Background In this study, we evaluated hepatobiliary involvement in inflammatory bowel disease (IBD) with FibroScan® (transient elastography) and examined drug effects on liver fibrosis and steatosis. We particularly focused on the effect of azathioprine (AZT) on spleen stiffness (SS). Methods A total of 352 subjects were included in this study, including 298 IBD patients and 54 healthy controls. LSM (liver stiffness measurement), SS, and CAP™ (controlled attenuation parameter) scores were measured by FibroScan®. In addition to disease and patient characteristics; laboratory tests, and effect of the drugs were evaluated and compared within the groups. Results The patient and control groups were similar in terms of age and gender. The characteristics of the groups are shown in Table 1. Mean LSM (5.2±3.1kPa vs 4.5±1,1kPa), mean SS (22.69±13,10kPa vs 17.96±7,44kPa), CAP™ score (hepatosteatosis) (233±56dB/m vs 224±47dB/m) were significantly higher in the patients with IBD than in the control group (p<0.05). Liver fibrosis and steatosis grades are shown in Figure 1. A positive correlation was found between CAP™ score and male gender, hypertension, diabetes, BMI, smoking, penetrating disease, GGT, triglyceride, LSM, and SS (p<0.05). LSM (5.7±3,1kPa vs 5.0±3,1kPa) was significantly higher in patients with extraintestinal involvement (p<0.05). In patients with significant liver fibrosis (F2-3-4), the frequency of anti-TNF treatment was lower (44,4% vs 69,5%; p=0,008) (Figure 2). In patients who use alcohol regularly compared to nondrinkers (25.54±14,83kPa vs 21.05±11,24kPa) SS was significantly higher (p<0.05). Additionally, in patients using AZT≥100 mg/day compared to those using AZT<100 mg/day (23.48±14,61kPa vs 19.99±11,84kPa; p<0,05) SS was significantly higher (Figure 3). AZT dose was positively correlated with SS (Spearman analysis; r=0.182 and p=0.013); however, no correlation was found with the duration or cumulative dose of AZT. The mean level of platelets was significantly higher in patients with IBD than in controls (300±104x10³/µL vs 251±52x10³/µL, p=0,001); however, there was no correlation between SS and trombosit level (p>0,05). 83% of patients were in clinical remission (Mayo score≤2/CDAI<150). No positive correlation was found between disease activity and SS in IBD patients. AZT-associated non-cirrhotic portal hypertension was detected in only one patient. Conclusion In this study, fatty liver, liver fibrosis, and SS were found to be significantly higher in IBD patients than in healthy controls. Although there is no relationship with the duration of AZT therapy, AZT dose was positively correlated with SS. We recommend that spleen stiffness should be evaluated in patients who use high doses of AZT (≥100 mg/day).

Background The aim of this study is to investigate the incidence of malignancy in patients with inflammatory bowel disease (IBD) followed up in a tertiary reference center. Methods IBD patients who were with at least 6 months of follow-up between the 1991-2022 from the gastroenterology clinic were evaluated retrospectively. Descriptive statistics for continuous variables in the study; expressed as mean (mean), standard deviation (SD), minimum, maximum, number (n) and percent (%). “Independent T-test” was used to compare continuous measurement values according to categorical groups. Chi-square test was used to determine the relationships between categorical variables. Results There were 696 patients in the study totally. 319 (45.83%) of these patients were female. Mean age of the patients were 48.27±14.58 years. IBD type was changed as; 307 (44.1%) had ulcerative colitis, 377 (54.1%) had Crohn's disease, 12 (1.8%) had indeterminate colitis. Before the diagnosis of IBD, 8 patients (1.1%) had a history of malignancy. The prevalence of malignancy after the diagnosis of IBD was 13 (1.86%). The characteristic of these 13 patients are described in Table 1. When the relationship between malignancy and gender, age, body mass index (BMI), disease age, and disease type in patients who developed malignancy in inflammatory bowel disease was examined, a statistically significant relationship was found in the elderly and those with high BMI (p=0.0019, p=0.004, respectively). When we look at the relationship between the risk of developing malignancy in IBD and the age of the disease at 10 and 8 years period, it was seen that there was no statistically significant relationship (p=0.245, p=0.343). When the patients who developed malignancy in IBD were compared in terms of the immunomodulators and biological agents used by the patients who did not develop malignancy, there was no statistical difference between the two groups (p>0.05). (Fig.1 Graphical abstract). Fig.1 Graphical abstract Conclusion Higher BMI and being older age found to be risk for the development of malignancy in IBD patients, although no relationship was found with the use of immunomodulator, biological agents, or disease type. The risk of malignancy, especially colorectal cancers, is increased in IBD. Therefore, close follow-up of these patients is important.