Increased Prevalence of Colorectal Adenomas in Patients With Non-Alcoholic Fatty Liver Disease: A Cross-Sectional Study

Abstract

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disorder worldwide. Previous studies have suggested an association between colonic adenomas and NAFLD. In this study we aimed to determine whether patients with biopsy-proven NAFLD have an increased colorectal adenoma prevalence on screening and surveillance colonoscopies compared to matched controls. Methods: We identified 254 patients at Columbia University Medical Center who underwent liver biopsy with steatosis in 2006-2018 and had also undergone screening or surveillance colonoscopy during the same period. Patients with a history of alcoholic liver disease or viral hepatitis were excluded, as were patients with inadequate bowel preparation, leaving 168 patients with NAFLD as the study group. Each patient was matched with 2 controls by age, gender, and endoscopist. The adenoma prevalence was then determined for each group, and compared using conditional logistic regression. Results: The mean age at time of colonoscopy was 60.8 years in the NAFLD group and 60.5 years in the control group (p=0.72). 49.4% of patients were male. Screening colonoscopies made up 68.5% of the NAFLD group vs. 69.4% of the controls, with the remainder surveillance colonoscopies (p=0.84). The adenoma prevalence was 33.9% in the NAFLD group vs. 25.9% in the control group (OR 1.55, p=0.047). On multivariable analysis comparing the subset of NAFLD patients with moderate or high-grade steatosis vs. mild steatosis, controlling for age, gender, colonoscopy indication, and endoscopist, there was a trend towards higher adenoma prevalence in the high-grade steatosis group (OR 2.26, p=0.053). Conclusion: Patients with biopsy-proven NAFLD have a significantly higher adenoma prevalence on screening and surveillance colonoscopies compared to matched controls. Patients with more severe NAFLD were noted to have a higher ADR than those with mild disease, although this did not reach statistical significance. NAFLD should undergo further investigation as a potential risk factor for colorectal neoplasia.276_A Figure 1 No Caption available.276_B Figure 2 No Caption available.276_C Figure 3 No Caption available.