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P152 Fatty liver disease in IBD patients as a part of extraintestinal manifestations

A. Atanassova*1, A. Georgieva2

1Medical University Varna, Clinic of Hepatogastroenterology, St. Marina University Hospital, Varna, Bulgaria, 2Medical University Varna, Clinic of Hepatogastroenterology, St. Marina University Hospital, Vаrna, Bulgaria

Background

Inflammatory bowel diseases (IBD) are frequently associated with pathologic findings in the liver and biliary tract, ranging from minor alterations, such as liver fatty changes, to severe conditions, like primary sclerosing cholangitis.1 Fatty liver disease (FLD) is the most common liver complication of IBD and is often reversible, affecting people with ulcerative colitis (UC) and Crohn’s disease (CD).

Methods

The aim of the study was to investigate the incidence of hepatic steatosis as a part of the extraintestinal manifestations (EIMs) in IBD patients and the related biochemical laboratory abnormalities. A total of 480 patients was studied, 160 with UC, and 160 with CD and the results were compared with those of a control group of 160 patients with irritable bowel syndrome (IBS). An abdominal ultrasound (AUS) was performed on all of them as a non-invasive method of assessing the presence and the degree of liver steatosis, in combination with the liver function tests (LFTs), lipid and glycaemic profile blood tests.

Results

Of all the studied IBD patients, hepatic steatosis based on AUS criteria was discovered in 59.4% with CD and in 51.9% with UC. In the control group steatosis was found in 38.8% of cases (р = 0.001). In both groups of patients predominant are those with mild steatosis: IBD group (33.43%) and IBS group (17.50%). 15.62% of IBD patients have moderate steatosis, only 5% have severe steatosis, unlike the IBS group, where 9.37% have severe steatosis. According to the severity of the disease (CDAI), we found that in patients with CD, steatosis prevailed in those with moderate disease activity (46.30%), while in patients with UC in those with severe activity (43.40%), as measured by the Mayo Scoring System. Over three-fourth (77.70%) of IBD patients with steatosis have other concomitant EIMs (р < 0.001), in CD (57.20%), and in UC (42.80%). Steatosis is frequent in the inflammatory-type behaviour of CD (51.60%) and ileocolonic localisation of CD (41.10%), and prevalent in the chronic recurrent form of UC (77.10%) and in those with pancolitis (51.80%). In patients with CD less than one-fourth (22.30%) of those with steatosis have perianal disease. There was no significant difference in steatosis grade and association between FLD and IBD behaviour and extent. In our study, we found that in IBD patients with hepatic steatosis, the presence of elevated liver enzymes, lipid and glycaemic status disorders was significantly more frequent than in the control group.

Conclusion

The incidence of hepatic steatosis is higher amongst IBD patients. We need further studies to determine the influence that the evolution of IBD has over the hepatic steatosis.