Noninvasive evaluation of liver fibrosis in newly diagnosed pediatric Crohn’s disease: Elastography and fibrotic biomarkers at diagnosis

BACKGROUND: Crohn's disease (CD) is increasingly diagnosed in children, a population in which hepatic dysfunction and coexisting liver conditions are not uncommon. These factors may contribute to the development of hepatic fibrosis. OBJECTIVES: This study aimed to evaluate liver involvement in pediatric CD at diagnosis and to explore the utility of noninvasive markers, including fibroblast growth factor 19 (FGF-19) and connective tissue growth factor (CTGF), in detecting early fibrotic changes. MATERIAL AND METHODS: Fifty children with newly diagnosed CD and 23 healthy controls without gastrointestinal disorders were enrolled. All participants underwent liver function testing, noninvasive fibrosis scoring, serum FGF-19 and CTGF measurement, and liver elastography. RESULTS: No patient in either group demonstrated significant hepatic fibrosis (>F2 on the METAVIR scale). No statistically significant differences were found in liver elastography results between the study group and the control group (3.98 kPa vs 3.92 kPa, p = 0.430). A positive correlation was found between liver stiffness values and fecal calprotectin levels, suggesting a link to intestinal inflammation. Compared to controls, CD patients had significantly lower serum FGF-19 (87.8 pg/mL vs 123.7 pg/mL, p = 0.028) and higher CTGF concentrations (710.8 pg/mL vs 252.2 pg/mL, p < 0.001). CONCLUSIONS: Elevated liver stiffness was uncommon at the time of CD diagnosis in pediatric patients; no patients had findings suggestive of advanced fibrosis (≥F3), and only 1 patient had liver stiffness corresponding to F2 fibrosis. Altered levels of FGF-19 and CTGF may reflect intestinal inflammation and a potential fibrotic response within the gut rather than the liver. Elevated elastography values appear to be influenced by intestinal disease activity, underscoring the importance of distinguishing hepatic from intestinal sources of biomarker changes in this population.