Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Aug 8, 2020; 11(3): 48-58
Published online Aug 8, 2020. doi: 10.4292/wjgpt.v11.i3.48
Hepatobiliary manifestations in children with inflammatory bowel disease: A single-center experience in a low/middle income country
Mortada HF El-Shabrawi, Sara Tarek, Maha Abou-Zekri, Safa Meshaal, Afaf Enayet, Engy Adel Mogahed
Mortada HF El-Shabrawi, Sara Tarek, Maha Abou-Zekri, Afaf Enayet, Engy Adel Mogahed, Department of Paediatrics, Kasr Alainy School of Medicine, Cairo University, Cairo 11562, Egypt
Safa Meshaal, Department of Clinical Pathology, Kasr Alainy School of Medicine, Cairo University, Cairo 11562, Egypt
Author contributions: El-Shabrawi MHF designed the study; Abou-Zekri M, Mogahed EA, Meshaal S and Tarek S participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; Enayet A participated in statistical analysis and drafting the initial manuscript; El-Shabrawi MHF wrote and revised the article critically for important intellectual content.
Institutional review board statement: The study was reviewed and approved by the ethical committee in our Department of Paediatrics, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mortada HF El-Shabrawi, MD, Professor, Department of Paediatrics, Kasr Alainy School of Medicine, Cairo University, 1 Gamaa Street, Giza, Cairo 11562, Egypt. melshabrawi@kasralainy.edu.eg
Received: January 14, 2020
Peer-review started: January 14, 2020
First decision: April 18, 2020
Revised: May 28, 2020
Accepted: July 1, 2020
Article in press: July 1, 2020
Published online: August 8, 2020
Abstract
BACKGROUND

There has been a worldwide increase in the reported incidence of inflammatory bowel disease (IBD) in children over the past 2-3 decades. The hepatobiliary (HB) manifestations of IBD have been well-studied in children in industrialized and developed countries but are infrequently reported in low- and middle-income countries (LMIC) such as Egypt.

AIM

To determine the prevalence of the HB manifestations in a cohort of Egyptian children with IBD.

METHODS

This cross-sectional observational study was carried out over a period of 6 mo (between June 2013 to December 2013) at the Paediatric Hepatology and Gastroenterology Units of Cairo University Children's Hospital, which is the largest paediatric tertiary care centre in the country.

RESULTS

The study included 48 patients with confirmed IBD based upon clinical, laboratory, endoscopic and histopathological features, 29 (60.4%) were male. Twenty-four patients (50%) had ulcerative colitis (UC), 11 (22.9%) had Crohn's disease (CD) and 13 (27.1%) had unclassified-IBD (IBD-U), which was formerly known as indeterminate colitis. The mean age of the patients at the time of presentation was 8.14 (± SD 4.02) years and the mean age at the time of study enrolment was 10.16 (± SD 4.19) years. All patients were screened for HB manifestations by physical examination, liver function tests, imaging and liver biopsy when indicated. HB disorders were confirmed in 13 patients (27.1%). Transaminases were elevated in 3 patients (6.3%). Two patients (4.2%) had elevated biliary enzymes (one was diagnosed as primary sclerosing cholangitis (PSC) and the other was diagnosed with PSC/autoimmune hepatitis overlap syndrome and the third patient had hepatitis C virus infection. Ten patients (20.8%) had bright echogenic liver on ultrasound suggesting fatty infiltration as a sequel of malnutrition or medication toxicity.

CONCLUSION

The commonest HB disorders in Egyptian children with IBD were abnormal liver function tests, fatty infiltration and PSC. These HB manifestations in paediatric patients in LMIC may be relatively more common than in industrialized countries. Therefore, IBD patients in LMIC should be meticulously screened for liver disease to allow prompt diagnosis and management.

Keywords: Children, Crohn's disease, Egypt, Elevated liver enzymes, Hepatobiliary, Inflammatory bowel disease, Ulcerative colitis

Core tip: The incidence of inflammatory bowel disease (IBD) in children has increased recently worldwide. Similarly, the reported incidence of the hepatobiliary (HB) manifestations of IBD in developed countries is rising, while in low- and middle-income countries, there are no much available reports especially in the paediatric age group. In this cohort of Egyptian children with IBD, all patients were screened for HB disorders by physical examination, liver function tests, imaging and liver biopsy when indicated. The most frequently reported HB disorders in these children with IBD were abnormal liver function tests, fatty infiltration and primary sclerosing cholangitis.