P320 Metabolic steatopathy and chronic intestinal inflammatory disease

Abstract

<h3>Introduction</h3> Metabolic fatty liver disease (MFLD) and non-alcoholic steatohepatitis (NASH) are the most common chronic liver diseases and constitute the hepatic manifestations of the metabolic syndrome. They are also the liver abnormalities most frequently associated with chronic inflammatory bowel disease (IBD). The aim of our work is to describe metabolic steatopathy in IBD and to study the outcome of these patients. <h3>Methods</h3> This was a single-center retrospective descriptive study including all patients treated for IBD, including 1154 patients with Crohn’s disease (CD) and 578 with hemorrhagic rectocolitis (UC). The diagnosis of metabolic steatopathy was based on abdomino-pelvic ultrasound and liver biopsy. It should be noted that all metabolic steatopathy were discovered with IBD, and in all patients other causes of metabolic steatopathy were excluded. <h3>Results</h3> Of the 1,732 IBD, 31 patients (1.8%) had metabolic steatopathy, including 28 patients followed for CD (1.6%), and 3 patients followed for UC (0.5%). Crohn’s disease was ileocolic in 12 cases, colonic in 9 cases, ileal in 6 cases and gelocolic in one case. It was luminal in 23 cases, stenosing in 3 cases and fistulising in 2 patients. UC was pancolic in 2 patients and left-sided in one. The mean age was 42.16 years, with extremes ranging from 13–60 years. The sex ratio F/M was 1.8. Functionally, all patients were asymptomatic. Metabolic syndrome was absent in all patients. Clinical examination of the liver revealed a normal liver in 96.7% and hepatomegaly in 3.3%. Abdominal and pelvic ultrasound showed steatosis in 41.9%, normal liver in 54.8% and hepatomegaly in 3.3%. Liver function tests were normal in 51.6%, isolated cytolysis in 22.6%, isolated anicteric cholestasis in 16.1% and combined cytolysis-cholestasis in 9.7%. Liver biopsy was performed in 19 (61.2%) patients (to rule out other causes of liver damage) and the profile was as follows: steatohepatitis in 17 (54.8%) patients, of which 88.2% were grade 1 and 5.9% were grade 3 severe, and discrete portitis with signs of hepatocyte damage in one patient. Evaluation of liver fibrosis showed F0-F1 in 88.2% (n=15) and F2 in 2 patients. All the CD patients in this study were treated with corticosteroids, followed by azathioprine or anti-TNF. UC patients were treated mainly with sulfasalazine or 5-aminosalicylate. In addition to these medical treatments, patients were also encouraged to follow hygienic and dietary measures and to engage in appropriate physical activity. Progression after IBD control under treatment was marked by normalization of the non-specific liver balance in 100% of cases, with histological control not being performed. <h3>Conclusions</h3> Metabolic steatopathy in IBD accounts for 1.8% of cases in our series. Treatment and control of the underlying inflammatory bowel disease is beneficial in normalizing liver tests.