Nonalcoholic steatohepatitis is associated with a higher risk of advanced colorectal neoplasm

Abstract

Background & Aims Nonalcoholic fatty liver disease (NAFLD) is known to increase the risk of adenomatous colonic polyps. However, the role of screening colonoscopy in patients with biopsy‐proven NAFLD in detecting advanced colorectal neoplasm is not clearly evidence‐based. Therefore, we investigated whether the histological severity of NAFLD is associated with advanced colorectal neoplasm. Methods This study included patients ≥18 years old who underwent screening colonoscopy between 2013 and 2018 within a biopsy‐evaluated prospective NAFLD cohort. Advanced colorectal neoplasm was defined as an adenomatous polyp greater than 10 mm in diameter and/or with villous histology and/or with high‐grade dysplasia or adenocarcinoma. Results Among the 476 patients with clinically suspected NAFLD, 379 patients were diagnosed with biopsy‐proven NAFLD and 97 patients had no evidence of NAFLD histologically, who were analyzed as healthy controls. The prevalence of advanced colorectal neoplasm was 11.1% (n = 53). Patients with advanced colorectal neoplasm had higher grade of steatosis (P = 0.004) and higher stage of hepatic fibrosis (P = 0.044) than those with normal colonoscopic findings or low‐grade adenomatous polyp. Multivariable logistic regression analysis revealed that the presence of nonalcoholic steatohepatitis (NASH) was an independent risk factor for both colorectal polyp (odds ratio [OR], 2.08; 95% confidential interval [CI], 1.12‐3.86; P = 0.020) and advanced colorectal neoplasm (OR, 2.81; 95% CI, 1.01‐7.87; P = 0.049). Conclusions The presence of biopsy‐proven NASH was significantly associated with an increased risk of advanced colorectal neoplasm among patients with NAFLD. This finding may alert physicians to conduct screening colonoscopy in patients with NASH to detect advanced colorectal neoplasm early.

Inflammation, etiologies and Model for End‐stage Liver Disease score: What makes liver disease patients susceptible to developing colorectal neoplasia?

“…NAFLD was associated with an increased polyp rate and HRS. These findings are in line with studies focusing on this specific subgroup of patients . The metabolic syndrome has already been linked to CRC and is closely associated with NAFLD .…”

“…These findings are in line with studies focusing on this specific subgroup of patients. 5,13 The metabolic syndrome has already been linked to CRC 32 and is closely associated with NAFLD. 33 Thus, it is difficult to keep the two entities' effects on the colon apart.…”

“…To follow up on these questions, we obtained detailed data that we added to our previously reported database. 4 There are few studies that investigate the links between colorectal polyps and single liver disease entities, among them non-alcoholic fatty liver disease (NAFLD), 5 alcohol-toxic liver disease (ALD), 6 and viral hepatitis. 7,8 Given the large number of existing etiologies, this list is still incomplete, and results are inconsistent.…”

High risk of colorectal polyps in men with non‐alcoholic fatty liver disease: A systematic review and meta‐analysis

“…The detailed selection flow diagram of eligible literature is presented in Figure 1. A total 20 eligible studies that were included in the meta-analysis include 12 cross-sectional studies, [14][15][16][21][22][23][24][25][26][27][28][29] six cohort studies, [30][31][32][33][34][35] and two case-control studies. 36,37 The main characteristics of the included studies are listed in Table 1.…”

Influence of Helicobacter pylori‐connected metabolic syndrome on non‐alcoholic fatty liver disease and its related colorectal neoplasm high risk

“…It is interesting to note that active Helicobacter pylori infection (Hp-I) with concomitant nonalcoholic fatty liver disease (NAFLD), metabolic syndrome, might be involved in colorectal adenoma (CRA) to colorectal cancer (CRC) sequence. The recent study also reported an impact of Hp-I related metabolic syndrome on lower gastrointestinal tract oncogenesis 1. There is growing evidence for a potential association between Hp-I and NAFLD and malignancies 2.…”