PREVALENCE OF NON ALCOHOLIC FATTY LIVER DISEASE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Dr. Vijant Singh Chandail* and Dr. Vinu Jamwal

ABSTRACT

Introduction: Ulcerative colitis and Crohn’s disease are immune mediated inflammatory bowel disease (IBD) which affects the gastrointestinal tract with several extraintestinal manifestations. Hepatic manifestations in IBD vary and range from benign disorders, such as fatty liver to end-stage hepatic failure. Non alcoholic fatty liver disease (NAFLD) is deemed to be hepatic manifestation of metabolic syndrome which is cluster of central obesity, hypertension, hypertriglyceridemia and low HDL. NAFLD is the most common chronic liver disease, characterized by the presence of steatosis in > 5% of the hepatocytes and whose prevalence is steeply increasing in parallel with obesity[1] NAFLD includes a wide spectrum of disorders, ranging from hepatic steatosis (NAFL) to non-alcoholic steatohepatitis (NASH). NAFLD patients are at high risk for liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC).[1,5] The prevalence of NAFLD in IBD patients is highly variable ranging from 1.5% to even 40%, in dependence of different diagnostic criteria.[6,8] Despite IBD is commonly considered a wasting disease characterized in some cases by malabsorption and severe weight loss, recent data indicate that the prevalence of NAFLD among IBD patients is increased as compared to the general population.[9] IBD patients develop NAFLD with fewer metabolic risk factors than general population.[6] Materials and methods. This retrospective analysis was conducted in IBD patients on regular follow up at the Gastroenterology division of the Department of Medicine w.e.f March 2018 to December 2019. The patients were evaluated with detailed clinical history, medical examination and blood investigations. Included were patients with age group of 18 -60 years with biopsy proven diagnosis of Idiopathic ulcerative colitis or Crohns disease. Exclusion criteria included patients with alcohol intake in excess of 20 grams per day, history of jejunoileal bypass surgery or extensive small bowel resection, type 2 diabetes mellitus, usage of drugs known to cause secondary steatosis like corticosteroids, methotrexate, and amiodarone. Results: A total of 236 patients were included in the study, out of which 45 were excluded as per the exclusion criteria and only 191 patients participated in the study design. Out of 191 patients, 158(83%) were identified as having idiopathic ulcerative colitis (IUC) and and 33(17%) had Crohns disease (CD). There was no significant difference in the IUC and CD patients when assessed separately, so both the groups were considered together. The prevalence of NAFLD was 55.5%(106/191) in our study group, with grade 1 hepatic steatosis in 61 out of 106 (57.5%), grade 2 steatosis in 27 out of 106 (25%), and grade 3 steatosis in 18 out of 106 patients (17.5%). Conclusion: Our study concludes that the prevalence of NAFLD in IBD is very high (55.5%) and regular follow up of the IBD patients for the development of NAFLD is the need of the hour, in order to prevent the further complications of NAFLD.

Keywords: Non-alcoholic fatty liver disease, inflammatory bowel disease, Ultrasonography.