Nonalcoholic Fatty Liver Disease Is Common in IBD Patients However Progression to Hepatic Fibrosis by Noninvasive Marker
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ORIGINAL ARTICLE
Nonalcoholic Fatty Liver Disease Is Common in IBD Patients However Progression to Hepatic Fibrosis by Noninvasive Markers Is Rare Gabrielle Ritaccio1 · Gianna Stoleru1 · Ameer Abutaleb2 · Raymond K. Cross2 · Kirti Shetty2 · Sasan Sakiani2 · Uni Wong2 Received: 10 May 2020 / Accepted: 26 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Nonalcoholic fatty liver disease (NAFLD) is the most common liver disorder in western countries and an increasing cause of end-stage liver disease and hepatocellular carcinoma. NAFLD is known to coexist in patients with inflammatory bowel disease (IBD). This study aims to examine the prevalence of NAFLD, as well as trends in NAFLD-associated fibrosis, in a well-characterized IBD cohort utilizing a validated noninvasive test. Methods We conducted a single-center retrospective chart review of patients at a large academic IBD center between 2007 and 2017. Patients with IBD and concurrent hepatic steatosis were identified. Charts were reviewed for baseline characteristics and laboratory data in order to calculate and trend NAFLD progression over time by a noninvasive marker, the NAFLD fibrosis score (NFS). Results Of 207 patients with IBD and concurrent NAFLD, NFS was able to be calculated for 138 patients at index diagnosis. A subsequent NFS was able to be calculated at 5-year follow-up for 56 patients. Over 5 years, 9 patients (16%) had worsening in NFS category, 4 patients (7%) had improvement in NFS category, and the remaining 43 patients (77%) stayed within their index NFS category. Conclusions IBD patients with NAFLD tend to have stable liver disease over 4–6 years, and the risk of liver disease progression is low. This is the first study to document the progression of NAFLD by noninvasive testing over time. Keywords Inflammatory bowel disease · Crohn’s disease · Ulcerative colitis · Nonalcoholic fatty liver disease · NAFLD fibrosis score
Introduction Nonalcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in western countries and a leading cause of end-stage liver disease (ESLD) and hepatocellular Gabrielle Ritaccio and Gianna Stoleru have contributed equally to this work.
carcinoma (HCC) [1]. The coexistence of NAFLD in patients with inflammatory bowel disease (IBD) has been described in published case reports as early as 1873 when CH Thomas described a patient with ulcerative colitis (UC) and hepatomegaly with steatosis [2]. Today, the prevalence of NAFLD in the US population has been estimated to be between 10 and 40% [3–5]. A meta-analysis investigating 19
* Uni Wong [email protected]
Kirti Shetty [email protected]
Gabrielle Ritaccio [email protected]
Sasan Sakiani [email protected]
Gianna Stoleru [email protected]
1
Ameer Abutaleb [email protected]
Department of Medicine, University of Maryland Medical Center, Baltimore, MD, USA
2
Division of Gastroenterology and Hepatology, Department of Medic
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