#29 Understanding Liver Disease in IBD - with Dr Sree Kotha and Dr Phil Berry

Send us Fan MailDid you know that up to 30% of people living with inflammatory bowel disease (IBD) will have abnormal liver tests at some point?In this episode of Wrestling the Octopus IBD, Nigel and I are joined by two expert hepatologists from Guy's and St Thomas' Hospital in London to explore the link between IBD and liver disease - what causes it, what to look out for and how it's monitored.Our GuestsDr. Sreelakshmi (Sree) Kotha – Hepatology Consultant and Clinical Lead for Endoscopy, St. Thomas' Hospital, London.Dr. Phil Berry – Consultant Gastroenterologist and Hepatologist, Guy's and St. Thomas' Hospital. Special interest in medical ethics and patient safety. Co-author of PSC: Voices, Journeys and Challenges.Why Does IBD Affect the Liver?IBD - including Crohn's disease and ulcerative colitis - is an autoimmune condition, and that autoimmune activity doesn't always stay confined to the gut. Liver involvement is more common than many patients realise. The main causes of abnormal liver tests in IBD include:Fatty liver disease - linked to high BMI or long-term steroid useMedication reactions - IBD treatments such as methotrexate, azathioprine and biologics can all affect liver functionAutoimmune hepatitis - where the immune system attacks liver cellsGallstones - Crohn's disease affects how the body processes bile acids, increasing the riskPrimary sclerosing cholangitis (PSC) - a serious bile duct condition closely linked to IBD.Key facts about PSC:Around 70–80% of people with PSC also have IBDPSC is more common in ulcerative colitis (affecting 3–8% of patients) than in Crohn's disease (1–3%)Treating IBD, even very successfully, does not appear to slow PSC — the two conditions can progress independently of each otherPSC is a lifelong condition requiring ongoing monitoringSymptoms to Watch ForEarly liver disease often causes no obvious symptoms, which is why routine blood tests matter. As things progress, patients may notice:Persistent fatigue and tiredness (though this can overlap with IBD symptoms)Jaundice - yellowing of the eyes or skinFevers, chills and rigors - signs of bile duct infectionAbdominal pain, particularly on the right sideGallstones and Crohn's DiseaseCrohn's disease carries a slightly higher risk of gallstones due to changes in how bile acids are processed in the gut. Because gallstones are common in the general population and the treatment (gallbladder removal) is the same regardless of cause, the Crohn's connection isn't always explored - but it's worth raising with your team if you have symptoms.When Should You Seek Help?Managing IBD alongside liver disease, gallstones or other complications can make it hard to know who to contact when something feels wrong. A few practical pointers:Severe abdominal pain with fever, vomiting or chills - call 111 or go to A&EGrumbling, uncertain symptoms - contact your gastroenterology team via Mentioned in This EpisodePSC: Voices, Journeys and Challenges - co-authored by Dr. Sree Kotha and Dr. Phil BerryNecessary Scars - by Dr. Phil Berry, exploring how medical professionals cope with mistakesGet in TouchHave a topic you'd like us to cover? Email us at [email protected] previous episodes are available wherever you listen to podcasts.Follow Rachel at @bottomlineibdFollow Nigel at @crohnoid