IBD, which are primary sclerosing cholangitis, cholangiocarcinoma and autoimmune hepatitis. There is a wide spectrum of hepatic injury that can occur from the agents used to treat IBD, such as acute or chronic hepatic injury directly attributable to the drugs used to treat IBD (e.g. sulfasalazine, mesalamine, thiopurines, methotrexate, TNF antagonists, quinolone antibiotics); liver toxicity from drugs used to treat complications of immunomodulators and TNF antagonists (e.g. isoniazid for treatment of reactivation tuberculosis), and exacerbation of underlying chronic viral hepatitis with infliximab and other TNF antagonists. Thiopurines are also associated with the development of hepatic vascular lesions, such as nodular regenerative hyperplasia and peliosis hepatic. In addition, biologics can be associated with the reactivation of underlying chronic viral hepatitis, mandating universal screening prior to initiation of TNF-alpha antagonist therapy.

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“…Directly toxicity from the 5-ASA component: This can lead to both acute or chronic hepatitis and has been shown to occur mostly between 6 days to 1 year of starting the drug Both 5-ASA and Sulfasalazine are equally responsible for the number of cases of drug induced hepatitis from Aminosalicylates [109][110][111][112][113]. Studies have reported liver enzyme abnormalities in up to 2% of patients on Mesalamine [114].…”

Section: Aminosalicylates: Sulfasalazine and Mesalaminementioning

confidence: 99%

A review of liver disorders in inflammatory bowel disease (IBD)

Shah¹,

Gupta²,

Borg³

2017

Clin Case Rep Rev

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Disorders of the liver and the biliary tract are frequently the extraintestinal manifestations of inflammatory bowel disease (IBD). The etiology of these hepato-biliary conditions is deemed secondary to their shared pathogenesis, the chronic effects of a long term, ongoing inflammation of the bowels, along with the medications used to manage IBD. For up to 30% of patients with IBD, abnormal liver biochemical tests are present. Other, selected patients with IBD are followed for reactivation of hepatitis B, through guidelines only relatively recently in place. The vast realm of related clinical conditions does not always correspond well with IBD severity, which can range from mild hepatic insult to end-stage liver disease, necessitating liver transplantation. Hence it is critical to follow its presence, clinical course and long term consequences. Moreover, the management of these disorders is necessarily individualized, with some patients requiring frequent monitoring and others a more multi-disciplinary approach. Studies aimed at improving the outcomes of patients with IBD who experience associated liver and biliary tract disorders are now needed to assess early identification, possible screening approaches and more effective systems of referral. This article covers the evidence-based literature on topics detailing the co-existence of liver conditions in inflammatory bowel disease with a focus on its epidemiology, clinical manifestations, diagnosis and management.

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Cholestasis associated with mesalazine therapy in a patient with Crohn's disease

Cited by 35 publications

References 23 publications

Hepatopancreatobiliary manifestations and complications associated with inflammatory bowel disease

Hepatopancreatobiliary manifestations and complications associated with inflammatory bowel disease

Hepatotoxicity of Agents Used in the Management of Inflammatory Bowel Disease

A review of liver disorders in inflammatory bowel disease (IBD)

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