Crohn's Disease Is Associated with Liver Fibrosis in Patients with Nonalcoholic Fatty Liver Disease

Background Chronic inflammation in IBD is postulated to drive NAFLD progression from steatosis to fibrosis. Aims To study the histopathological spectrum of NAFLD in Crohn disease (CD) and Ulcerative colitis (UC). Methods Patients with biopsy proven NAFLD at a quaternary center from 2008 to 2018 were included in this retrospective analysis. Inflammatory bowel disease (IBD) diagnosed either clinically and/or endoscopically at the time of liver biopsy. Multivariable regression and propensity score (PS) weighted analysis were conducted. Statistical analysis were performed using SAS statistical software. Results Among 1009 patients with NAFLD a diagnosis of IBD was identified in 50 cases (34 CD and 16 UC). On multivariable analysis; CD was independently associated with significantly higher odds of advanced fibrosis (AF) on liver biopsy (adjusted OR = 4.09, 95% CI = 1.40-11.94) compared to NAFLD patients without IBD. Similar results were obtained with both the overlap PS weighted model (OR = 3.17, 95% CI = 1.55-6.49) and the PS matched model (OR = 3.49, 95% CI = 1.50-8.13). Conclusion In a large cohort of patients with histologically well characterized NAFLD, AF was more common in CD patients than NAFLD patients without IBD. These findings must be confirmed in a larger cohort, but suggest CD patients with NAFLD could be at greater risk for liver fibrosis.

Automated summary

This study aimed to investigate the histopathological spectrum of non-alcoholic fatty liver disease (NAFLD) in patients with Crohn's disease (CD) and ulcerative colitis (UC). The results showed that CD was independently associated with a higher risk of liver fibrosis. These findings suggest that CD patients with NAFLD may be at greater risk for liver fibrosis.