Prevalence and risk factors of nonalcoholic fatty liver disease in patients with inflammatory bowel diseases: A cross-sectional and longitudinal analysis

Hoffmann, Péter; Jung, V; Behnisch, Rouven; Gauss, Annika

doi:10.3748/wjg.v26.i46.7367

Cited by 23 publications

(49 citation statements)

References 29 publications

(10 reference statements)

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“…There were 11 studies reporting the prevalence of NAFLD in IBD patients according to NAFLD severity. 5,19,21,23,26,28,30,35,39,44,57 The pooled prevalence of mild-to-moderate NAFLD was higher than severe NAFLD among patients with IBD (78.7% [95% CI 69.4-88.1] versus 21.3% [95% CI 11.9-30.6]). In patients with CD, the pooled prevalence of mild-to-moderate NAFLD was higher than severe NAFLD (69.7% [95% CI 64.4-74.9] versus 30.3% [95% CI 25.1-35.6]).…”

Section: Pooled Prevalence Of Nafld In Patients With Ibd According To...mentioning

confidence: 99%

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Meta‐analysis: prevalence of, and risk factors for, non‐alcoholic fatty liver disease in patients with inflammatory bowel disease

Zamani

Alizadeh-Tabari

Singh

et al. 2022

Aliment Pharmacol Ther

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Summary Background Non‐alcoholic fatty liver disease (NAFLD) is found in inflammatory bowel disease (IBD). However, uncertainties remain on the magnitude of the association. Aims To explore systematically the prevalence of, and risk factors for, NAFLD in IBD patients. Methods We searched medical literature using Embase, PubMed, Web of Science, Scopus and ProQuest, from inception to September 30, 2021. We included observational studies reporting the prevalence of NAFLD in ≥50 adult patients with IBD. Diagnosis of NAFLD could be based on imaging, histopathology, and/or hepatic steatosis index. Sex, age, body mass index (BMI), diabetes, hypertension, dyslipidemia, prior surgery (bowel resection), corticosteroids, biologics and immunomodulators were assessed as potential risk factors for NAFLD. Results Of 1893 citations, 44 eligible studies were finally included, comprising 14 947 subjects from 18 different countries. Pooled prevalence of NAFLD was 30.7% (95% confidence interval [CI] 26.5–34.9) in patients with IBD worldwide, which varied regionally. No significant difference was observed in the odds ratio (OR) of NAFLD among Crohn’s disease (CD) patients compared with ulcerative colitis (UC) patients (1.16, 95% CI 0.93–1.44). Risk of NAFLD was almost twice as high in patients with IBD as in healthy subjects (OR 1.96, 95% CI 1.13–3.41). Age (adjusted OR 1.03, 95% CI 1.01–1.05) and BMI (adjusted OR 1.27, 95% CI 1.22–1.32) were statistically significantly associated with increased risk of NAFLD. The pooled prevalence of advanced liver fibrosis in IBD patients with NAFLD was 13.6% (95% CI 7.6–19.7) based on six studies. Conclusion Up to one‐third of patients with IBD experienced NAFLD worldwide. The risk of NAFLD was two times higher in IBD patients versus healthy subjects.

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Section: Pooled Prevalence Of Nafld In Patients With Ibd According To...mentioning

confidence: 99%

“…There were 15 studies that reported the prevalence of NAFLD according to sex. 5,6,13,24,30,31,33,35,[37][38][39]42,48,53,54 Overall, the pooled prevalence was higher in men with IBD (33.2%, 95% CI 25. 1).…”

Section: Pooled Prevalence Of Nafld In Patients With Ibd According To...mentioning

confidence: 99%

Meta‐analysis: prevalence of, and risk factors for, non‐alcoholic fatty liver disease in patients with inflammatory bowel disease

Zamani

Alizadeh-Tabari

Singh

et al. 2022

Aliment Pharmacol Ther

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“…, steroids, biological agents, immunomodulators, methotrexate) and the risk of developing NAFLD[ 78 ]. Several studies also reported a higher prevalence of NAFLD among IBD patients with severe disease activity at the time of liver evaluation, compared to mild-moderate IBD cases[ 77 , 79 , 80 ].…”

Section: Non-immune-mediated Disordersmentioning

confidence: 99%

Liver-side of inflammatory bowel diseases: Hepatobiliary and drug-induced disorders

Mazza¹,

Soro²,

Verga³

et al. 2021

WJH

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Hepatobiliary disorders are among the most common extraintestinal manifestations in inflammatory bowel diseases (IBD), both in Crohn’s disease and ulcerative colitis (UC), and therefore represent a diagnostic challenge. Immune-mediated conditions include primary sclerosing cholangitis (PSC) as the main form, variant forms of PSC (namely small-duct PSC, PSC-autoimmune hepatitis overlap syndrome and IgG4-related sclerosing cholangitis) and granulomatous hepatitis. PSC is by far the most common, presenting in up to 8% of IBD patients, more frequently in UC. Several genetic foci have been identified, but environmental factors are preponderant on disease pathogenesis. The course of the two diseases is typically independent. PSC diagnosis is based mostly on typical radiological findings and exclusion of secondary cholangiopathies. Risk of cholangiocarcinoma is significantly increased in PSC, as well as the risk of colorectal cancer in patients with PSC and IBD-related colitis. No disease-modifying drugs are approved to date. Thus, PSC management is directed against symptoms and complications and includes medical therapies for pruritus, endoscopic treatment of biliary stenosis and liver transplant for end-stage liver disease. Other non-immune-mediated hepatobiliary disorders are gallstone disease, whose incidence is higher in IBD and reported in up to one third of IBD patients, non-alcoholic fatty liver disease, pyogenic liver abscess and portal vein thrombosis. Drug-induced liver injury (DILI) is an important issue in IBD, since most IBD therapies may cause liver toxicity; however, the incidence of serious adverse events is low. Thiopurines and methotrexate are the most associated with DILI, while the risk related to anti-tumor necrosis factor-α and anti-integrins is low. Data on hepatotoxicity of newer drugs approved for IBD, like anti-interleukin 12/23 and tofacitinib, are still scarce, but the evidence from other rheumatic diseases is reassuring. Hepatitis B reactivation during immunosuppressive therapy is a major concern in IBD, and adequate screening and vaccination is warranted. On the other hand, hepatitis C reactivation does not seem to be a real risk, and hepatitis C antiviral treatment does not influence IBD natural history. The approach to an IBD patient with abnormal liver function tests is complex due to the wide range of differential diagnosis, but it is of paramount importance to make a quick and accurate diagnosis, as it may influence the therapeutic management.

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“…A recent retrospective study showed that the presence of clinical activity (Harvey Bradshaw Index > 4), history of intestinal resection, endoscopic activity, and the use of AZA would be risk factors with statistical association for NAFLD in patients with CD. In the case of UC, there was an association between NAFLD and endoscopic activity[ 61 ]. MS appears not to be the only triggering factor for NAFLD in patients with IBD.…”

Section: Nafldmentioning

confidence: 99%

Hepatobiliar manifestations in inflammatory bowel disease: A practical approach

Núñez¹,

Castro²,

Mezzano³

et al. 2022

WJH

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Inflammatory bowel diseases (IBD) are associated with various hepatobiliary disorders. They can occur at any moment in the course of the disease or associated with the treatment. The prevalence of liver dysfunction can reach up to 50% in different studies. Nonalcoholic fatty liver disease is considered the most common hepatobiliary complication in IBD, while primary sclerosing cholangitis is the most specific. Management of hepatic manifestations in IBD involves a multidisciplinary approach that includes a high index of suspicion and joint management with hepatologists. The medical confrontation with abnormal liver tests must include an exhaustive study to determine if these patterns can be related to IBD, associated diseases or to the therapies used.

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Prevalence and risk factors of nonalcoholic fatty liver disease in patients with inflammatory bowel diseases: A cross-sectional and longitudinal analysis

Cited by 23 publications

References 29 publications

Meta‐analysis: prevalence of, and risk factors for, non‐alcoholic fatty liver disease in patients with inflammatory bowel disease

Meta‐analysis: prevalence of, and risk factors for, non‐alcoholic fatty liver disease in patients with inflammatory bowel disease

Liver-side of inflammatory bowel diseases: Hepatobiliary and drug-induced disorders

Hepatobiliar manifestations in inflammatory bowel disease: A practical approach

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