Liver Problems and Crohn’s Disease

Medically Reviewed by Sabrina Felson, MD on June 29, 2022
3 min read

Crohn’s disease is a chronic condition in your digestive tract. Most often it causes problems in your digestive tract, with symptoms like fever, abdominal pain, diarrhea, and weight loss.

People with Crohn’s disease may also be at higher risk of liver problems. They can occur at any stage of your illness. Doctors are not sure how the two diseases relate to each other. But if you have Crohn’s, it’s important that you get screened regularly to see how your liver is working.

While liver damage can often be reversed, about 5% of people with Crohn’s or ulcerative colitis, the other type of inflammatory bowel disease (IBD), develop serious liver disease.

Often people with Crohn’s disease who also have liver damage may not be aware of any additional symptoms. Usually the first and only sign of a liver problem is found in routine blood tests. But tell your doctor if you:

  • Have low energy or fatigue
  • Feel full
  • Have pain in the upper right abdomen
  • Show signs of jaundice, a yellowing of your skin and eyes
  • Bruise easily
  • Retain fluids

These symptoms may be signs of advanced liver damage.

Fatty liver disease is the most common liver complication for people with Crohn’s. There are two kinds: alcohol-related fatty liver disease and nonalcoholic fatty liver disease. It develops when extra fat is deposited in the liver. Your doctor may recommend weight loss and better control of your blood cholesterol levels to help your body get rid of the extra fat in your liver.

Some liver problems may be caused by the medications you are taking to ease the inflammation in your digestive tract caused by Crohn’s. That’s why it’s important that your doctor tests for liver inflammation or damage.

Crohn’s medications that may cause side effects include:

  • 6-mercaptopurine (6MP)
  • Azathioprine
  • Methotrexate
  • Anti-TNF agents (drugs that help stop inflammation)

Hepatitis is any inflammation of the liver. While it is usually caused by a viral infection, there is a condition called autoimmune hepatitis that can occur with Crohn’s. This happens when your immune system attacks your liver cells. Autoimmune hepatitis can lead to permanent liver damage if it is not properly treated.

If routine blood tests show abnormalities in your liver, your doctor may do additional screenings to find out if the liver problems are related to your Crohn’s disease or not. Knowing the cause of your liver problems can help guide your future medications and treatment.

Your doctor may ask for these additional tests:

  • Ultrasound
  • CT scan
  • MRI scan
  • Endoscopic examination of the bile ducts
  • Liver biopsy

Liver-related complications tied to your Crohn’s diagnosis can also affect bile ducts and your gallbladder. Those organs all work together with your digestive tract. Bile ducts are thin tubes that go from the liver to the small intestine. They deliver a fluid called bile to help your small intestine digest the fats in food.

Primary sclerosing cholangitis (PSC) affects the bile duct system of the liver. It is uncommon in people with Crohn’s: Less than 3% of people with Crohn’s have it. But it can be very serious. Inflammation causes scarring within the bile ducts and can lead to liver damage. If severe scarring of the liver happens, which is called cirrhosis, you might need a liver transplant.

Complications of PSC include infection of the bile ducts and cancer of the bile duct system. People with PSC are also at a higher risk for colon cancer, so your doctor may recommend yearly colonoscopies.

Gallstones are common in patients with Crohn’s disease. Instead of staying liquid until it is needed for digestion, bile sometimes hardens to form stones within the gallbladder. These gallstones block the ducts that bile is supposed to travel through. This can cause pain, nausea, and vomiting. Your doctor may recommend surgery to remove the gallbladder.

Proper care of your Crohn’s and liver disease can be complex. It may involve your gastroenterologist, who treats disorders of the stomach and intestines. You may also be under the care of a hepatologist, who is a gastroenterologist who focuses on or has a special interest in the liver.