5 Conditions Linked to IBD
Digestive HealthUlcerative Colitis

5 Liver Conditions Linked to IBD

If you have an inflammatory bowel disease like ulcerative colitis or Crohn’s disease, liver disease can be a complication, among other conditions.
5 Liver Conditions Linked to IBD
Yaroslav Danylchenko/Stocksy; Everyday Health
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Updated on October 21, 2025
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Liver disease can be a complication of an inflammatory bowel disease (IBD) like ulcerative colitis (UC) or Crohn’s disease. Research suggests that up to 30 percent of people with IBD have liver abnormalities and 5 percent are diagnosed with chronic liver disease.

The liver serves as a processing plant for the body, filtering waste from the blood, helping to digest food, and making substances called clotting factors that help your blood flow.

 Researchers do not yet fully understand why liver disease occurs in people with IBD.

In addition to the condition itself, some drugs that treat IBD may also damage the liver.

Signs and Symptoms of Liver Disease

Considering the increased risk of liver disease when you have IBD, it makes sense to take precautions. Laura Raffals, MD, a gastroenterologist at the Mayo Clinic in Rochester, Minnesota, recommends that people with UC have their liver enzymes checked at least once a year. It’s also wise to be aware of the common symptoms of liver dysfunction, so that you can address the problem before it gets worse. Symptoms of liver disease include the following:

  • Low energy or fatigue
  • Pain or a feeling of fullness in the upper right abdomen
  • Itchy skin
  • Jaundice (yellowing of the skin and the whites of the eyes)
  • Swelling in the abdomen, legs, or ankles
  • Easy bruising

Many people with liver dysfunction have no symptoms. If you experience any of these symptoms, contact your doctor for an evaluation.

Blood tests can usually confirm liver dysfunction. However, additional testing using an ultrasound, computerized tomography scan, magnetic resonance imaging, or liver biopsy, among other tests, may be necessary to make a specific diagnosis.

5 IBD-Associated Liver Conditions

Here are five liver-related conditions that may develop alongside IBD.

1. Primary Sclerosing Cholangitis

Primary sclerosing cholangitis (PSC) is a form of liver disease associated with IBD. It most commonly occurs with UC, says Donald Jensen, MD, a hepatologist at Rush University Medical Center in Chicago.

According to a systematic review and meta-analysis of 776,700 patients with IBD, 2.16 percent also had PSC.

PSC is characterized by inflammation, thickening, and the formation of fibrous tissue in the bile ducts, which carry bile from the liver to help with the digestion of fats. Eventually, scarring of the liver can develop. Without treatment, people with PSC may ultimately need a liver transplant.

“We don’t know why they’re connected, and there is no effective treatment for PSC,” says Dr. Jensen.

According to a review article, the link between PSC and IBD indicates an emerging concept called the gut-liver axis. In the gut-liver axis, the gut and the liver affect each other in a bidirectional relationship.

Men with ulcerative colitis are more likely than women to develop PSC, with a prevalence of about 60 to 70 percent. The typical age at diagnosis is between 30 and 40 years old, however, it can vary by region.

2. Metabolic Dysfunction–Associated Steatotic Liver Disease

Metabolic dysfunction–associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease, is the most common liver complication of IBD.

MASLD is a condition in which extra fat is deposited in the liver. People with MASLD rarely experience symptoms. In many cases, weight loss and managing blood cholesterol levels and diabetes can reverse the disease.

According to a systematic review and meta-analysis of 89 studies, MASLD occurred in 24.4 percent of people with IBD. Of those, 20.2 percent occurred in people with Crohn’s disease, and 18.5 percent in people with UC.

3. Autoimmune Hepatitis

Autoimmune hepatitis is when your immune system attacks your own liver cells. It is caused by chronic liver inflammation.

There are two main forms of autoimmune hepatitis: type 1 and type 2. Type 1 is the most common form of the disease. About half of people with type 1 also have other autoimmune disorders, such as celiac disease, rheumatoid arthritis, or ulcerative colitis.

Autoimmune hepatitis is typically treated with a high-dose corticosteroid, such as prednisone. The dosage is eventually reduced.

Sometimes, a medication called azathioprine (Imuran) is used as a second line of treatment. Azathioprine is an immunomodulator, meaning it modifies the activity of the immune system, reducing inflammation.

4. Gallstones

Gallstones form when bile, produced by the liver and stored in the gallbladder, hardens into small, stonelike pieces. If one or more stones block the ducts of the gallbladder, you may experience upper abdominal pain, nausea, and vomiting.

The blockage can lead to serious complications. “When gallstones pass from the gallbladder to the bile ducts, it can be associated with infection or pancreatitis,” Jensen says.

Dr. Raffals notes that ulcerative colitis itself does not lead to gallstones, but gallstones are common in older patients with IBD. They’re also more common in patients with Crohn’s disease than those with UC.

According to a meta-analysis of five studies, people with IBD had a significantly higher rate of gallstone disease than the general population. However, most of these cases occurred in people with Crohn’s disease. The authors note that larger-scale studies are needed to confirm those findings.

5. Pancreatitis

Pancreatitis, or inflammation of the pancreas, occurs more often in people with IBD, compared with the general population.

In most cases, pancreatitis with IBD seems to be related to gallstones or medications used to treat IBD. However, some cases may be due to direct damage from the condition.

 “Pancreatitis and inflammatory bowel diseases often present similarly, so patients may be misdiagnosed,” says Raffals.

Symptoms of pancreatitis may include abdominal pain, vomiting, nausea, and diarrhea.

The Takeaway

  • Up to 30 percent of people with inflammatory bowel disease are affected by liver abnormalities.
  • IBD itself, as well as certain drugs to treat the disease, can cause liver damage.
  • People with IBD should get their liver enzymes checked at least once a year and know the symptoms of liver disease.
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Yuying Luo, MD

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Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.

Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.

She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.

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Resources
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