Inflammation, etiologies and Model for End‐stage Liver Disease score: What makes liver disease patients susceptible to developing colorectal neoplasia?

Abstract

Aim Research has identified patients with chronic liver disease as a risk group for colorectal neoplasia. In this study, we aimed to identify liver disease subgroups at enhanced risk of developing colorectal neoplasia, as well as causal factors. Methods The present retrospective study included patients with chronic liver disease undergoing colonoscopy during liver transplantation evaluations, and liver‐healthy patients as part of the German screening protocol. We assessed inflammatory laboratory values, Model for End‐stage Liver Disease score, portal hypertension, and liver disease etiologies as explanatory variables. Outcomes included polyps, adenomas, high‐risk situations, and colorectal cancer, tested in uni‐ and multivariable analyses. Results A total of 1046 patients were included, 407 with liver disease, 639 without. Alcohol‐toxic, metabolic, cryptogenic, non‐alcoholic fatty liver disease, and hepatocellular carcinoma were significantly associated with colorectal neoplasia, as were low compared with high Model for End‐stage Liver Disease scores. Portal hypertension showed no associations with neoplasia. Inflammatory markers were associated with colorectal neoplasia, independent of liver disease severity. Conclusions Low Model for End‐stage Liver Disease score, inflammatory markers, and certain etiologies were associated with colorectal neoplasia. Our findings suggest that inflammation may play an important role in the development of colonic adenomas in patients with chronic liver disease. Findings need to be confirmed in prospective studies, but may allow risk stratification and, possibly, development of prophylactic treatments.