Gastro Flash Vol-6, No-1, 2020

Liver function tests (LFTs) are one of the most commonly- requested screening blood tests. Whether for the investigation of suspected liver disease, monitoring of disease activity, or simply as ‘routine’ blood analysis, these tests can provide a host of information on a range of disease processes.1 Evaluation of abnormal liver enzyme levels in an otherwise healthy patient can pose a challenge to even an experienced clinician. Though, it may not be necessary to pursue extensive evaluation for all abnormal test results as they may not be directed towards actual liver diseases and can cause unnecessary concern and expose many patients to procedural risks and expenses. Conversely, failure to investigate mild or moderate liver enzyme elevations in turn increase the risk of missing the early diagnosis of potential life- threatening yet treatable conditions.

Irritable bowel syndrome (IBS), a common functional gastrointestinal disorder involving the gut-brain axis, and inflammatory bowel disease (IBD), a chronic relapsing inflammatory disorder, are both increasing in incidence and prevalence in Asia. Both have significant overlap in terms of symptoms, pathophysiology, and treatment, suggesting the possibility of IBS and IBD being a single disease entity albeit at opposite ends of the spectrum. IBS is characterized by a disordered gut-brain axis, but can develop following an enteric infection, and is associated with persistent immune activation that is also a feature of IBD. Of note, the considerable overlap of symptoms and colitis points to the possibility of IBS as a prodromal or mild subset of IBD, or IBD being pathologically related to the cause of IBS, or representing same pathophysiological spectrum of a disease.