Prevalence of Non-Alcoholic Steatohepatitis (NASH) in Individuals With Crohnʼs Disease: A Population-Based National Study

Abstract

Introduction: Previous studies have suggested a possible association between Crohn's Disease (CD) and non-alcoholic steatohepatitis (NASH). However, this link is controversial since most of these studies have been limited by small sample sizes. We sought to examine the association between Crohn's disease and NASH using a large population based database. Methods: We queried a commercial database (Explorys Inc., Cleveland, OH), an aggregate of Electronic Health Record (EHR) data from 26 major integrated healthcare systems in the US from 1999 to June 2018. We identified an aggregated patient cohort of eligible patients with diagnoses of Crohn's Disease and NASH based on Systemized Nomenclature of Medical terminology (SNOMED-CT) codes, excluding patients with autoimmune liver disease, viral liver disease, and alcoholic liver disease. We calculated the prevalence of NASH in patients with and without Crohn's disease and performed univariate analyses to assess the prevalence of conditions co-morbid to both Crohn's disease and NASH. Results: A total of 34,605,400 individuals were included in the study period between June, 2013 and June, 2018. Of these, 153,810 (0.44%) had a diagnosis of Crohn's disease and 27,170 (0.08%) had a diagnosis of NASH. Of the individuals with Crohn's disease, 520 also had a diagnosis of NASH (0.34%) [Odds Ratio (OR): 5.4 (p< 0.0001)]. Compared to individuals with Crohn's disease and without NASH, individuals with Crohn's disease and NASH had higher prevalence of HTN, 71% vs 43% (OR 3.2, p<0.0001), HLD 65% vs 33% (OR 3.9, p<0.0001), metabolic disease 90% vs 58% (OR 6.8, p<0.0001), diabetes 52% vs 21% (OR 4.0, p<0.0001), obesity 60% vs 20% (OR 5.8, p<0.0001), and morbid obesity 29% vs 5.9% (OR 6.5; p< 0.0001). Crohn's patients with NASH had increased prevalence of azathioprine use at 15% compared to 8.8% (OR 1.9; p< 0.0001), and TNF-alpha inhibitors at 23% compared to 16% in subjects with Crohn's disease and without NASH (OR 1.6; p< 0.0001). Conclusion: In this large population-based study, the overall prevalence of NASH in Crohn's disease patients was 0.34% compared to 0.08% in the general population. Patients with Crohn's disease and NASH had higher rates of metabolic risk factors and higher rates of use of immunomodulators and anti-TNF-alpha agents.854_A Figure 1 No Caption available.854_B Figure 2 No Caption available.