Background While there is higher prevalence of autoimmune, cholestatic and fatty liver disease in celiac disease (CeD), most data is from small-scale studies. We evaluated the prevalence and risk factors of the same using large cohort data. Methods A population-based cross-sectional study was conducted using Explorys, a multi-institutional database. Prevalence and risk factors of autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC) and nonalcoholic fatty liver disease (NAFLD) in CeD were assessed. Results Out of 70 352 325 subjects, 136 735 had CeD (0.19%). The prevalence of AIH (0.32%), PBC (0.15%), PSC (0.004%) and NAFLD (0.7%) were high in CeD. After adjusting for age, gender, Caucasian race and anti-tissue transglutaminase antibody (anti-TTG), CeD subjects had higher odds of AIH [adjusted odds ratio (aOR) 7.06, 95% confidence interval (CI) 6.32–7.89] and PBC (aOR 4.16, 95% CI 3.46–5.0). Even after adjusting for CeD, anti-TTG positivity concurred with higher odds of AIH (aOR 4.79, 95% CI 3.88–5.92) and PBC (aOR 9.22, 95% CI 7.03–12.1). After adjusting for age, gender, Caucasian race, diabetes mellitus (DM), obesity, hypothyroidism and metabolic syndrome, there was higher prevalence of NAFLD in CeD, with the aOR in the presence of DM type 1 being 2.1 (95% CI 1.96–2.25), and in the presence of DM type 2 being 2.92 (95% CI 2.72–3.14). Conclusion Subjects with CeD are more likely to have AIH, PBC, PSC and NAFLD. AIH and PBC have higher odds in the presence of anti-TTG. The odds of NAFLD in CeD are high regardless of type of DM.

Backgrounds: Nonalcoholic fatty liver disease (NAFLD) is linked to obesity and metabolic syndrome conditions. However, a subset of NAFLD patients express a normal or low body mass index (lean NAFLD [L-NAFLD]). Our aim is to compare the prevalence of L-NAFLD to the obesity-associated NAFLD in the United States by assessing prevalence, potential risk factors, liver-related complications, and coronary artery disease outcomes. Methodology: A multicenter database (Explorys Inc.) of >70 million patients across the United States was screened. A cohort of patients with "nonalcoholic fatty liver" between 1999 and 2021 was identified. Two sub-cohorts of NAFLD patients were identified: those with a body mass index (BMI) < 25 kg/m 2 (L-NAFLD) and those with a BMI > 30 kg/m 2 (obesity-associated NAFLD). We excluded patients with age <18 and those who have viral hepatitis, hemochromatosis, Wilson's disease, biliary cirrhosis, alcoholic liver disease, cystic fibrosis, alpha-1-antitrypsin deficiency, and autoimmune hepatitis. Multivariate analysis was performed to adjust for confounders. Results: 68 892 260 individuals were screened. NAFLD prevalence was four per 100 000, and L-NAFLD prevalence was 0.6 per 100 000. Compared with those without, patients with L-NAFLD tended to be older (OR 2.16), females (OR 1.28), and smokers (OR 4.67) and of Asian race (OR 2.12). L-NAFLD patients were more likely to have acute coronary syndromes (OR 30.00) and metabolic syndrome (OR 2.31) despite the normal/low BMI. Esophageal varices and hepatocellular carcinoma risks were high in both cirrhosis patients. Conclusion: This is the largest study to assess L-NAFLD prevalence in the United States. L-NAFLD are at a significantly higher risk for acute coronary syndromes, esophageal varices, and hepatocellular carcinoma. with NAFLD, which is known as lean NAFLD (L-NAFLD).

Background and objectiveThe global health burden of inflammatory bowel disease (IBD) stems from its increasing incidence over the years. Comprehensive studies on the topic hypothesize that IBD plays a more dominant in the development of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). In light of this, we conducted this study with the aim of assessing the prevalence and risk factors of developing NASH in patients who have had a diagnosis of ulcerative colitis (UC) and Crohn's disease (CD). MethodologyA validated multicenter and research platform database of more than 360 hospitals from 26 different healthcare systems across the United States from 1999 to September 2022 was utilized for conducting this study. Patients aged 18-65 years were included. Pregnant patients and individuals diagnosed with alcohol use disorder were excluded. The risk of developing NASH was calculated using a multivariate regression analysis to account for potential confounding variables including male gender, hyperlipidemia, hypertension, type 2 diabetes mellitus (T2DM), and obesity. A two-sided p-value <0.05 was considered statistically significant, and all statistical analyses were performed using R version 4.0.2 (R Foundation for Statistical Computing, Vienna, Austria, 2008). ResultsA total of 79,346,259 individuals were screened in the database and 46,667,720 were selected for the final analysis based on the inclusion and exclusion criteria. Using multivariate regression analysis, the risk of developing NASH among patients with UC and CD was calculated. The odds of having NASH among patients with UC was 2.37 (95% CI: 2.17-2.60, p<0.001). Similarly, the odds of having NASH were high in patients with CD as well, at 2.79 (95% CI: 2.58-3.02, p<0.001). ConclusionBased on our findings, patients with IBD have an increased prevalence and higher odds of developing NASH after controlling for common risk factors. We believe that a complex pathophysiological relationship exists between both disease processes. Further research is required to establish appropriate screening times to enable earlier disease identification and thereby improve patient outcomes.

Background Numerous modifiable risk factors have been associated with colon cancer. Helicobacter pylori ( H. pylori ) is the most common bacterial infection worldwide and the strongest known risk factor for gastric cancer. We aim to assess whether the risk of colorectal cancer (CRC) is higher in patients with a history of H. pylori infection. Methods A validated multicenter and research platform database of more than 360 hospitals was queried. Patients aged 18-65 years were included in our cohort. We excluded all patients who had previously had a diagnosis of inflammatory bowel disease or celiac disease. Univariate and multivariate regression analyses were used to calculate CRC risk. Results A total of 47,714,750 patients were selected after application of the inclusion and exclusion criteria. The 20-year-period prevalence rate of CRC in the United States population from 1999 to September 2022 was 370 of 100,000 individuals (0.37%). According to multivariate analysis, the risk of CRC was higher in smokers (odds ratio [OR] 2.52, 95% confidence interval [CI] 2.47-2.57), obese patients (OR 2.26, 95%CI 2.22-2.30), those with irritable bowel syndrome (OR 2.02, 95%CI 1.94-2.09), or type 2 diabetes mellitus (OR 2.89, 95%CI 2.84-2.95), and patients who had a diagnosis of H. pylori infection (OR 1.89, 95%CI 1.69-2.10). Conclusion We provide the first evidence from a large population-based study demonstrating an independent association between a history of H. pylori infection and CRC risk.

Background and aim: The association between celiac disease (CD) and the development of small bowel lymphoproliferative disorders and esophageal adenocarcinoma has been established in the literature. However, there is only a little evidence demonstrating an increased risk of colorectal cancer (CRC) in patients with CD. Hence, we conducted a cross-sectional population-based study to evaluate the risk of developing CRC in patients who have had a diagnosis of CD.Methodology: We used a commercial database (Explorys Inc, Cleveland, OH), which includes electronic health records from 26 major integrated US healthcare systems. Patients aged 18-65 years were included. Patients with inflammatory bowel disease (IBD) were excluded. Multivariate analysis using backward stepwise logistic regression was performed to calculate the risk of developing CRC in potential confounders. A two-sided P-value <0.05 was considered statistically significant.Results: 79,843,332 individuals were screened in the database and 47,400,960 were selected in the final analysis after accounting for inclusion and exclusion criteria. Using a stepwise multivariate regression analysis, the odds of having CRC among patients with CD was 10.18 (95% CI 9.72-10.65) (P-value <0.001). The odds also remained high among males 1.49 (95% CI 1.36-1.63), African Americans 1.51 (95% CI 1.35-1.68), patients who have type 2 diabetes mellitus (T2DM) 2.71 (95% CI 2.66-2.76), are smokers 2.49 (95% CI 2.44-2.54), are obese 2.21 (95% CI 2.17-2.25), and are alcoholic 1.72 (95% CI 1.66-1.78). Conclusion:Our study demonstrates that patients with CD are frequently found to have CRC even when adjusting for common risk factors. This adds to the literature and helps spread awareness to clinicians that the effects of CD are not only limited to the small bowel as the disease tends to involve other parts of the gastrointestinal tract also, especially the colon. The threshold to screen patients with CD should be considered to be lowered.