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Did you know that up to 30% of people living with inflammatory bowel disease (IBD) will have abnormal liver tests at some point?

In this episode of Wrestling the Octopus IBD, Nigel and I are joined by two expert hepatologists from Guy's and St Thomas' Hospital in London to explore the link between IBD and liver disease – what causes it, what to look out for and how it's monitored.

Our Guests

Dr. Sreelakshmi (Sree) Kotha – Hepatology Consultant and Clinical Lead for Endoscopy, St. Thomas' Hospital, London.

Dr. Phil Berry – Consultant Gastroenterologist and Hepatologist, Guy's and St. Thomas' Hospital. Special interest in medical ethics and patient safety. Co-author of PSC: Voices, Journeys and Challenges.

Why Does IBD Affect the Liver?

IBD – including Crohn's disease and ulcerative colitis – is an autoimmune condition, and that autoimmune activity doesn't always stay confined to the gut. Liver involvement is more common than many patients realise. The main causes of abnormal liver tests in IBD include:

• Fatty liver disease – linked to high BMI or long-term steroid use
• Medication reactions – IBD treatments such as methotrexate, azathioprine and biologics can all affect liver function
• Autoimmune hepatitis – where the immune system attacks liver cells
• Gallstones – Crohn's disease affects how the body processes bile acids, increasing the risk
• Primary sclerosing cholangitis (PSC) – a serious bile duct condition closely linked to IBD.

Key facts about PSC:

• Around 70–80% of people with PSC also have IBD
• PSC is more common in ulcerative colitis (affecting 3–8% of patients) than in Crohn's disease (1–3%)
• Treating IBD, even very successfully, does not appear to slow PSC — the two conditions can progress independently of each other
• PSC is a lifelong condition requiring ongoing monitoring

Symptoms to Watch For

Early liver disease often causes no obvious symptoms, which is why routine blood tests matter. As things progress, patients may notice:

• Persistent fatigue and tiredness (though this can overlap with IBD symptoms)
• Jaundice – yellowing of the eyes or skin
• Fevers, chills and rigors – signs of bile duct infection
• Abdominal pain, particularly on the right side

Gallstones and Crohn's Disease

Crohn's disease carries a slightly higher risk of gallstones due to changes in how bile acids are processed in the gut. Because gallstones are common in the general population and the treatment (gallbladder removal) is the same regardless of cause, the Crohn's connection isn't always explored – but it's worth raising with your team if you have symptoms.

When Should You Seek Help?

Managing IBD alongside liver disease, gallstones or other complications can make it hard to know who to contact when something feels wrong. A few practical pointers:

• Severe abdominal pain with fever, vomiting or chills – call 111 or go to A&E
• Grumbling, uncertain symptoms – contact your gastroenterology team via 

Mentioned in This Episode

• PSC: Voices, Journeys and Challenges – co-authored by Dr. Sree Kotha and Dr. Phil Berry
• Necessary Scars – by Dr. Phil Berry, exploring how medical professionals cope with mistakes

Get in Touch

Have a topic you'd like us to cover? Email us at [email protected]

Follow Rachel at @bottomlineibd

Follow Nigel at @crohnoid