What’s the Link Between Crohn’s and Liver Disease?

Up to 30 percent of people with IBD also have liver disease. Here’s what you need to know about risk factors, prevention, and treatment.

health link between liver disease and chrons disease
Doctors are just beginning to understand the association between liver disease and Crohn’s disease, but healthy weight maintenance through diet and exercise and regular screening can help.
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Although inflammatory bowel diseases (IBD)ulcerative colitis (UC) and Crohn’s disease — primarily affect the gut, both have been linked to a host of other issues throughout the body.

According to a review published in the World Journal of Hepatology, as many as 50 percent of people with IBD experience side effects of the disease that extend outside the gut. Liver conditions are some of the most common, with as many as 30 percent of people with IBD affected by liver abnormalities and 5 percent diagnosed with chronic liver disease.

“We’re just starting to understand [the association between liver disease and Crohn’s disease],” explains Benjamin Click, MD, the director of the UCHealth Digestive Health Center at the University of Colorado School of Medicine in Aurora. “There may be interactions between the liver and IBD activity, or the microbiome and the medications we use to manage IBD that we don’t fully understand, so it’s important to be aware of the association and to be proactive about minimizing risk factors.”

Risk Factors for Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD)

MASLD is a condition of increased accumulation of fat in the liver from causes other than alcohol consumption. Formerly known as non-alcoholic fatty liver disease, MASLD is associated with metabolic risk factors, such as abdominal obesity, insulin resistance, and hypertension.

“Previously, we’d see IBD patients that were thin and weren’t able to gain weight because of their disease, but now we see people with both obesity and IBD, much more than previously,” says Bincy Abraham, MD, a gastroenterologist in Houston who is affiliated with Houston Methodist Hospital.

According to?Mayo Clinic, the number of people with both obesity and IBD increased as much as threefold among those diagnosed between 2000 and 2010, compared with those diagnosed between 1970 and 1980.

But obesity may be less of a risk factor for people with IBD who develop MASLD. The World Journal of Hepatology review found that while people with IBD appear to be at a higher risk for MASLD, the main driver does not appear to be metabolic syndrome — conditions including diabetes and obesity — as is the case in people without IBD.

For people with Crohn’s disease, small bowel surgery, disease activity and duration, parenteral nutrition, and use of high doses of corticosteroids for treatment appear to increase the risk of MASLD more than obesity, the review found.

Research is also beginning to make a connection between disruptions in the gut microbiome and MASLD, which could uncover clues to how the gut microbiome and the liver appear to be linked. An early study in mice, published in the journal Microorganisms, explored the connection. Although the results of animal studies are not always applicable to humans, the researchers did find that certain gut microbiota appeared at different levels of MASLD severity, suggesting that as the disease progresses, it impacts the gut microbiome.

Much of this connection is still a mystery, and although IBD and MASLD do have a clear link, a study of nearly 60,000 people published in May 2022 in Frontiers in Pharmacology found that while a genetic predisposition to IBD may cause a slightly increased risk of fat accumulation in the liver. IBD alone — that is, without complications — does not seem to cause MASLD, and vice versa.

Common Liver Complications Among People With IBD

Fatty liver disease is commonly associated with IBD, but it isn't the only liver concern.

According to the Crohn's & Colitis Foundation, other common complications include:

  • Autoimmune hepatitis, which is inflammation in the liver that occurs when the immune system attacks liver cells, rather than from a viral infection as with other forms of hepatitis.
  • Gallstones, which occur when bile that’s used in digestion and stored in the gallbladder hardens and forms stones that can’t pass. “Patients who have Crohn’s disease have a higher risk of gallstones, because Crohn’s causes malabsorption of nutrients in the small intestine,” says Dr. Abraham.
  • Primary sclerosing cholangitis (PSC), or inflammation of the bile ducts in the liver. This inflammation, which affects about 3 percent of people with UC and even fewer patients with Crohn’s, leads to scarring of the bile ducts and eventually the liver, preventing bile from flowing normally.

According to the Crohn’s & Colitis Foundation, most liver disease is reversible; but about 5 percent of people living with IBD experience serious liver disease that may lead to liver failure.

MASLD is the most common liver disease in patients with Crohn’s, says Dr. Click, but it can sometimes be reversed through diet and exercise. If you cannot reduce the fat content in the liver, it may lead to cirrhosis or permanent scarring, he explains. Fatty liver disease can also lead to an increased risk of heart disease, liver cancer, and kidney disease, according to Mayo Clinic.

Late-stage liver disease, called cirrhosis, can cause the abdomen and legs to swell, and the skin and eyes to turn yellow.

?But early signs of liver disease are hard to detect, and most of the time, the condition is discovered on routine blood tests in otherwise asymptomatic people.

“Unfortunately, liver disease is often asymptomatic until there has been a significant degree of damage to the liver, so addressing risk factors is critical to avoiding liver disease in the first place,” says Click.

Abdominal swelling, enlarged blood vessels just beneath the surface of the skin, red palms, an enlarged spleen, and yellowing of the skin and eyes could be signs of advanced liver disease, which can result from metabolic dysfunction–associated steatohepatitis (MASH), autoimmune hepatitis, PSC, or other liver diseases.

How to Prevent Liver Disease When You Have Crohn’s

Although other factors in people with IBD appear to be in play, the best way to lower your risk of liver disease is still to maintain a healthy weight through diet and exercise, advises Abraham. An active lifestyle that can be modified during a flare-up is key for people who suffer from Crohn’s. “It all comes down to what the patient enjoys, so they will keep it up,” she says. “Do something routinely and keep it as a habit — even if it’s exercising for 5 to 10 minutes each day, that’s better than nothing at all.”

Exercise may also keep flares at bay. In a self-reported survey of more than 300 people with IBD, published in BMC Gastroenterology, people who exercised regularly reported fewer flares.

In a review of 28 studies on the subject, published in June 2022 in Crohn's & Colitis 360, the journal of the Crohn’s and Colitis Foundation, researchers concluded that although more studies are needed to investigate how exercise may be able to quell disease activity for people with Crohn’s disease, the current data showed that regular physical activity reduced the risk of flares.

A diet low in processed foods and simple carbohydrates and high in fiber can be hard to maintain if you’re living with Crohn’s. High-fiber foods like whole grains and vegetables including broccoli are hard to digest and can exacerbate Crohn’s symptoms, according to the Crohn's & Colitis Foundation.

Abraham suggests cooking vegetables to make them easier to digest — steam veggies to ensure no nutrients are lost in the process. Peeled fruits (fruit peels contain fiber and can be difficult for people with Crohn’s to digest can also be a good source of low-calorie energy. Abraham says that the most important rule of weight loss is to make sure you’re burning more calories than you’re eating and to eat a balanced diet.
Click adds that high blood cholesterol, called hyperlipidemia, can also lead to a fatty liver. Your liver makes all the cholesterol your body needs, so foods like fatty or skin-on meats or full-fat dairy products add excess cholesterol to your body and cause your liver to produce more cholesterol, he explains. According to the American Heart Association, foods that are high in trans and saturated fats, like animal products and hydrogenated oils, have the worst impact on blood cholesterol levels.

How Often to Get Screened for Liver Disease

Since liver disease usually only shows symptoms during the very advanced stages, such as cirrhosis or liver failure, it's crucial to identify the disease while it’s still in the early stages in order to treat or perhaps reverse it. Regular monitoring of liver enzymes — which can be an indication of liver disease — is a key step in early detection.

“[If a patient has Crohn’s disease, their physician] should be doing annual labs at a minimum,” says Abraham. “If there is a family history of liver disease, they can be evaluated early or more frequently.” She suggests that people who have an increased risk of liver disease — either due to family history or an underlying condition such as obesity or diabetes — should talk to their doctor about getting tested every six months.

Editorial Sources and Fact-Checking

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources

  1. Gaspar R et al. Liver Manifestations and Complications in Inflammatory Bowel Disease: A Review. World Journal of Hepatology. December 27, 2021.
  2. How Obesity Affects IBD Management and Patient Outcomes: Q&A With Amanda M Johnson, MD. Mayo Clinic. February 5, 2021.
  3. Burz S. Fecal Microbiota Transplant From Human to Mice Gives Insights Into the Role of the Gut Microbiota in Non-Alcoholic Fatty Liver Disease (NAFLD). Microorganisms. January 9, 2021.
  4. Chen L et al. Mendelian Randomization Rules Out Causation Between Inflammatory Bowel Disease and Non-Alcoholic Fatty Liver Disease. Frontiers in Pharmacology. May 10, 2022.
  5. Fact Sheet Liver Complications. Crohn’s & Colitis Foundation. January 2015.
  6. Diabetes: How Do I Help Protect My Liver? Mayo Clinic. September 23, 2022.
  7. Nonalcoholic Fatty Liver Disease. Mayo Clinic. October 6, 2023.
  8. Lamers C et al. Patient Experiences With the Role of Physical Activity in Inflammatory Bowel Disease: Results From a Survey and Interviews. BMC Gastroenterology. April 14, 2021.
  9. Neal W et al. Physical Activity in Adults With Crohn’s Disease: A Scoping Review. Crohn’s & Colitis 360. April 2, 2022.
  10. What Should I Eat? Crohn’s & Colitis Foundation.
  11. The Skinny on Fats. American Heart Association. February 20, 2024.
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