Nonalcoholic Fatty Liver Disease and Inflammatory Bowel Disease: Complex Interactions, Evaluations, and Management Decisions

Diseases of the liver are commonly encountered in patients with Inflammatory Bowel Disease (IBD). While the differential for IBD patients with elevated liver associated enzymes is broad, it is similar to that of the general population. This differential includes including non-alcoholic fatty liver disease (NAFLD), the most common liver disease in North America. When initial work-up for elevated liver associated enzymes is negative and patients have steatosis on ultrasound, we counsel IBD patients aggressively about weight loss in order to prevent the progression of liver disease. Here, we describe the association between liver disease and IBD and illustrate an approach to management of elevated liver associated enzymes in this unique patient population.