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Clinicopathological features and predictors of fibrosis in non-alcoholic fatty liver disease (NAFLD) patients in the south west of England
200
I
693
CLlNlCOPATHOLOGlCAL FIBROSIS (NAFLD)
K.S. Samsheer’, ‘Endoscopy D.G.H.,
FEATURES
IN NON ALCOHOLIC
AND PREDICTORS
FAlTY
OF
LIVER DISEASE
PATIENTS IN THE SOUTH WEST OF ENGLAND
D. Farrel12, S. Campbel13, N. Kochar’,
Unit, Torbay Dg.H.,
Torquay, UK; ‘Gastro
D.K. George’.
Torquay, UK; 2Patholgy Dep., Unit, Southern
General
Torbay
Hospital,
Glasgow, UK
Aims: To document the phenotypic and histological features of patients with NAFLD and to investigate features predictive of fibrosis. Methods: Patients with NAFLD were identified retrospectively from the hospital histology database and identified prospectively from 2000. Patients were excluded if they drank >21 units (men) or 14 units (women) of alcohol. Liver biopsies were scored by a single pathologist (DF) according to the method described by Brunt. Results: 82 patients with biopsy proven NAFLD were identified (5.5 men and 27 women). Mean (range) age was 50.8 (19-74) years and mean (range) BMI was 31.4 (22.43).12/82 patients were diabetic and 23/82 were hypertensive.41/82 patients had fibrosis including 16 patients with cirrhosis or near cirrhosis (Brunt stage 3 or 4).35/82 patients had AST and ALT less than twice normal including 16 patients with fibrosis. 5 patients had > 1 liver biopsy performed with 3 patients showing disease progression.1205 patients with AST > ALT were Brunt stage 2, 3 or 4. Female gender, increasing age and AST were significantly associated with fibrosis (p
I
694
CLINICAL
AND DEMOGRAPHIC
CHARACTERISTICS
PATIENTS WITH NON-ALCOHOLIC A MULTICENTER
OF
hypercholesterolemia and 239 (58.4%) had hypertrigliseridemia. These results were given for male and females in table 1. Diabetes was more frequently observed in western Turkey (24.2%) compared to central (18.4%) and eastern (16%) part of Turkey. Obesity was more common in patients from central region (39%). Conclusions: NASH in Turkey is more frequent in males. Male patients are one decade younger than females, and are predominantly non-obese and non-diabetic patients in contrast to NASH patients from western countries. In females, age, frequencies of obesity, diabetes and hyperlipidemia are similar to the patients of western countries.
I 695
PREDICTIVE
2Hepatology, Ankara,
Turkey; ‘Internal
Gulhane
Military School, Ankara,
Gazi University, Ankara,
Turkey
STEATOHEPATITIS:
Ege University, 9 Eylul
Turkey; ‘Gastroenterology,
Cerrahpasa
Medical School,
University, Istanbul University Medical School, Istanbul, Dicle University, D.Bakis
‘Gastroenterology,
Akdeniz
6Gastroenterology,
Cumhuriyet
7Gastroenterology,
Trakya University, Edirne,
Adana,
Medicine,
Ankara
High Speciality Hospital,
Fibrosis
Turkey; 2Gastroenterology,
University, Samsun,
Turkey; ‘Pathology,
STUDY
Turkey;
University, Antalya, Turkey;
University, Eskisehis
IN NON-ALCOHOLIC
Background and Aims: Non-alcoholic steatohepatitis progress to cirrhosis and hepatocellular carcinoma. In this study we investigate the clinical, biochemical and histological characteristics of NASH patients. Our aim was to determine the factors associated with severe fibrosis in these patients. Methods: 147 biopsy-proven NASH patients (mean age 44.6~t10.6, male/female: 95/52) were included. Biopsy specimens were assessed by a single pathologist. Fibrosis was graded as absent, mild/moderate and severe; steatosis was graded as: 1: 130%, 2: 30.60%, 3: >60%; inflammation was graded as mild, moderate and severe. Patients with body mass index (BMI) >30 were accepted as obese. Results: Results are given in the table below.
Type II Diabetes
Osmangazi
University, Ankara,
Turkey; 4Gastroenterology,
Turkey; 6Gastroenterology,
YIH, Ankara,
Turkey; 4Gastroenterology,
Ankara
University, Ankara,
-be
University, I&s
FOR FIBROSIS
M. Sarioglu’, 0. Uzunalimoglu2, E. Erden3, B. Cicek4, H. Cetinkaya’, K. Cinar’, R. Mas’, S. 0zenirler6, M. Bozdayi2, H. Bozkaya’, C. Yurdaydin I. ’Gastroenterology, Ankara University, Ankara, Turkey;
M. Sarioglu’, U. Akarca2, A. Sonsuz3, D. Duman3, E. Tankut2, H. Degertekin4, I. Suleymanlar’, C. Turkay6, A. Teze17, T. aricam’, A. Bektas’, H. Akkiz”, H. Bozkaya’, T. Sahin’, Y. Batur2, N. Tozun3, C. Yurdaydin I, 0. Uzunalimoglu I. ’Gastroenterology, Ankara University,
Marmara
FACTORS
STEATOHEPATITIS
University, Sivas, Turkey; Turkey; ‘Gastroenterology,
Turkey; ‘Gastroenterology,
Turkey; “Gastroenterology,
Cukurova
19 Mayis
Absence
Background and Aims: Risk factors and demographic characteristics of non-alcoholic-steatohepatitis (NASH) vary in different ethnic groups and in different geographical areas. In this study we aimed to investigate the clinical/demographic characteristics of NASH and geographical differences of these findings in Turkey. Methods: 411 NASH patients with elevated ALT (>Nx1.5) for at least 6 months and with ultrasonographic findings of fatty liver from 15 centers representing all geographical areas in Turkey were included. Viral and autoimmune serologies were negative and alcohol consumption was less than 20 g/day in all patients. None had any evidence of metabolic liver disease. The diagnosis was confirmed by liver biopsy in 321 (78%) patients. Turkey was artificially divided into 3 regions as western, central and eastern Turkey. Results: Mean age of 411 patients was 44.15~t18.85. 258 of 411 (63%) patients were male, remaining 153 (37%) were female. 81 (19.7%) patients had diabetes mellitus, 116 (31%) was obese (BMI > 30), 228 (56%) had
45.4&11.6
Mild-moderate
(n=66)
43.6&9.X
Severe (1~16)
p value
44.X&9.4
NS
Female
33.8%
(22/65)
30.3%
(20/66)
62.5%
Obesity
43.1%
izmxj
42.9%
i24/56j
42.9%
(604)
NS
(5165)
18.2% (u/66)
43.8%
(706)
p
7.7%
(10166) p
Hypercholesterolemia
56.9%
(37165)
50.8%
(33/65)
56.3%
(906)
NS
Hyperhiglyceridemia
52.3%
(34/65)
52.3%
(34/65)
56.3%
(906)
NS
ALT
x1.5*51.5
78.9&44.7
X6&42.7
AST
48.8&24.X
56.3&44.6
60&21
ASTIALT
0.71&0.36
0.x5*1.13
0.X5&1.13
NS
GGT
64.2&63.6
60.6&63.4
41.6&l&3
NS
ALP
161.2&73.7
141.3*74.1
177.5&81.X
NS
NS pzo.05
Steatosis
University,
Turkey
(n=65)
24.6%
(16/65)
18.2% (u/66)
35.4%
(23/65)
24.2%
(16/66)
57.6%
(38/66)
62.5%
(10116)
40% (26/65)
37.5%
(606) p=O.OX
Inflammation Mild
84.6%
(55/65)
68.2%
(45/66)
43.8%
(706)
Moderate
15.4% (10165)
30.3%
(20/66)
31.3%
(506)
1.5% (1166)
25% (406)
p
Female sex, presence of diabetes mellitus, AST elevation, severe steatosis and inflammation were more frequently observed in patients with severe fibrosis. Fibrosis score correlated with AST levels (r=O. 175, p
I
693
CLlNlCOPATHOLOGlCAL FIBROSIS (NAFLD)
K.S. Samsheer’, ‘Endoscopy D.G.H.,
FEATURES
IN NON ALCOHOLIC
AND PREDICTORS
FAlTY
OF
LIVER DISEASE
PATIENTS IN THE SOUTH WEST OF ENGLAND
D. Farrel12, S. Campbel13, N. Kochar’,
Unit, Torbay Dg.H.,
Torquay, UK; ‘Gastro
D.K. George’.
Torquay, UK; 2Patholgy Dep., Unit, Southern
General
Torbay
Hospital,
Glasgow, UK
Aims: To document the phenotypic and histological features of patients with NAFLD and to investigate features predictive of fibrosis. Methods: Patients with NAFLD were identified retrospectively from the hospital histology database and identified prospectively from 2000. Patients were excluded if they drank >21 units (men) or 14 units (women) of alcohol. Liver biopsies were scored by a single pathologist (DF) according to the method described by Brunt. Results: 82 patients with biopsy proven NAFLD were identified (5.5 men and 27 women). Mean (range) age was 50.8 (19-74) years and mean (range) BMI was 31.4 (22.43).12/82 patients were diabetic and 23/82 were hypertensive.41/82 patients had fibrosis including 16 patients with cirrhosis or near cirrhosis (Brunt stage 3 or 4).35/82 patients had AST and ALT less than twice normal including 16 patients with fibrosis. 5 patients had > 1 liver biopsy performed with 3 patients showing disease progression.1205 patients with AST > ALT were Brunt stage 2, 3 or 4. Female gender, increasing age and AST were significantly associated with fibrosis (p
I
694
CLINICAL
AND DEMOGRAPHIC
CHARACTERISTICS
PATIENTS WITH NON-ALCOHOLIC A MULTICENTER
OF
hypercholesterolemia and 239 (58.4%) had hypertrigliseridemia. These results were given for male and females in table 1. Diabetes was more frequently observed in western Turkey (24.2%) compared to central (18.4%) and eastern (16%) part of Turkey. Obesity was more common in patients from central region (39%). Conclusions: NASH in Turkey is more frequent in males. Male patients are one decade younger than females, and are predominantly non-obese and non-diabetic patients in contrast to NASH patients from western countries. In females, age, frequencies of obesity, diabetes and hyperlipidemia are similar to the patients of western countries.
I 695
PREDICTIVE
2Hepatology, Ankara,
Turkey; ‘Internal
Gulhane
Military School, Ankara,
Gazi University, Ankara,
Turkey
STEATOHEPATITIS:
Ege University, 9 Eylul
Turkey; ‘Gastroenterology,
Cerrahpasa
Medical School,
University, Istanbul University Medical School, Istanbul, Dicle University, D.Bakis
‘Gastroenterology,
Akdeniz
6Gastroenterology,
Cumhuriyet
7Gastroenterology,
Trakya University, Edirne,
Adana,
Medicine,
Ankara
High Speciality Hospital,
Fibrosis
Turkey; 2Gastroenterology,
University, Samsun,
Turkey; ‘Pathology,
STUDY
Turkey;
University, Antalya, Turkey;
University, Eskisehis
IN NON-ALCOHOLIC
Background and Aims: Non-alcoholic steatohepatitis progress to cirrhosis and hepatocellular carcinoma. In this study we investigate the clinical, biochemical and histological characteristics of NASH patients. Our aim was to determine the factors associated with severe fibrosis in these patients. Methods: 147 biopsy-proven NASH patients (mean age 44.6~t10.6, male/female: 95/52) were included. Biopsy specimens were assessed by a single pathologist. Fibrosis was graded as absent, mild/moderate and severe; steatosis was graded as: 1: 130%, 2: 30.60%, 3: >60%; inflammation was graded as mild, moderate and severe. Patients with body mass index (BMI) >30 were accepted as obese. Results: Results are given in the table below.
Type II Diabetes
Osmangazi
University, Ankara,
Turkey; 4Gastroenterology,
Turkey; 6Gastroenterology,
YIH, Ankara,
Turkey; 4Gastroenterology,
Ankara
University, Ankara,
-be
University, I&s
FOR FIBROSIS
M. Sarioglu’, 0. Uzunalimoglu2, E. Erden3, B. Cicek4, H. Cetinkaya’, K. Cinar’, R. Mas’, S. 0zenirler6, M. Bozdayi2, H. Bozkaya’, C. Yurdaydin I. ’Gastroenterology, Ankara University, Ankara, Turkey;
M. Sarioglu’, U. Akarca2, A. Sonsuz3, D. Duman3, E. Tankut2, H. Degertekin4, I. Suleymanlar’, C. Turkay6, A. Teze17, T. aricam’, A. Bektas’, H. Akkiz”, H. Bozkaya’, T. Sahin’, Y. Batur2, N. Tozun3, C. Yurdaydin I, 0. Uzunalimoglu I. ’Gastroenterology, Ankara University,
Marmara
FACTORS
STEATOHEPATITIS
University, Sivas, Turkey; Turkey; ‘Gastroenterology,
Turkey; ‘Gastroenterology,
Turkey; “Gastroenterology,
Cukurova
19 Mayis
Absence
Background and Aims: Risk factors and demographic characteristics of non-alcoholic-steatohepatitis (NASH) vary in different ethnic groups and in different geographical areas. In this study we aimed to investigate the clinical/demographic characteristics of NASH and geographical differences of these findings in Turkey. Methods: 411 NASH patients with elevated ALT (>Nx1.5) for at least 6 months and with ultrasonographic findings of fatty liver from 15 centers representing all geographical areas in Turkey were included. Viral and autoimmune serologies were negative and alcohol consumption was less than 20 g/day in all patients. None had any evidence of metabolic liver disease. The diagnosis was confirmed by liver biopsy in 321 (78%) patients. Turkey was artificially divided into 3 regions as western, central and eastern Turkey. Results: Mean age of 411 patients was 44.15~t18.85. 258 of 411 (63%) patients were male, remaining 153 (37%) were female. 81 (19.7%) patients had diabetes mellitus, 116 (31%) was obese (BMI > 30), 228 (56%) had
45.4&11.6
Mild-moderate
(n=66)
43.6&9.X
Severe (1~16)
p value
44.X&9.4
NS
Female
33.8%
(22/65)
30.3%
(20/66)
62.5%
Obesity
43.1%
izmxj
42.9%
i24/56j
42.9%
(604)
NS
(5165)
18.2% (u/66)
43.8%
(706)
p
7.7%
(10166) p
Hypercholesterolemia
56.9%
(37165)
50.8%
(33/65)
56.3%
(906)
NS
Hyperhiglyceridemia
52.3%
(34/65)
52.3%
(34/65)
56.3%
(906)
NS
ALT
x1.5*51.5
78.9&44.7
X6&42.7
AST
48.8&24.X
56.3&44.6
60&21
ASTIALT
0.71&0.36
0.x5*1.13
0.X5&1.13
NS
GGT
64.2&63.6
60.6&63.4
41.6&l&3
NS
ALP
161.2&73.7
141.3*74.1
177.5&81.X
NS
NS pzo.05
Steatosis
University,
Turkey
(n=65)
24.6%
(16/65)
18.2% (u/66)
35.4%
(23/65)
24.2%
(16/66)
57.6%
(38/66)
62.5%
(10116)
40% (26/65)
37.5%
(606) p=O.OX
Inflammation Mild
84.6%
(55/65)
68.2%
(45/66)
43.8%
(706)
Moderate
15.4% (10165)
30.3%
(20/66)
31.3%
(506)
1.5% (1166)
25% (406)
p
Female sex, presence of diabetes mellitus, AST elevation, severe steatosis and inflammation were more frequently observed in patients with severe fibrosis. Fibrosis score correlated with AST levels (r=O. 175, p