Screening for Liver Steatosis and Fibrosis in Patients with Inflammatory Bowel Disease Using Vibration Controlled Transient Elastography with Controlled Attenuation Parameter

Abstract

Background and Aims: Inflammatory bowel diseases (IBD) are frequently associated with extraintestinal manifestations, hepatic injury being of concern in these patients. Current literature reports an increased prevalence of liver steatosis and fibrosis in subjects with IBD and the pathophysiology is yet to be completely understood. The aim of this study was to assess the prevalence of non-alcoholic fatty liver disease (NAFLD) in patients with IBD, as well as to determine the factors that connect these two disorders. Methods: From September 2021 to June 2022, 82 consecutive IBD patients were enrolled from a tertiary care center hospital in Iasi. Vibration-Controlled Transient Elastography with Controlled Attenuation Parameter (CAP) was used to assess the presence of NAFLD, with a cut-off score for CAP of 248 dB/m. Significant liver fibrosis was considered at a cut-off for liver stiffness measurements (LSM) of 7.2 kPa. Results: In total, 82 IBD patients (54.8% men, mean age of 49 ± 13 years) were included, 38 (46.3%) of them being diagnosed with NAFLD, with a mean CAP score of 286 ± 35.4 vs. 203 ± 29.7 in patients with IBD only. Age (β = 0.357, p = 0.021), body mass index (BMI) (β = 0.185, p = 0.048), disease duration (β = 0.297, p = 0.041), C—reactive protein (β = 0.321, p = 0.013), fasting plasma glucose (β = 0.269, p = 0.038), and triglycerides (β = 0.273, p = 0.023) were strongly associated with the presence of liver steatosis. The multivariate analysis showed that older age, BMI, and disease duration were strongly associated with significant liver fibrosis in our group. Conclusions: NAFLD is a multifaced pathology with growing prevalence among IBD patients. Additional studies are needed to completely understand this problem and to create a solid evidence-based framework for more effective preventative and intervention strategies.

Liver Fibrosis in Non-Alcoholic Fatty Liver Disease and Progression to Hepatocellular Carcinoma in Patients with Inflammatory Bowel Disease: A Systematic Review

“…Eighty-eight full-texts were reviewed, excluding 65 additional reports being the most frequent reasons: lack of liver fibrosis assessment in IBD population with NAFLD (n = 27), conference abstracts (n = 18), and studies focused on patients receiving hepatotoxic drugs (n = 13). Finally, 23 studies were included in the systematic review [ 10 , 11 , 12 , 16 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 ].…”

“…All the included studies were observational, including 10 (43.5%) cross-sectional studies [ 11 , 12 , 32 , 34 , 36 , 38 , 39 , 40 , 46 , 48 ], 10 (43.5%) cohort studies [ 10 , 31 , 33 , 35 , 37 , 42 , 43 , 45 , 47 , 49 ], and 3 (13%) case-control studies [ 16 , 41 , 44 ] ( Table S1 ). All studies were published between 2015 and 2023.…”

“…All studies were published between 2015 and 2023. Eleven (47.8%) were conducted in North America [ 10 , 11 , 12 , 32 , 33 , 34 , 35 , 38 , 39 , 41 , 42 ], ten (43.5%) in Europe [ 16 , 36 , 37 , 40 , 43 , 44 , 45 , 46 , 47 , 48 ] and two (8.7%) in Asia [ 31 , 49 ]. Only six (26.1%) studies had a control group composed by patients without IBD [ 16 , 32 , 36 , 37 , 41 , 44 ].…”

“…Regarding the diagnostic method for NAFLD, 3 performed a retrospective review of database records [ 10 , 35 , 42 ], 2 combined liver US and TE [ 48 , 49 ], 5 used US [ 31 , 36 , 39 , 40 , 44 ], 6 used TE [ 12 , 16 , 38 , 45 , 46 , 47 ], 2 used laboratory tests alone [ 33 , 37 ], 3 liver histology [ 32 , 34 , 43 ], 1 computed tomography [ 11 ], and 1 Magnetic Resonance [ 41 ]. Regarding the diagnostic method for liver fibrosis, two performed a retrospective review of database records [ 10 , 35 ], 10 used TE [ 12 , 16 , 36 , 38 , 40 , 45 , 46 , 47 , 48 , 49 ], seven used laboratory tests alone [ 11 , 31 , 33 , 37 , 39 , 41 , 42 ], two used liver histology [ 32 , 34 ], one used a combination of TE and laboratory tests [ 44 ], and one used a combination of TE and histology [ 43 ]. Therefore, NAFLD and liver fibrosis were assessed by non-invasive methods in 20 (86.9%) and 21 (91.3%) studies, respectively.…”

“…Therefore, NAFLD and liver fibrosis were assessed by non-invasive methods in 20 (86.9%) and 21 (91.3%) studies, respectively. Studies using TE for liver fibrosis assessment defined significant liver fibrosis as liver stiffness above 7 kPa in five (41.7%) studies [ 12 , 40 , 43 , 45 , 48 ], 7.2 kPa [ 16 , 46 ] in two (16.7%) studies, 7.3 kPa [ 47 ] in one (8.3%) study, 7.7 kPa in one (8.3%) study [ 36 ], ≥8 kPa [ 38 , 49 ] in two (16.7%) studies, and no specified in one (8.3%) study [ 44 ].…”