Hepatobiliary manifestations of ulcerative colitis: an example of gut–liver crosstalk

The interaction between inflammatory bowel disease (IBD) and hepatobiliary manifestations represents a classic example of liver–gut crosstalk. The importance of liver–gut crosstalk in IBD is demonstrated in the pathogenesis and outcome of primary sclerosing cholangitis (PSC) in IBD patients. Immunoglobulin G4-associated cholangitis (IAC), which has recently been described in UC patients, may also illustrate the significance of gut–liver interaction in these patients. Presence of these hepatobiliary manifestations influences the outcome of associated IBD, in particular ulcerative colitis (UC), and vice versa. The pathogenesis of PSC is postulated to be related to gut inflammation in IBD that results in inflammation in the portal tracts (the ‘leaky gut’). Enterohepatic circulation of lymphocytes from the gut to the liver is also of potential relevance to PSC pathogenesis and outcomes. The presence of PSC and gut inflammation in IBD influences the course and outcomes of both diseases. Further research is required, to understand the mutual effect of liver–gut crosstalk in the outcomes of UC patients, and highlights the importance of an interdisciplinary approach—involving gastroenterologists, hepatologists, advanced endoscopists and liver transplant surgeons—in the management of these patients.