Nonalcoholic Steatohepatitis Is Associated With a Higher Risk of Advanced Colorectal Neoplasm

Yuri Cho; Soo-Kyung Lim; Sae Kyung Joo; Dong-Hyong Jeong; Jung Ho Kim; Jeong Mo Bae; Jeong Hwan Park; Mee Soo Chang; Dong Hyeon Lee; Yong Jin Jung; Byeong Gwan Kim; Donghee Kim; Kook Lae Lee; Won Kim

Disclosures

Liver International. 2019;39(9):1722-1731. 

In This Article

Results

Clinical Characteristics of Study Population According to Colonoscopic Findings

A total of 476 patients with clinically suspected NAFLD (No-NAFLD, n = 97; NAFL, n = 194; and NASH, n = 185; by liver biopsy) underwent screening colonoscopy. Among 476 patients, 323 (67.9%) showed no evidence of colorectal polyps. The prevalence of low-grade colorectal adenomatous polyps and advanced colorectal neoplasm were 21.0% (n = 100) and 11.1% (n = 53), respectively. The baseline characteristics of the study population according to colonoscopic findings are shown in Table 1. Patients with advanced colorectal neoplasm had noticeable differences in age and the prevalence of hypertension, and metabolic syndrome compared with those who had normal colonoscopic findings or adenomatous polyps.

Features of Colorectal Polyps

Comparing the number and location of colorectal polyps between patients with low-grade tubular adenoma and patients with advanced colorectal neoplasm, there were no significant differences in the number and location of polyps according to the category of colorectal polyps. Mean number of polyps found in colonoscopic studies was 3.0 ± 3.5 in patients with low-grade adenomatous colorectal polyp and 3.1 ± 2.2 in patients with advanced colorectal neoplasm, respectively. Ascending colon was found to be the most frequent location of both low-grade adenomatous colorectal polyp and advanced colorectal neoplasm (Table 2).

Histological Comparison of NAFLD According to the Presence of Low-grade Tubular Adenoma or Advanced Colorectal Neoplasm

The mean NAS was 3.1 (±1.8) in patients with low-grade adenomatous colorectal polyp and 3.4 (±1.5) in those with advanced colorectal neoplasm, respectively. The distribution of histological steatosis grade differed significantly among the three groups, demonstrating higher grade of steatosis in patients with adenomatous colorectal polyp including advanced colorectal neoplasm (Table 3; P = 0.004). The distribution of histological fibrosis stage also differed significantly among the three groups; higher stage of fibrosis was observed more frequently in patients with advanced colorectal neoplasm (P = 0.044).

Among the patients without NAFLD, only 5% of patients had advanced colorectal neoplasm. Approximately, 12% and 13% of patients experienced advanced colorectal neoplasm among the patients with NAFL and NASH, respectively (Figure 1).

Figure 1.

Prevalence of low-grade tubular adenoma and advanced colorectal neoplasm in patients with (A) no NAFLD, (B) NAFL, and (C) NASH. NAFL, nonalcoholic fatty liver; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis

After stratified by age, only patients with NAFL or NASH developed advanced colorectal polyp among the patients aged <50 years, although the difference did not reach statistical significance because of the small number of subjects in each subgroup (Figure 2). Among the patients aged ≥50 years, the prevalence of low-grade tubular adenoma and advanced colorectal neoplasm in patients with NAFL or NASH were significantly higher than in those without NAFLD (P = 0.003 and P = 0.05, respectively).

Figure 2.

Prevalence of (A) low-grade tubular adenoma and (B) advanced colorectal neoplasm by age in patients with no NAFLD, NAFL, and NASH. NAFL, nonalcoholic fatty liver; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis

Risk Factors Associated With Adenomatous Colorectal Polyp in the Overall Population

Risk factors for developing adenomatous colorectal polyps including advanced colorectal neoplasm are shown in Table 4. In the binary logistic regression analysis, univariate analysis suggested that age, the presence of diabetes mellitus, the presence of hypertension, lobular inflammation, the grade of hepatic steatosis, and the presence of NAFLD were the risk factors for colorectal adenomatous polyp. Multivariate analysis included the presence of NAFLD due to the positive co-linearity with other histological findings including lobular inflammation and the grade of steatosis. In age-, sex-, the presence of hypertension and diabetes mellitus-adjusted multivariate analysis, the presence of NAFL (OR, 2.76; 95% CI, 1.51-5.06; P = 0.001) and the presence of NASH (OR, 2.08; 95% CI, 1.12-3.86; P = 0.020) were the independent risk factors for developing adenomatous colorectal polyp.

Risk Factors Associated With Advanced Colorectal Neoplasm in the Overall Population

Based on the binary logistic regression analysis of the risk factors for advanced colorectal neoplasm, univariate analysis demonstrated that age, the presence of diabetes mellitus, and the presence of NAFLD were significantly associated with advanced colorectal neoplasm (Table 5). According to the age-, sex-, and the presence of diabetes mellitus-adjusted multivariate analysis, the presence of NASH (OR, 2.81; 95% CI, 1.01-7.87; P = 0.049) was an independent risk factor for developing advanced colorectal neoplasm.

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