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Mo1559 The Impact of Nonalcoholic Fatty Liver Disease on Prevalence of Colorectal Adenomas and Advanced Adenomas in Thai Patients With Average Risk for Colorectal Cancer Screening
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Table 2 Factors associated with colorectal adenoma and/or advanced adenoma detection
Incidence of Non-Alcoholic Fatty Liver Disease in Patients With Biopsy-Proven Celiac Disease Apeksha Shah, She-Yan Wong, Raymond Janowski, Stephanie M. Moleski, Dina Halegoua-De Marzio
Mo1559 The Impact of Nonalcoholic Fatty Liver Disease on Prevalence of Colorectal Adenomas and Advanced Adenomas in Thai Patients With Average Risk for Colorectal Cancer Screening Panida Piyachaturawat, Kessarin Thanapirom, Satimai Aniwan, Rungsun Rerknimitr, Pinit Kullavanijaya, Chaninya Patanasakpinyo, Ackrapong Chudhakorn, Thawee Ratanachu-ek, Sombat Treeprasertsuk Background: A relationship of metabolic syndrome to the risk of colorectal adenomatous polyps has been implicated in several existing studies. The prevalence of adenomas and advanced adenomas, in the NAFLD subjected were varied from 14%-34% and 4%-18%, respectively. However, these data are controversial and may be effected by age, sex and the diagnostic methods of fatty liver. We aimed to evaluate the prevalence of colorectal lesions in Thai patients with and without NAFLD using Transient Elastography (TE) with Controlled Attenuation Parameter (CAP) or TE-CAP. Methods: We prospectively enrolled asymptomatic 289 participants which had average risk for colorectal cancer screening aged 50-75 years who underwent screening colonoscopy from the community and a tertiary-care academic medical center during 2014-2015. All participants' stool were tested for the fecal immunochemical test (FIT) and liver fat content was measured by TE-CAP (S0<215, S1-2=215-296, S3>296 dB/m). Results: The total of 289 participants were included with mean age of 57.9 + 9.9 years and 8.6% of family history of colorectal cancer. We divided the 289 participants into 3 groups; the healthy control group (S0 = 128, 44.3%), the mild to moderate fatty liver group (S1-2 = 125, 43.2%) and the severe fatty liver group (S3 = 36, 12.5%). The overall prevalence of colonic adenoma and advanced adenoma detection rate were 19.4% and 15.6%, respectively whereas the prevalence of subjects with fatty liver (TE-CAP> 215 dB/m) was 161/289 = 55.7%. Baseline characteristics were not different between subjects with and without adenoma (101, 34.9% vs 188, 65%) except more proportion of male gender (51.5% vs 32.4%, p=0.002), more frequent history of smoking (25.7% vs 13.3%, p=0.008), more frequent diabetes (21.8% vs 11.7%, p=0.023) and older age (59.6+9.8 vs 57.0+9.9, p=0.035) in those with adenoma group. In adenoma and non-adenoma group had similar prevalence of NAFLD which were 54.5% and 56.4%, respectively. Among 3 groups of NAFLD patients classified by the degree of liver steatosis (S0-S3), the prevalence of adenoma and advanced adenoma were not significantly different (table 1). By using multivariate logistic regression analysis, the independent risk factors for adenoma detection were the male gender (OR 2.13), ever smoker (OR 2.39) and diabetes (OR 2.23) (table2). Conclusion: All participants, which had average risk for colorectal cancer screening, the presence of NAFLD and degree of steatosis were not the risk factors for adenoma detection. In addition, the independent risk factors for adenoma detection were the older age, male gender and diabetes. Table 1 The prevalence of adenoma and advanced adenoma in 289 Subjects classified by the degree of liver steatosis
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The Heart Age Is Increased in Patients With Nonalcoholic Fatty Liver Disease and Correlates With Fibrosis and Hepatocyte Ballooning Neal A. Mehta, Sajan Jiv Singh Nagpal, Rocio Lopez, Naim Alkhouri Background: Cardiovascular disease (CVD) is the leading cause of death in patients with nonalcoholic fatty liver disease (NAFLD). Recent evidence suggests that the histologic severity of NAFLD may correlate not only with liver-related outcomes but with overall mortality including that from CVD. In 2015, the Center for Disease Control (CDC) developed a Heart Age Calculator using data from the Framingham Heart Study. The aim of this study was to estimate the Heart Age in patients with biopsy-proven NAFLD and assess its correlation to the individual histologic features of NAFLD. Methods: The study included consecutive patients aged 30-74 with biopsy-proven NAFLD. Liver biopsies were evaluated by an experienced pathologist and the individual histologic features were scored using the Nonalcoholic Steatohepatitis Clinical Research Network criteria. The stage of fibrosis was categorized based on a 0 to 4 scale. The Heart Age was calculated using the CDC online calculator. A paired t-test was used to evaluate differences between actual and heart age. Spearman correlations coefficients (rho) were used to assess correlation between heart age and disease severity. S AS (version 9.4, The SAS Institute, Cary, NC) was used for all analyses and a p < 0.05 was considered statistically significant. Results: 170 patients were included, mean BMI of 32.8 +/- 4.9 kg/m2, 51% male, 91% Caucasian, and 39% with type 2 diabetes. The mean actual age was 51.6 +/- 10.2 years compared to a calculated Heart Age of 67.6 +/- 17.1 years indicating a significant increase in Heart Age in this population with a mean difference (95% CI) of 16.0 (14.4, 17.9) years, p value < 0.001 (Figure) . Furthermore, there was a significant, although weak, correlation between the Heart age and the stage of liver fibrosis rho (95% CI) of 0.3 (0.16, 0.45), p value of <0.001and the grade of hepatocyte ballooning [0.2 (0.05, 0.35), p =0.009]. There was no correlation between Heart Age and the grade of steatosis, lobular inflammation or the overall NAFLD activity score. Conclusion: Adults with NAFLD have a significant increase in Heart Age indicating an increase in overall cardiovascular risk. Liver fibrosis and ballooning should be investigated further as independent cardiovascular risk factors in this population.
Figure. Difference between Heart Age and Actual Age
Mo1561 High Prevalence of Functional Dyspepsia According to Rome III Criteria in Patients With Non-Alcoholic Fat Liver Disease Erika C. Lima, Silvia M. Ferolla, Geyza N. Armiliato, Quelson C. Lisboa, Tabata L. Souza, Ana Luiza M. Bicalho, Lucas I. Pereira, Ana Luiza A. Silva, Vitor Arantes, Maria C. Passos, Claudia A. Couto Background and aims: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. Individuals with NAFLD can present multiple associated symptoms related to the gastrointestinal tract. We undertook this study with the aims of evaluate the prevalence of functional dyspepsia and metabolic features in NAFLD patients comparing to control subjects. Patients and methods: A cross-sectional study included 100 adult patients with NAFLD (group 1) and 107 subjects without known liver disease (group 2). NAFLD was diagnosed according AGA criteria and all participants were questioned and scored for gastrointestinal (GI) symptoms according to Rome III criteria. NAFLD score, upper endoscopy and glucose hydrogen breath test were performed in all NAFLD patients. Patients with peptic ulcer or erosive duodenitis were excluded. Metabolic syndrome (MS) was defined using NCEP (ATP III). Results: Mean age and gender of groups 1 and 2 were not different: 55.9±12.7 yrs. vs. 55.2 ±12.8 yrs. and 19% vs. 22% were males, respectively.
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Mo1560
AASLD Abstracts
AASLD Abstracts
Background: Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten. Non-alcoholic fatty liver disease (NAFLD) is becoming an increasingly common cause of chronic liver disease, and thought in part to be due to metabolic syndrome. Recent studies have shown that there may be a link between the two disease entities. Whereas previous studies have investigated patients with evidence of fatty liver disease and found that 2.2% of these patients had celiac disease, we aimed to determine the prevalence of NAFLD in patients with biopsy-proven celiac disease in the United States. Methods: A retrospective cohort study was conducted of patients at a tertiary care center with biopsy proven CD. The electronic medical record was reviewed to collect the following data: age, sex, race/ethnicity, basic metabolic index, Marsh score based on pathology review of duodenal biopsy, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, alkaline phosphatase, total cholesterol, low-density lipoprotein, high-density lipoprotein; abdominal ultrasound, computed tomography, or magnetic resonance imaging; liver biopsy. Results: A total of 140 patients were found to have evidence of CD based on pathology. Of these, 43 (30%) were male. The average BMI was 26.22 with 45 patients (32%) overweight or obese, 48 (34%) had dyslipidemia and 8 (5.7%) had diabetes mellitus. Marsh score was assigned with 39 (27.8%) being Marsh 1, 6 (4%) as Marsh 2, 43 (30.7%) as Marsh 3a, 30 (21.4%) as Marsh 3b, and 20 (14%) as Marsh 3c. In total, 11 (7.8%) had hyperbilirubinemia (total bilirubin > 0.9 mg/dL), 17 (12.1%) had an elevated AST (AST > 30 IU/L), 29 (20.7%) had an elevated ALT (ALT > 30 IU/dL), 11 (7.8%) had an elevated alkaline phosphatase (alkaline phosphatase > 120 IU/L). Of the 37 (26.4%) patients with abnormal liver test as defined by the parameters stated above, 32 (86.4%) had abdominal imaging performed. Of those with imaging done, 7 (21%) had evidence of NAFLD and 3(9%) had evidence of cirrhosis. In addition, 3 (8%) of those patients with abnormal LFTs had liver biopsies performed, with 2 (5.4%) showing fatty liver and 1 (2.7%) showing cirrhosis. Conclusions: Although there has been a correlation between CD and elevated transaminases, a clear link to NAFLD has not been noted previously. Our study confirms the high prevalence of elevated liver tests in CD patients of which a large percentage was attributable to NAFLD. NAFLD is a potentially serious cause of liver injury and CD population may be at increased risk. Further study is needed with increased evaluation for NAFLD in patient with CD who present with abnormal liver tests.
Table 2 Factors associated with colorectal adenoma and/or advanced adenoma detection
Incidence of Non-Alcoholic Fatty Liver Disease in Patients With Biopsy-Proven Celiac Disease Apeksha Shah, She-Yan Wong, Raymond Janowski, Stephanie M. Moleski, Dina Halegoua-De Marzio
Mo1559 The Impact of Nonalcoholic Fatty Liver Disease on Prevalence of Colorectal Adenomas and Advanced Adenomas in Thai Patients With Average Risk for Colorectal Cancer Screening Panida Piyachaturawat, Kessarin Thanapirom, Satimai Aniwan, Rungsun Rerknimitr, Pinit Kullavanijaya, Chaninya Patanasakpinyo, Ackrapong Chudhakorn, Thawee Ratanachu-ek, Sombat Treeprasertsuk Background: A relationship of metabolic syndrome to the risk of colorectal adenomatous polyps has been implicated in several existing studies. The prevalence of adenomas and advanced adenomas, in the NAFLD subjected were varied from 14%-34% and 4%-18%, respectively. However, these data are controversial and may be effected by age, sex and the diagnostic methods of fatty liver. We aimed to evaluate the prevalence of colorectal lesions in Thai patients with and without NAFLD using Transient Elastography (TE) with Controlled Attenuation Parameter (CAP) or TE-CAP. Methods: We prospectively enrolled asymptomatic 289 participants which had average risk for colorectal cancer screening aged 50-75 years who underwent screening colonoscopy from the community and a tertiary-care academic medical center during 2014-2015. All participants' stool were tested for the fecal immunochemical test (FIT) and liver fat content was measured by TE-CAP (S0<215, S1-2=215-296, S3>296 dB/m). Results: The total of 289 participants were included with mean age of 57.9 + 9.9 years and 8.6% of family history of colorectal cancer. We divided the 289 participants into 3 groups; the healthy control group (S0 = 128, 44.3%), the mild to moderate fatty liver group (S1-2 = 125, 43.2%) and the severe fatty liver group (S3 = 36, 12.5%). The overall prevalence of colonic adenoma and advanced adenoma detection rate were 19.4% and 15.6%, respectively whereas the prevalence of subjects with fatty liver (TE-CAP> 215 dB/m) was 161/289 = 55.7%. Baseline characteristics were not different between subjects with and without adenoma (101, 34.9% vs 188, 65%) except more proportion of male gender (51.5% vs 32.4%, p=0.002), more frequent history of smoking (25.7% vs 13.3%, p=0.008), more frequent diabetes (21.8% vs 11.7%, p=0.023) and older age (59.6+9.8 vs 57.0+9.9, p=0.035) in those with adenoma group. In adenoma and non-adenoma group had similar prevalence of NAFLD which were 54.5% and 56.4%, respectively. Among 3 groups of NAFLD patients classified by the degree of liver steatosis (S0-S3), the prevalence of adenoma and advanced adenoma were not significantly different (table 1). By using multivariate logistic regression analysis, the independent risk factors for adenoma detection were the male gender (OR 2.13), ever smoker (OR 2.39) and diabetes (OR 2.23) (table2). Conclusion: All participants, which had average risk for colorectal cancer screening, the presence of NAFLD and degree of steatosis were not the risk factors for adenoma detection. In addition, the independent risk factors for adenoma detection were the older age, male gender and diabetes. Table 1 The prevalence of adenoma and advanced adenoma in 289 Subjects classified by the degree of liver steatosis
Page 1145
The Heart Age Is Increased in Patients With Nonalcoholic Fatty Liver Disease and Correlates With Fibrosis and Hepatocyte Ballooning Neal A. Mehta, Sajan Jiv Singh Nagpal, Rocio Lopez, Naim Alkhouri Background: Cardiovascular disease (CVD) is the leading cause of death in patients with nonalcoholic fatty liver disease (NAFLD). Recent evidence suggests that the histologic severity of NAFLD may correlate not only with liver-related outcomes but with overall mortality including that from CVD. In 2015, the Center for Disease Control (CDC) developed a Heart Age Calculator using data from the Framingham Heart Study. The aim of this study was to estimate the Heart Age in patients with biopsy-proven NAFLD and assess its correlation to the individual histologic features of NAFLD. Methods: The study included consecutive patients aged 30-74 with biopsy-proven NAFLD. Liver biopsies were evaluated by an experienced pathologist and the individual histologic features were scored using the Nonalcoholic Steatohepatitis Clinical Research Network criteria. The stage of fibrosis was categorized based on a 0 to 4 scale. The Heart Age was calculated using the CDC online calculator. A paired t-test was used to evaluate differences between actual and heart age. Spearman correlations coefficients (rho) were used to assess correlation between heart age and disease severity. S AS (version 9.4, The SAS Institute, Cary, NC) was used for all analyses and a p < 0.05 was considered statistically significant. Results: 170 patients were included, mean BMI of 32.8 +/- 4.9 kg/m2, 51% male, 91% Caucasian, and 39% with type 2 diabetes. The mean actual age was 51.6 +/- 10.2 years compared to a calculated Heart Age of 67.6 +/- 17.1 years indicating a significant increase in Heart Age in this population with a mean difference (95% CI) of 16.0 (14.4, 17.9) years, p value < 0.001 (Figure) . Furthermore, there was a significant, although weak, correlation between the Heart age and the stage of liver fibrosis rho (95% CI) of 0.3 (0.16, 0.45), p value of <0.001and the grade of hepatocyte ballooning [0.2 (0.05, 0.35), p =0.009]. There was no correlation between Heart Age and the grade of steatosis, lobular inflammation or the overall NAFLD activity score. Conclusion: Adults with NAFLD have a significant increase in Heart Age indicating an increase in overall cardiovascular risk. Liver fibrosis and ballooning should be investigated further as independent cardiovascular risk factors in this population.
Figure. Difference between Heart Age and Actual Age
Mo1561 High Prevalence of Functional Dyspepsia According to Rome III Criteria in Patients With Non-Alcoholic Fat Liver Disease Erika C. Lima, Silvia M. Ferolla, Geyza N. Armiliato, Quelson C. Lisboa, Tabata L. Souza, Ana Luiza M. Bicalho, Lucas I. Pereira, Ana Luiza A. Silva, Vitor Arantes, Maria C. Passos, Claudia A. Couto Background and aims: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. Individuals with NAFLD can present multiple associated symptoms related to the gastrointestinal tract. We undertook this study with the aims of evaluate the prevalence of functional dyspepsia and metabolic features in NAFLD patients comparing to control subjects. Patients and methods: A cross-sectional study included 100 adult patients with NAFLD (group 1) and 107 subjects without known liver disease (group 2). NAFLD was diagnosed according AGA criteria and all participants were questioned and scored for gastrointestinal (GI) symptoms according to Rome III criteria. NAFLD score, upper endoscopy and glucose hydrogen breath test were performed in all NAFLD patients. Patients with peptic ulcer or erosive duodenitis were excluded. Metabolic syndrome (MS) was defined using NCEP (ATP III). Results: Mean age and gender of groups 1 and 2 were not different: 55.9±12.7 yrs. vs. 55.2 ±12.8 yrs. and 19% vs. 22% were males, respectively.
S-1145
X : 10052$CH02 03-28-16 22:36:37 PDFd : 10052B : o
Mo1560
AASLD Abstracts
AASLD Abstracts
Background: Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten. Non-alcoholic fatty liver disease (NAFLD) is becoming an increasingly common cause of chronic liver disease, and thought in part to be due to metabolic syndrome. Recent studies have shown that there may be a link between the two disease entities. Whereas previous studies have investigated patients with evidence of fatty liver disease and found that 2.2% of these patients had celiac disease, we aimed to determine the prevalence of NAFLD in patients with biopsy-proven celiac disease in the United States. Methods: A retrospective cohort study was conducted of patients at a tertiary care center with biopsy proven CD. The electronic medical record was reviewed to collect the following data: age, sex, race/ethnicity, basic metabolic index, Marsh score based on pathology review of duodenal biopsy, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, alkaline phosphatase, total cholesterol, low-density lipoprotein, high-density lipoprotein; abdominal ultrasound, computed tomography, or magnetic resonance imaging; liver biopsy. Results: A total of 140 patients were found to have evidence of CD based on pathology. Of these, 43 (30%) were male. The average BMI was 26.22 with 45 patients (32%) overweight or obese, 48 (34%) had dyslipidemia and 8 (5.7%) had diabetes mellitus. Marsh score was assigned with 39 (27.8%) being Marsh 1, 6 (4%) as Marsh 2, 43 (30.7%) as Marsh 3a, 30 (21.4%) as Marsh 3b, and 20 (14%) as Marsh 3c. In total, 11 (7.8%) had hyperbilirubinemia (total bilirubin > 0.9 mg/dL), 17 (12.1%) had an elevated AST (AST > 30 IU/L), 29 (20.7%) had an elevated ALT (ALT > 30 IU/dL), 11 (7.8%) had an elevated alkaline phosphatase (alkaline phosphatase > 120 IU/L). Of the 37 (26.4%) patients with abnormal liver test as defined by the parameters stated above, 32 (86.4%) had abdominal imaging performed. Of those with imaging done, 7 (21%) had evidence of NAFLD and 3(9%) had evidence of cirrhosis. In addition, 3 (8%) of those patients with abnormal LFTs had liver biopsies performed, with 2 (5.4%) showing fatty liver and 1 (2.7%) showing cirrhosis. Conclusions: Although there has been a correlation between CD and elevated transaminases, a clear link to NAFLD has not been noted previously. Our study confirms the high prevalence of elevated liver tests in CD patients of which a large percentage was attributable to NAFLD. NAFLD is a potentially serious cause of liver injury and CD population may be at increased risk. Further study is needed with increased evaluation for NAFLD in patient with CD who present with abnormal liver tests.