Pattern and Prognosis of Liver Function Test Abnormalities During Parenteral Nutrition in Inflammatory Bowel Disease

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Abstract
The pattern of liver function test abnormalities was examined during total parenteral nutrition (TPN), using both dextrose and fat emulsions as caloric sources, in 92 patients with inflammatory bowel disease. Seventy–two patients had completely normal tests before TPN while 20 had one or more abnormal liver function tests before TPN was started. Serum bilirubin levels were normal in all patients before TPN; within 2 weeks on TPN, 25% of patients had elevated bilirubin levels. Serum alkaline phosphatase rose to values above normal in 25% of patients with normal starting values but did not change in those with abnormal baseline liver function tests. Elevations of SGPT were characteristically more pronounced than were elevation of SGOT. After 2 weeks of TPN, mean serum SGOT rose from 15 to 26 IU per liter (p < 0.01) in patients with normal baseline values and from 28 to 50 IU per liter in those with abnormal baseline values. Elevations of serum SGPT were most common, affecting 25% of patients with normal baseline. The mean SGPT value rose from 13 to 38 IU per liter (p < 0.01) at 1 week of TPN. In patients with abnormal tests before TPN, the mean SGPT value rose from 45 to 102 IU per liter (p < 0.05). Liver biopsies performed in four patients with substantial elevations of aminotransferases revealed only minor nonspecific changes and no fatty infiltration. Elevated liver function tests promptly returned to baseline after TPN was discontinued, and progressive liver disease was not observed in any patient. Although abnormalities of liver function tests, particularly the aminotransferases, are common during balanced TPN in patients with inflammatory bowel disease, the favorable prognosis and benign histologic changes argue against the need to discontinue TPN in the presence of such changes.