What is the relationship between steatotic (fatty) hepatic disease and Inflammatory Bowel Disease (IBD)?

From the Guidelines

Steatotic hepatic disease is less frequent in people with PSC-IBD than in those with IBD alone, indicating a complex relationship between fatty liver disease and inflammatory bowel disease [@1@]. The association between steatotic hepatic disease and IBD is multifaceted, involving chronic intestinal inflammation, malnutrition, malabsorption, and the use of hepatotoxic medications [@1@].

Key Points

• The prevalence of steatotic hepatic disease in IBD patients is significant, with approximately 20-40% of patients developing this condition [@2@].
• Chronic intestinal inflammation in IBD can disrupt the gut barrier, allowing bacterial products to enter portal circulation and trigger liver inflammation [@1@].
• Management of steatotic hepatic disease in IBD patients should focus on treating the underlying IBD with appropriate medications, minimizing hepatotoxic drugs, and implementing lifestyle modifications [@2@].
• Lifestyle modifications, including maintaining a healthy weight, following a Mediterranean-style diet, regular exercise, and avoiding alcohol, are crucial for managing both conditions [@2@].

Recommendations

• Regular monitoring of liver function tests is essential, especially when using potentially hepatotoxic IBD medications [@1@].
• Early intervention for both conditions is important, as they can exacerbate each other through shared inflammatory pathways [@2@].
• A stepwise approach using non-invasive tests, such as blood-based scores and imaging techniques, can help identify liver fibrosis and predict liver-related outcomes in patients with steatotic hepatic disease [@2@].

From the Research

Relationship between Steatotic Hepatic Disease and Inflammatory Bowel Disease (IBD)

• Steatotic hepatic disease, also known as non-alcoholic fatty liver disease (NAFLD), is a common extra-intestinal manifestation of IBD 1.
• The prevalence of NAFLD in IBD patients is estimated to be around 16.7% to 25% 2, 3.
• IBD patients with NAFLD are more likely to have cardiometabolic risk factors such as type 2 diabetes mellitus, hypertension, and higher body mass index (BMI) 4, 2.
• Hepatic steatosis is independently associated with increased risks of clinical relapse in patients with ulcerative colitis and Crohn's disease 3.
• Liver steatosis is also a risk factor for hepatotoxicity in patients with IBD under immunosuppressive treatment 5.

Clinical Features of Steatotic Hepatic Disease in IBD Patients

• IBD patients with steatotic hepatic disease tend to be older and have higher BMI, waist circumference, and triglyceride levels 4.
• They are also more likely to have type 2 diabetes mellitus and hypertension 4, 2.
• Patients with IBD and NAFLD may require more frequent surgical interventions and have higher disease activity scores 4.
• The presence of liver steatosis is associated with higher age and body weight, and male individuals may have an increased likelihood of developing elevated liver enzymes (ELE) associated with steatosis 5.

Pathogenesis and Management of Steatotic Hepatic Disease in IBD Patients

• The pathogenesis of NAFLD in IBD patients is complex and involves genetic factors, inflammatory signals, and microbiota 1.
• The management of NAFLD in IBD patients requires a multidisciplinary approach, including early detection of liver steatosis and assessment of cardiometabolic risk factors 4, 2.
• Further studies are needed to explore the pathophysiological mechanisms involved and to investigate whether assessment and therapeutic intervention for NAFLD will improve the clinical outcomes of patients with IBD 3.