Arrested Development: Slow Progression of Fibrosis in Patients with NAFLD and IBD
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EDITORIAL
Arrested Development: Slow Progression of Fibrosis in Patients with NAFLD and IBD Yejoo Jeon1 · Berkeley N. Limketkai1 Accepted: 9 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Nonalcoholic fatty liver disease (NAFLD) that has recently emerged as one of the most common chronic liver diseases worldwide is a significant contributor to hepatic cirrhosis and hepatocellular carcinoma [1]. Following general population trends, NAFLD has also been increasingly recognized among patients with inflammatory bowel diseases (IBD). A recent meta-analysis estimated NAFLD to be present in approximately 28% of patients with IBD and more commonly among patients with features of severe IBD, such as longer disease duration or a history of abdominal surgery [2]. A proposed mechanism for this observation suggests that an increased systemic inflammatory burden from IBD contributes to hepatic steatosis; such inflammation could theoretically drive progression of hepatic fibrosis. Nevertheless, the clinical implications of the concurrent occurrence of IBD and NAFLD are yet unclear. The natural history of NAFLD may vary greatly among patients, with some individuals experiencing a clinically benign course and others progressing to advanced liver disease. This disparity in outcomes and the morbidity of the more severe complications highlight the importance of proper disease diagnosis and prognosis. Prior studies have shown hepatic fibrosis to be the most reliable marker associated with overall and liver-related mortality in patients with NAFLD, although features of inflammation or the NAFLD activity score (correlated with the presence of NASH) were not [3, 4]. Though fibrosis is usually a histologic diagnosis, with the rising prevalence of NAFLD combined with the dynamic nature of fibrosis, variable disease trajectory, and risks associated with liver biopsy, it would be impractical to monitor NAFLD-associated fibrosis in large populations solely through biopsy [5]. As such, noninvasive radiologic * Berkeley N. Limketkai [email protected] 1
Vatche and Tamar Manoukian Division of Digestive Diseases, UCLA School of Medicine, 100 UCLA Medical Plaza Suite #345, Los Angeles, CA 90095, USA
and serum-based tests have emerged as potential alternatives to monitor fibrosis progression in NAFLD. In the context of patients with IBD, many who already undergo numerous invasive procedures, receive potent immunosuppressive medications, and endure recurrent flares, the availability of minimally or noninvasive measures to monitor disease activity becomes increasingly important. In this issue of Digestive Diseases and Sciences, Ritaccio et al. [6] report their findings on the prevalence of NAFLD and trends in the progression of NAFLD-associated fibrosis among patients with IBD. In a large population of 1672 patients with IBD seen at a tertiary-care academic center, 14% had radiologic or biopsy-proven evidence of hepatic steatosis. The investigators also employed the NAFLD fibrosis score (NFS)—a valida
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