Pancreatobiliary manifestations of nonalcoholic fatty liver disease: a retrospective case-control multicenter study

Abstract

Background: Nonalcoholic fatty liver disease (NAFLD) has become a major cause of chronic liver disease. Several extrahepatic manifestations have been reported in relation to NAFLD. However, data regarding pancreatobiliary manifestation are scarce. Aim: We aimed to explore the association of pancreatobiliary manifestation with NAFLD. Methods: A retrospective multicenter study that included all patients who underwent an endoscopic ultrasound performed for hepatobiliary indications and for whom the endosonographer reported on the presence or absence of fatty liver. The endoscopic ultrasound reports were reviewed and all pathological findings were reported. Results: Overall, 545 patients were included in the study, among them, 278 patients had fatty liver (group A) as compared to 267 who did not have (group B). The average age in group A was 64.5 ± 13.5 years vs. 61.2 ± 14.7 years in group B. Male sex constituted 49.6 and 58% in groups A and B, respectively. On multivariate analysis, fatty pancreas [odds ratio (OR) 4.02; P = 0.001], serous cystadenoma (SCA) (OR 5.1; P = 0.0009), mucinous cystadenoma (MCA) (OR 9.7; P = 0.005), side-branch intraductal papillary mucinous neoplasm (IPMN) (OR 2.76; P < 0.0001), mixed-type IPMN (OR 16.4; P = 0.0004), pancreatic neuroendocrine tumor (NET) (OR 8.76; P < 0.0001), gallbladder stones (OR 1.9; P = 0.02) and hilar lymphadenopathy (OR 6.8; P < 0.0001) were significantly higher among patients with NAFLD. After adjustment for fatty pancreas, the association remained significant for SCA (OR 3; P = 0.01), MCA (OR 4.6; P = 0.03), side-branch IPMN (OR 1.7; P = 0.02), mixed-type IPMN (OR 5.5; P = 0.01) and pancreatic NET (OR 4.5; P = 0.001). Conclusion: Pancreatobiliary manifestations are common among patients with NAFLD. Assessment of these coexistent manifestations should be considered in the setting of patients with NAFLD.

Bidirectional association between non-alcoholic fatty liver disease and fatty pancreas: a systematic review and meta-analysis

“…The meta-analysis of three included studies [13,28,34] showed the association between fatty pancreas and the risk of NAFLD (OR, 9.56; 95% CI, 5.09–17.95; I 2 = 83%), as shown in Fig. 4a.…”

“…Subsequently, 85 articles underwent the second round of review. Finally, 26 observational studies comprising a total of 67 803 patients were included in the analysis: 4 case-control studies and 22 cross-sectional studies [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]26,[28][29][30][31][32][33][34]41,42]. No longitudinal cohort studies reporting the outcomes of interest were identified.…”

“…Nineteen studies, involving a total of 52 723 subjects, reported the odds of fatty pancreas in patients with and without NAFLD [11,12,[14][15][16][17]19,[21][22][23][24]26,[29][30][31][32][33]41,42]. Three articles, with a total of 802 patients, evaluated the odds of NAFLD in patients with and without fatty pancreas [13,28,34]. Four articles, involving a total of 358 NAFLD patients [10,18,20,25], and three studies, involving a total of 215 NAFLD patients [10,18,20], reported the odds of having advanced fibrosis and NASH, respectively, in NAFLD patients with and without fatty pancreas.…”

“…Age, sex, ethnicity, unhealthy lifestyle, and metabolic disorders have been recognized as the common risk factors for fatty pancreas [3,7,9]. Growing evidence has shown associations between fat content in the pancreas and the liver, suggesting a potential relationship between fatty pancreas and NAFLD [10–34]. Some research has discovered evidence that fatty pancreas contributes to fat accumulation in the liver, potentially accelerating the progression of NAFLD [18].…”

Nonalcoholic fatty liver disease as a risk factor for severity of acute cholangitis

“…Our study results indicate that NAFLD is strongly associated with severe cholangitis (de ned as Tokyo score Grade III). To the best of our knowledge, no previous studies have studied the relationship between NAFLD and severe cholangitis, although a wide array of pancreatobiliary manifestations are commonly found among patients with NAFLD [19] .…”