When the Gut Speaks, the Liver Listens: Pathogenesis, Diagnostic Spectrum, and Artificial Intelligence Guided Interventions in Colitis-Driven Hepatopathies

About 5% of people with inflammatory bowel disease (IBD) eventually develop clinically severe, chronic liver disease, even though up to 50% of patients have temporary hepatobiliary alterations, and up to 30% have abnormal liver biochemistries.Colitis-associated liver disorders (CALD) range from transitory rises in liver enzymes to serious, life-threatening conditions such as primary sclerosing cholangitis (PSC), autoimmune hepatitis (AIH), and metabolic dysfunction-associated steatotic liver disease (MASLD).Currently available diagnostic criteria for gut-associated liver disorders are limited due to the complexity and bidirectional nature of the gut-liver axis.Large-duct PSC is primarily diagnosed by magnetic resonance cholangiopancreatography (MRCP), but liver biopsy is especially recommended to confirm potential PSC-autoimmune hepatitis (AIH) overlap syndromes and diagnosis of small-duct variations in the context of a normal MRCP.These methods contain sampling errors, lack interobserver variability, and have limited sensitivity to pre-symptomatic changes.Thus, the standard of care available to date is primarily palliative rather than curative.Modern biologic treatments are effective for colonic inflammation, but they don't always alter the course of liver disease.The prevailing treatments for the above-mentioned disorders (e.g., ursodeoxycholic acid (UDCA), immunosuppressants, or metabolic stabilizers) are often ineffective against fibrotic progression.This review evaluates the impact of Artificial Intelligence (AI) in tackling these challenges.Highly effective AI-enhanced diagnostics and therapeutic pipeline, focusing on computational models and multi-omic integration, has also been discussed.