Liver biopsy to rule out liver conditions related to crohn's?

Hello -

While I'm a Crohn's patient (and this is a colitis forum), I thought someone might be able to help with this question:

I'm a 31 year old male with crohn's disease and recent history (past 4 to 6 months) of consistent mild elevation in liver enzymes AST and ALT.  I hear there are some things such as autoimmune hepatisis or other conditions that tend to appear with patients with other autoimmune diseases (e.g., primary bilary something-or-other), usually colitis. But I would suspect that should be a correlation with Crohn's since it is also autoimmune.

Anyway, I'm thinking that my doc will be recommending a liver biopsy and I want to know whether I should submit to one.  All my other blood work (so far) in terms of more advanced liver workup has been negative. (though I historically have small RBCs and looks a bit anemic, and a mildly low lymphocyte count).

Other pertinent history:  I had an MRI abdomen/pelvis about 6 months ago for crohn's issues and the liver was noted on the report as unremarkable.  (And I wonder whether a negative MRI would negate the need for further imaging of the liver, e.g., through an ultasound - which I am also wondering whether the doc will advise.

Other than the past few monhts of elevated enzymes, the only other time that a test has shown such results was a few years ago when I had about six days of high fever (coming on in afternoon and breaking during the night) - up to 104. Liver tests were all elevated in AP and AST ALT (200 range for these).  They never knew the source of the fever, but it was assumed to be chrons related.  However, a CT taken at that time showed mildely englarged liver and spleen.

Would a liver biospy be useful? Or an ultrasound? Just checking to see if anyone has thoughts.

[Ratnakar Kini, MD]

Hi,
Ultrasound and MRI may not show anything typical of autoimmune hepatitis.
Though liver enzymes can be raised in many conditions, in the background of Crohn' s disease it could be due to causes like fatty liver, autoimmune hepatitis and rarely primary sclerosing cholangitis.
Liver biospy would be ideal to know the cause of elevated liver enzymes when all the other tests done do not point towards any cause.
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The information provided is for patients’ education only and is not a medical advice. Always consult your personal physician for complete evaluation of your health problem.

- Ratnakar Kini M.D.