Attitudes of physicians managing inflammatory bowel disease toward alterations of liver function tests: an Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD) survey

Background: Liver diseases are common in patients with inflammatory bowel disease (IBD). Little is known about how specialists perceive and manage liver enzyme abnormalities. This study investigates the current practice and educational needs of IBD specialists in the management of liver enzyme abnormalities. Methods: A 22-question web-based survey was distributed to members of the Italian Group for the study of IBD, covering their demographics, workplace features, and approaches to managing liver enzyme abnormalities in IBD patients. Results: The survey was completed by 205/439 (46.7%) respondents. The majority of respondents were over 45 years old (38.5%) and worked in Northern Italy (61%). Most were gastroenterologists (86%) practicing in public hospitals (45%), with 21.5% having a defined referral pathway to a dedicated liver unit for IBD patients. Ninety-seven percent of physicians reported regular monitoring of transaminases, while 88% also monitored gamma-glutamyl transpeptidase and 76% alkaline phosphatase (ALP). In cases of abnormal enzyme levels, over 70% reported ordering additional diagnostic tests independently, with notable heterogeneity in the thresholds used to trigger further investigation. The conditions most frequently suspected in cases of mild transaminase elevations were metabolic dysfunction-associated steatotic liver disease (71%) and drug-induced liver injury (17%). A significant proportion of physicians (57%) considered their training in managing liver enzyme abnormalities adequate but acknowledged the need for further educational opportunities. The main barrier identified was the lack of specific guidelines and actionable flowcharts (62%). Conclusion: This survey reveals heterogeneity in monitoring and management of liver enzyme abnormalities among IBD specialists. Most physicians recognize the need for improved training and specific guidelines.