Liver Involvement in Celiac Disease and Immune-Mediated Diseases of the Small Bowel

Disorders of the hepatobiliary system are commonly associated with gastrointestinal (GI) diseases. The GI and hepatobiliary systems interact through the portal vein system and enterohepatic circulation, creating a gut-liver axis that allows for a complex multidirectional interplay between immune, hormonal, dietary and environmental luminal factors that include the gut microbiota. This interaction may underlie the liver affection in autoimmune and immune-mediated small bowel diseases through a variety of pathways that include autoimmune, metabolic, immune-mediated, and/or iatrogenic mechanisms. Despite evidence of a gut-liver axis and co-morbid liver associations with small bowel diseases, the clinical implications and how these conditions should be clinically managed remain unclear. In this narrative review, we describe the hepato-biliary manifestations associated with chronic immune-mediated enteropathies of the small bowel in adults, with particular focus on CeD and Crohn's disease.