P783 Non-alcoholic fatty liver disease and advanced liver disease in patients with inflammatory bowel disease: prevalence and risk factors

Abstract

Abstract Background Increased occurrence of non-alcoholic fatty liver disease NAFLD is observed in patients with IBD. The aim of this study was to assess the prevalence and risk factors of NAFLD and associated advance liver fibrosis in patients with IBD Methods This is a retrospective study. Between January 2010 and August 2019, patients with Crohn’s disease/ulcerative colitis who admitted to our Gastroenterology Unit were included in the study. Hepatic steatosis was assessed by abdominal ultrasound. The diagnosis of advanced fibrosis was evaluated with non-invasive FIB 4 score and FIB-4>3.25 was considered an advanced liver disease. Patients with a history of excessive alcohol or recent steroid use, chronic viral hepatitis and other chronic liver diseases were excluded. Univariate and multivariate analysis were performed. Results Five hundred and thirty-nine, 52% male, mean age 44 ± 18 years, were enrolled. Among 539 IBD patients, 322 (59.7%) in ulcerative colitis patients vs. 217 (41.3%) in Crohn’s disease patients were diagnosed. The sonographic prevalence of NAFLD was 32% (172/539) and advanced liver disease was found in 12% (21/172) in IBD patients with NAFLD. Univariate analysis showed that >40 years old (p = 0.034), ≥25 Body Mass Index (BMI)(p < 0.001), presence of metabolic syndrome(p < 0.001) and type 2 diabetes(p < 0.001), ≥5 years of duration of disease (p < 0.001), biological agents and/or azothiopurine use in the past (p < 0.001), ≥126mg/dl fasting plasma glucose (p = 0.04), elevated alanine aminotransferase (ALT) (p < 0.001), ≥240mg/dl total cholesterol (p = 0.021), ≥150mg/dl triglyceride (p = 0.038) and hyperuricemia (p = 0.019) were risk factors for NAFLD in patients with IBD. According to the multivariate analysis presence of metabolic syndrome and type 2 diabetes, ≥5 years of duration of disease and elevated ALT were an independent predictive factor of NAFLD (respectively, p < 0.003, p = 0.002, p < 0.001, p < 0.001). Univariate analysis showed that >40 years old (p = 0.037), the presence of metabolic syndrome (p < 0.001), type 2 diabetes (p < 0.001) and Crohn’s disease (p = 0.012), history of surgery (p = 0.003), ≥5 years of duration of disease (p < 0.001), elevated ALT (p < 0.001) and <3 mg/dl albumin (p = 0.038) were risk factors for advanced liver disease in IBD patients with NAFLD. According to the multivariate analysis, the presence of type 2 diabetes and ≥5 years of duration of disease was an independent predictive factor of advanced liver disease in IBD patients with NAFLD (respectively, p < 0.001, p < 0.001). Conclusion NAFLD is a very common disease in patients with IBD. NAFLD is not rare cause of advanced liver disease in patients with IBD. Type 2 diabetes and ≥5 years of duration of disease were an independent predictive factor of advanced liver disease in IBD patients with NAFLD.