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. 2021 Sep;66(9):3186-3191.
doi: 10.1007/s10620-020-06588-6. Epub 2020 Sep 7.

Nonalcoholic Fatty Liver Disease Is Common in IBD Patients However Progression to Hepatic Fibrosis by Noninvasive Markers Is Rare

Gabrielle Ritaccio #  1 , Gianna Stoleru #  1 , Ameer Abutaleb  2 , Raymond K Cross  2 , Kirti Shetty  2 , Sasan Sakiani  2 , Uni Wong  3
Affiliations

Nonalcoholic Fatty Liver Disease Is Common in IBD Patients However Progression to Hepatic Fibrosis by Noninvasive Markers Is Rare

Gabrielle Ritaccio et al. Dig Dis Sci. 2021 Sep.

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: Crohn’s disease; Inflammatory bowel disease; NAFLD fibrosis score; Nonalcoholic fatty liver disease; Ulcerative colitis.

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Conflict of interest statement

Conflict of interest The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
NAFLD inclusion criteria for IBD population. Nonalcoholic fatty liver disease (NAFLD), inflammatory bowel disease (IBD), hepatitis c virus (HCV), hepatitis b virus (HBV), human immunodeficiency virus (HIV), alcohol (EtOH), methotrexate (MTX), primary sclerosing cholangitis (PSC)
Fig. 2
Fig. 2
NFS change at 5 years: 56 patients had sufficient laboratory data to calculate NFS initially and at 5-year follow-up. The majority of IBD patients had stable NAFLD by NFS
Fig. 3
Fig. 3
NFS change at 5 years by medication exposure: of the 56 patients with sufficient laboratory data to calculate NFS initially and at 5-year follow-up, ever-exposure to biologic therapy, methotrexate therapy, and thiopurine therapy was identified. There was no apparent effect on NFS according to medication exposure
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