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Inflammatory Bowel Disease (IBD) encompasses a group of chronic inflammatory conditions affecting the gastrointestinal tract, with Ulcerative Colitis (UC) and Crohn's disease (CD) being the two main subtypes. These disorders are characterized by periods of active inflammation interspersed with remission phases. While the primary focus of IBD management is to control intestinal inflammation and improve quality of life, there's growing recognition of the interplay between IBD and other organs, including the liver. Acute Liver Injury (ALI) is a known complication in IBD patients, and understanding the therapeutic approaches to manage both conditions is crucial for comprehensive patient care.

One of the mainstays in managing IBD is the use of anti-inflammatory medications. Corticosteroids like prednisone or budesonide are often prescribed during acute flares to rapidly reduce inflammation and symptoms. While effective for intestinal inflammation, prolonged or highdose corticosteroid use can contribute to liver dysfunction, including ALI. Thus, clinicians must balance the benefits of controlling IBD symptoms with the potential hepatotoxicity of corticosteroids, especially in patients with pre-existing liver conditions. Another class of medications commonly used in IBD therapy is immune-modulators. Thiopurines (azathioprine, 6-mercaptopurine) and methotrexate are examples of immunomodulatory drugs that help maintain remission and reduce the need for corticosteroids. However, these medications can also affect liver function, leading to hepatotoxicity in a subset of patients. Monitoring liver enzymes and adjusting drug dosages accordingly are essential strategies to prevent ALI while optimizing IBD management. Biologic therapies have revolutionized the treatment landscape for moderate to severe IBD. Tumor necrosis factor-alpha (TNF-α) inhibitors such as infliximab, adalimumab, and certolizumab pegol target specific inflammatory pathways, offering effective control of IBD activity. However, biologics may be associated with liver-related adverse events, including drug-induced liver injury (DILI) or exacerbation of pre-existing liver conditions. Close monitoring of liver function tests and prompt intervention in case of liver abnormalities are integral components of biologic therapy in IBD. Recent advances in IBD treatment include the emergence of targeted therapies. Janus kinase (JAK) inhibitors like tofacitinib and upadacitinib modulate intracellular signaling pathways involved in inflammation, providing an alternative for patients who have failed conventional therapies. While generally well-tolerated, JAK inhibitors have been associated with liver function abnormalities, necessitating vigilant monitoring during treatment. In the context of acute liver injury in IBD patients, therapeutic strategies focus on managing both the underlying liver dysfunction and concurrent intestinal inflammation. Liver-supportive measures such as discontinuing potentially hepatotoxic medications, optimizing fluid and electrolyte balance, and addressing nutritional deficiencies are paramount. In severe cases of ALI, liver transplantation may be considered, although this remains a last resort due to the risks associated with surgery and immunosuppression. The symbiotic relationship between IBD therapies and acute liver injury underscores the importance of multidisciplinary care involving gastroenterologists, hepatologists, and specialized nursing teams. Collaborative efforts in monitoring drug-related hepatotoxicity, implementing timely interventions, and optimizing treatment regimens tailored to individual patient needs are fundamental in achieving favorable outcomes for IBD patients with liver complications.

Managing Inflammatory Bowel Disease (IBD) and acute liver injury presents significant therapeutic challenges due to overlapping symptoms, complex treatment regimens, and potential drug-induced hepatotoxicity. Effective management requires a multidisciplinary approach, careful monitoring, and individualized treatment plans to balance controlling IBD symptoms while preventing and addressing liver complications.