Emre GERÇEKER, Serkan CERRAH, Ahmed Ramiz BAYKAN

İnflamatuvar bağırsak hastalığında nonalkolik yağlı karaciğer hastalığı sıklığı

Giriş ve Amaç: Nonalkolik yağlı karaciğer hastalığı, inflamatuvar bağırsak hastalığında yaygındır. Bu çalışmanın amacı inflamatuvar bağırsak hastalığında nonalkolik yağlı karaciğer hastalığı prevalansını eşleştirilmiş bir kontrol grubuyla karşılaştırıldığında değerlendirmek ve inflamatuvar bağırsak hastalığında nonalkolik yağlı karaciğer hastalığı ile ilişkili özellikleri tanımlamaktır. Gereç ve Yöntem: Karın ağrısı nedeniyle gastroenteroloji poliklinik kontrollerinde ultrasonografi tetkiki yapılan 225 inflamatuvar bağırsak hastalığı tanılı olgunun tıbbi kayıtları geriye dönük olarak incelendi. Bu olgular yaş ve vücut kitle indeksi ile Diabetes Mellitus varlığı açısından eşleştirilmiş, inflamatuvar bağırsak hastalığı olmayan 70 kontrol olgusu ile karşılaştırıldı. Batın ultrasonografi verileri, karaciğerdeki hepatosteatoz varlığı veya yokluğu açısından analiz edildi. Bulgular: Çalışma popülasyonu içinde nonalkolik yağlı karaciğer hastalığı oranı %38.3 saptandı. İnflamatuvar bağırsak hastalarında kontrol grubuna göre anlamlı olarak daha yüksek oranda nonalkolik yağlı karaciğer hastalığı izlendi (%43.3’e karşı %25; p = 0.004). Ülseratif kolit alt grubunda kontrol grubuna göre anlamlı olarak daha yüksek oranda nonalkolik yağlı karaciğer hastalığı izlendi (%43.9’a karşı %25, p = 0.007). Crohn hastalığı alt grubunda kontrol grubuna göre anlamlı olarak daha yüksek oranda yağlı karaciğer izlendi (%42.4’e karşı %25, p = 0.015). İnflamatuvar bağırsak hastalığı varlığının, Diabetes Mellitus varlığının, vücut kitle indeksinin >25 üzerinde olmasının bağımsız olarak nonalkolik yağlı karaciğer hastalığı gelişimi riskini arttırdığı saptandı. Sonuç: İnflamatuavar bağırsak hastalığı varlığı nonalkolik yağlı karaciğer hastalığı gelişim riskini arttırmaktadır. İnflamatuvar bağırsak hastalarında sistemik iltihaplanma ve bağırsak mikrobiyomunun değişmesi nonalkolik yağlı karaciğer hastalığı gelişiminde potansiyel nedensel faktörler olarak belirtilmiştir, ancak patofizyolojiyi aydınlatmak için daha fazla çalışmaya ihtiyaç duyulacaktır.

Prevalence of nonalcoholic fatty liver disease in inflammatory bowel disease

Background and Aims: Nonalcoholic fatty liver disease is common among patients with inflammatory bowel disease. We aimed to evaluate and compare the prevalence of nonalcoholic fatty liver disease in inflammatory bowel disease cases and matched controls, and to define the features of nonalcoholic fatty liver disease associated with inflammatory bowel disease. Materials and Methods: The medical records of 225 patients with inflammatory bowel disease who underwent ultrasonography examination for abdominal pain in our gastroenterology clinic were analyzed retrospectively. The records of these cases were compared with those of 70 controls without inflammatory bowel disease, matched for age, body mass index, and the presence of Diabetes Mellitus. Abdominal ultrasonography findings were analyzed for the presence or absence of hepatosteatosis. Results: The rate of nonalcoholic fatty liver disease in the study population was 38.3%. Nonalcoholic fatty liver disease was observed at a significantly higher rate in the inflammatory bowel disease patient group than in the control group (43.3% versus 25%; p = 0.004). Nonalcoholic fatty liver disease was observed at a significantly higher rate in the ulcerative colitis subgroup than in the control group (43.9% versus 25%, p = 0.007). A significantly higher percentage of nonalcoholic fatty liver disease was observed in the Crohn’s disease subgroup than in the control group (42.4% versus 25%, p = 0.015). The presence of inflammatory bowel disease, Diabetes Mellitus, and body mass index >25 were found to increase the risk independently of developing nonalcoholic fatty liver disease. Conclusion: The presence of inflammatory bowel disease increases the risk of developing nonalcoholic fatty liver disease. The current results suggest systemic inflammation and alteration of the gut microbiome in inflammatory bowel disease as causal factors in the development of nonalcoholic fatty liver disease, but further studies are required to elucidate the pathophysiology involved.

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1. Le MH, Devaki P, Ha NB, et al. Prevalence of non-alcoholic fatty liver disease and risk factors for advanced fibrosis and mortality in the United States. PLoS One 2017;12:e0173499.
2. Ratziu V, Bellentani S, Cortez-Pinto H, Day C, Marchesini G. A position statement on NAFLD/NASH based on the EASL 2009 special conference. J Hepatol 2010;53:372-84.
3. Vernon G, Baranova A, Younossi ZM. Systematic review: The epidemiology and natural history of nonalcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther 2011;34:274-85.
4. Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 2016;64:73-84.
5. Loftus EV, Jr. Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology 2004,126:1504-17.
6. Saroli Palumbo C, Restellini S, Chao CY, et al. Screening for nonalcoholic fatty liver disease in inflammatory bowel diseases: A cohort study using transient elastography. Inflamm Bowel Dis 2019;25:124-33.
7. Bessissow T, Le NH, Rollet K, et al. Incidence and predictors of nonalcoholic fatty liver disease by serum biomarkers in patients with inflammatory bowel disease. Inflamm Bowel Dis 2016;22:1937-44.
8. Nagahori M, Hyun SB, Totsuka T, et al. Prevalence of metabolic syndrome is comparable between inflammatory bowel disease patients and the general population. J Gastroenterol 2010;45:1008- 13.
9. Principi M, Iannone A, Losurdo G, et al. Nonalcoholic fatty liver disease in inflammatory bowel disease: Prevalence and risk factors. Inflamm Bowel Dis 2018;24:1589-96.
10. Likhitsup A, Dundulis J, Ansari S, et al. Prevalence of non-alcoholic fatty liver disease on computed tomography in patients with inflammatory bowel disease visiting an emergency department. Ann Gastroenterol 2019;32:283-6.
11. Carr RM, Oranu A, Khungar V. Nonalcoholic fatty liver disease: Pathophysiology and management. Gastroenterol Clin North Am 2016;45:639-52.
12. Sanyal D, Mukherjee P, Raychaudhuri M, et al. Profile of liver enzymes in non-alcoholic fatty liver disease in patients with impaired glucose tolerance and newly detected untreated type 2 diabetes. Indian J Endocrinol Metab 2015;19:597-601.
13. Younossi ZM, Koenig AB, Abdelatif D, et al. Global epidemiology of nonalcoholic fatty liver diseasemeta-analytic assessment of prevalence, incidence, and outcomes. Hepatology 2016;64:73-84.
14. Scalera A, Di Minno MN, Tarantino G. What does irritable bowel syndrome share with non-alcoholic fatty liver disease? World J Gastroenterol 2013;19:5402-20.
15. Bargiggia S, Maconi G, Elli M, et al. Sonographic prevalence of liver steatosis and biliary tract stones in patients with inflammatory bowel disease: study of 511 subjects at a single center. J Clin Gastroenterol 2003;36:417-20.
16. Sourianarayanane A, Garg G, Smith TH, et al. Risk factors of non-alcoholic fatty liver disease in patients with inflammatory bowel disease. J Crohns Colitis 2013;7:e279-e285.
17. Bessissow T, Le NH, Rollet K, et al. Incidence and predictors of nonalcoholic fatty liver disease by serum biomarkers in patients with inflammatory bowel disease. Inflamm Bowel Dis 2016;22:1937-44.
18. Bosch DE, Yeh MM. Primary sclerosing cholangitis is protective against nonalcoholic fatty liver disease in inflammatory bowel disease. Hum Pathol 2017;69:55-62.
19. Carr RM, Patel A, Bownik H, et al. Intestinal inflammation does not predict nonalcoholic fatty liver disease severity in inflammatory bowel disease patients. Dig Dis Sci 2017;62:1354-61.
20. McGowan CE, Jones P, Long MD, Barritt ASt. Changing shape of disease: nonalcoholic fatty liver disease in Crohn’s disease-a case series and review of the literature. Inflamm Bowel Dis 2012;18:49- 54.
21. Bessissow T, Le NH, Rollet K, Afif W, et al. Incidence and predictors of nonalcoholic fatty liver disease by serum biomarkers in patients with inflammatory bowel disease. Inflamm Bowel Dis 2016;22:1937-44.