A Practical Approach to Abnormal Liver Enzymes in Pediatric IBD in the Biologic and Targeted Therapy Era.

What To Know

This narrative review summarizes practical evaluation and management steps for abnormal liver enzymes in children and adolescents with IBD receiving biologic and targeted therapies.

It outlines using the biochemical pattern of liver injury, timing relative to drug exposure, disease activity, laboratory testing, imaging, and selective liver biopsy to distinguish drug-induced liver injury from PSC, autoimmune hepatitis (including overlap), infection, MASLD, and other causes.

The review emphasizes individualized monitoring based on the hepatic safety profiles of different biologic and targeted agents and timely hepatology referral when indicated.

What to watch for: clinicians should integrate the pattern of enzyme elevation (hepatocellular vs cholestatic vs mixed), recent medication starts or dose changes, and IBD activity when deciding on further testing.

Initial workup typically includes liver blood tests, viral hepatitis screening, inflammatory markers, targeted imaging, and consideration of biopsy if diagnosis remains unclear.

Medication context: the article reviews hepatic safety considerations across classes used in pediatric IBD (anti-TNFs, anti-integrin, IL-12/23 and IL-23 inhibitors, JAK inhibitors, S1P modulators) and notes that monitoring strategies should be tailored to each agent's profile.

Referral and management: the piece supports stepwise evaluation to avoid unnecessary treatment interruption while identifying patients who need hepatology input or more invasive testing.