Prevalence and characteristics of non-alcoholic steatohepatitis in patients with inflammatory bowel disease in the Novosibirsk region: a cross-sectional, one center study in 245 patients

Abstract

Rationale: Recently, the incidence of inflammatory bowel disease (IBD) and non-alcoholic steatohepatosis has increased in developed countries. Also, there are fundamental prerequisites to mutually negative influence of these diseases. Therefore, evaluation of the characteristics of non-alcoholic steatohepatosis in patients with IBD is of practical interest. Aim: To identify particulars of non-alcoholic steatohepatosis / steatohepatitis in IBD patients. Materials and methods: This cross-sectional study included 245 patients aged from 18 to 77 years from the IBD Registry the Novosibirsk State Medical University and the State Scientific-Research Institute of Physiology and Basic Medicine (Novosibirsk, Russian Federation). Within one year before the study entry, the patients were assessed by abdominal ultrasound and diagnosed with steatohepatosis. All patients were examined clinically with measurement of their antropometric parameters and underwent laboratory assessments, including hematology tests, alanine and aspartate transaminases, creatinine, triglycerides and total cholesterol measurements. Patients with viral and autoimmune hepatitis, alcoholic liver disease, primary sclerosing cholangitis, iron and copper metabolism disorders were excluded. In the colon biopsy samples of 45 patients, Epstein-Barr virus, cytomegalovirus, herpes simplex virus were identified by polymerase chain reaction. One hundred and fifty two (152) patients were also assessed for small intestine bacterial overgrowth (SIBO) syndrome. Results: The prevalence of steatosis in patients with Crohn's disease (CD) was 34.2%, and in those with ulcerative colitis (UC), 30.4%. IBD patients with steatohepatosis were more likely to have received steroids (63.6% vs. 53%, p = 0.0006), had greater IBD du-ration (median 5.9 years, Q1/Q3, 2.7/12.9 years vs. 4.5, 2.9/8.5 years; p = 0.0324) and a higher body mass index (median 24.1, Q1/Q3, 21.4/29.9 vs. 21, 18.6/23.5; p = 0.0336). UC patients with non-alcoholic steatosis / steatohepatitis were older (odds ratio [OR] for the age above 40 years, 1.46; 95% confidence interval [CI] 1.01-2.1). CD patients with steatohepatosis had higher platelet counts (median 287 x 109/L, Q1/Q3, 192 x 109/L / 420 x 109/L vs. 250 x 109/L, 180 x 109/L / 379 x 109/L; p = 0.0183). SIBO was a risk factor for the development of steatohepatosis in IBD patients (OR 2.34, 95% CI 1.4-4.8, p = 0.021). Conclusion: The study has identified the differences in the steatohepatosis-associated factors in UC and CD patients. There is a link between the presence of SIBO and the risk of steatohepatosis development in IBD patients.

Keywords

• inflammatory bowel disease
• crohn's disease
• ulcerative colitis
• steatohepatosis
• microflora