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Differentiating DILI from IBD-associated hepatobiliary disorders remains difficult due to variable latency and heterogeneous presentations, and the lack of standardized monitoring protocols. This narrative review synthesizes epidemiology, mechanisms, diagnostic approaches, causality assessment limitations, and practical baseline and longitudinal monitoring 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[https://www.f6publishing.com](https://www.f6publishing.com) World J Hepatol 2025 December 27; 17(12): 114084  \nDOI: 10.4254/wjh.v17.i12.114084 ISSN 1948-5182 (online)  \nMINIREVIEWS  \nDrug-induced liver injury in inflammatory bowel disease: Challenges in diagnosis and monitoring  \nArshdeep Singh, Arshia Bhardwaj, Harmeet Kaur, Ashutosh Bawa, Vandana Midha, Ajit Sood  \nSpecialty type: Gastroenterology and hepatology  \nProvenance and peer review:  \nInvited article; Externally peer reviewed.  \nPeer-review model: Single blind  \nPeer-review report’s classification Scientific Quality: Grade B  \nNovelty: Grade B  \nCreativity or Innovation: Grade C  \nScientific Significance: Grade B  \nP-Reviewer: Vargas-Beltran AM, MD, Mexico  \nReceived: September 15, 2025  \nRevised: October 1, 2025  \nAccepted: November 24, 2025  \nPublished online: December 27, 2025  \nProcessing time: 104 Days and 21.6 Hours  \nArshdeep Singh, Arshia Bhardwaj, Ajit Sood, Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India  \nHarmeet Kaur, Department of Obstetrics and Gynaecology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India  \nAshutosh Bawa, Department of Surgery, Government Medical College, Srinagar 190001, Jammu and Kashmīr, India  \nVandana Midha, Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India  \nCorresponding author: Arshdeep Singh, Associate Professor, Department of Gastroenterology, Dayanand Medical College and Hospital, Tagore Nagar Civil Lines, Ludhiana 141001, Punjab, [India.](India. drarshdeepsingh@gmail.com)[ drarshdeepsingh@gmail.com](India. drarshdeepsingh@gmail.com)  \nAbstract  \nDrug-induced liver injury (DILI) is an important but often underrecognized complication in the management of inflammatory bowel disease (IBD), particularly in patients receiving long-term immunomodulatory or biologic therapies. Agents such as thiopurines, methotrexate, anti-tumor necrosis factor agents, and newer small molecules including tofacitinib and upadacitinib have all been implicated in hepatotoxicity, with clinical manifestations ranging from asymptomatic elevations in liver enzymes to severe hepatic injury. Differentiating DILI from hepatobiliary disorders commonly associated with IBD, such as primary sclerosing cholangitis, metabolic dysfunction-associated steatotic liver disease, and autoimmune hepatitis, remains a significant diagnostic challenge. The absence of standardized monitoring protocols, coupled with the variable latency and heterogeneous presentation of DILI, further complicates early recognition and management. In this narrative review, we synthesize current evidence on the epidemiology, pathophysiological mechanisms, and clinical spectrum of DILI in IBD. We also outline diagnostic strategies, including the role and limitations of causality assessment tools, and propose practical considerations for baseline evaluation, longitudinal monitoring, and therapeutic decision-making.  \nKey Words: Drug-induced liver injury; Hepatotoxicity; Immunosuppressive agents; Inflammatory bowel diseases; Monitoring  \n WJH  [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 27, 2025  Volume 17  Issue 12   \nSingh A et al. DILI in IBD  \n©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.  \nCore Tip: Drug-induced liver injury (DILI) in inflammatory bowel disease (IBD) is often underrecognized due to overlapping hepatobiliary disorders and nonspecific presentations. Distinguishing true DILI from IBD-related liver disease requires systematic evaluation, multidisciplinary input, and structured monitoring strategies. This review synthesizes current evidence on the epidemiology, mechanisms, and diagnostic challenges of DILI in IBD, highlighting practical approaches to optimize early detection and safe therapeutic decision-m","cbCaiqvNIMMqeDbW","https://ap.wps.com/l/cbCaiqvNIMMqeDbW","pdf",2542699,14,"English","# INTRODUCTION\n## Inflammatory bowel disease and treatment risks\n## DILI types and clinical patterns\n# Abstract\n## Epidemiology and therapeutic context\n## Diagnostic differentiation challenges\n## Monitoring and decision-making approach","[{\"question\":\"Why is drug-induced liver injury underrecognized in inflammatory bowel disease?\",\"answer\":\"DILI is often overlooked because its manifestations overlap with hepatobiliary disorders commonly associated with IBD and because presentations can be nonspecific.\"},{\"question\":\"Which therapies used in IBD have been implicated in DILI?\",\"answer\":\"Thiopurines, methotrexate, anti–tumor necrosis factor agents, and newer small molecules including tofacitinib and upadacitinib have all been implicated in hepatotoxicity.\"},{\"question\":\"What makes diagnosis and monitoring of DILI challenging in IBD?\",\"answer\":\"Challenges stem from heterogeneous clinical spectra, variable latency, absence of standardized monitoring protocols, and the limitations of causality assessment tools when distinguishing DILI from other IBD-related liver conditions.\"}]","Drug-induced liver injury in inflammatory bowel disease - Challenges in diagnosis and monitoring | PDF",1790566823,35]