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Poster presentations: Clinical: Diagnosis and Outcome 2020

P175 Fatty liver disease as a complication of immune-mediated inflammatory diseases: prevalence and risk factors in inflammatory bowel disease

M.T. Arias Loste1, M.J. García García1, J.C. Rodriguez-Duque1, P. Iruzubieta1, C. Rivas1, M. Pascual1, B. Castro1, A. García2, L. Lopez-Montejo1, L. Rasines1, E. Garcia-Nieto2, M.L. Cagigal3, M. Rivero1, J. Crespo1

1Marqués de Valdecilla University Hospital., Gastroenterology, Santander- Cantabria, Spain, 2Investigation Institute Marques de Valdecilla- IDIVAL, Infection- Immunity and Digestive Diseases Group, Santander- Cantabria, Spain, 3Marqués de Valdecilla University Hospital, Pathology, Santander- Cantabria, Spain

Background

Previous publications made by our group showed an increased prevalence of fatty liver disease (NAFLD) in immune-mediated inflammatory diseases (IMIDs). However, the existing data on inflammatory bowel disease (IBD) are contradictory.

Hypothesis: the prevalence of NAFLD is increased in IBD independently of the presence of metabolic factors.

Methods

Cross-sectional case–control study. Cases: prospective cohort single-center IBD patients. Controls: random sample from general population (Ethon cohort) paired 1: 2 by age, sex, BMI and T2D diagnosis. The diagnosis of NAFLD has been established by transition elastography (TE) CAP and confirmed by liver biopsy.

Results

The study scheme is presented in the figure. The prevalence of NAFLD is higher in IBD vs. general population (p = 0.04) and is associated with age, BMI, sex and metabolic syndrome. More frequently, IBD patients with NAFLD presented with severe complications of IBD and to a lesser extent receive TNF therapy. There is a mean serum elevation of CRP, ESR and ferritin compared with IBD subjects without NAFLD. In multivariant analysis, IBD is an independent predictor of NAFLD (adjusted OR 1.31; p = 0.007). The NAFLD associated with IBD is less frequently associated with T2D than NAFLD in the general population, and has a higher proportion of subjects with advanced fibrosis (TE > 8.7 kPa: 45/350 [12.9%] vs. 23/669 [3.4%]; p < 0.0001) and mean value of TE is significantly higher (6.09 vs. 5.11 kPa; p < 0.0001). Non-invasive fibrosis scores have a high NPV in the diagnosis of advanced fibrosis in IBD (FIB4: 88%; APRI: 87%; NFS: 88%; HepametFS: 87 %)

Conclusion

The prevalence of NAFLD is higher in IBD patients, with IBD being an independent predictor of NAFLD. Patients with IBD and NAFLD have a higher systemic inflammatory burden and this results in an increased risk of advanced fibrosis associated with IBD comparatively with the control NAFLD population.