Abstract
Aim Nonalcoholic fatty liver disease (NAFLD) has been known as a risk for the presence of colon polyp and CRC development. This study was aimed to find out the clinical significance of colon polyps' pathology among NAFLD patients. Method A retrospective database study was done in patients who underwent elective colonoscopy within one-year period in a referral private hospital, Jakarta. Subjects were adult patients who also had documented abdominal ultrasound (US). The association between NAFLD and colonic polyp was analyzed using Chi-square test with odds ratio (OR) and its corresponding 95% confidence interval (CI). Results A total of 138 adult patients were enrolled; 68 (51.1%) were men. Patients' mean age was 56.8 ± 15.3 years old. Colon polyps were found in 49 (35.5%) cases; the most common histopathology was adenoma (42.9%). NAFLD was found in 68 (49.3%) of patients. Colon polyps were found to be more among patients with NAFLD than in those without NAFLD (44.1% vs. 27.1%; OR: 2.119; 95% CI: 1.040–4.318). Colon polyps were found in 30 (44.1%) NAFLD patients, where 18 (26.5%) patients had adenomatous polyp, and from this subset of patients with adenomatous polyp, 6 (8.8%) patients had mild dysplasia, 8 (11.8%) had moderate dysplasia, 1 (1.5%) had severe dysplasia, and 3 (4.4%) had adenocarcinoma. Conclusions NAFLD is associated with increased risk of any colon polyp, regardless of the histopathological type, compared with patients without NAFLD. This finding implies the necessity to perform screening colonoscopy in patients with NAFLD in the future.
Highlights
Colorectal cancer (CRC) is still one of the most common cancers in the Western and Asian countries
The general recommendation for CRC screening is still based on invasive diagnostic tests, such as colonoscopy, and noninvasive tests, such as Asia-Pacific colorectal screening score (APCS) and fecal immunochemical test (FIT) [1, 2]
Nonalcoholic fatty liver disease (NAFLD) compared with controls [4, 5]. e presence of NAFLD was found as an independent risk factor for colorectal adenomatous polyps in asymptomatic subjects who underwent routine colonoscopy [6, 7]
Summary
Colorectal cancer (CRC) is still one of the most common cancers in the Western and Asian countries. E presence of NAFLD was found as an independent risk factor for colorectal adenomatous polyps in asymptomatic subjects who underwent routine colonoscopy [6, 7]. A large prospective cross-sectional study in a referral private hospital in Indonesia showed that NAFLD is a common finding in unselected adult patients who underwent routine medical check-up. Notwithstanding, retrospective data analysis study of a large sample size in the same private hospital for colon polyps or cancer detection rate found almost similar important risk factors, that is, older age (≥50 years old) and male gender [11]. Erefore, considering the increased prevalence of NAFLD in younger age, possible genetic and environment differences, different CRC molecular pathways, and different conclusion of pathologist’s specimen evaluation, the author would like to highlight this issue based on the pathology finding of colon polyp in NAFLD patients
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