RT Journal Article
SR Electronic
T1 High prevalence of colorectal neoplasm in patients with non-alcoholic steatohepatitis
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 829
OP 836
DO 10.1136/gut.2011.237974
VO 60
IS 6
A1 Wong, Vincent Wai-Sun
A1 Wong, Grace Lai-Hung
A1 Tsang, Steven Woon-Choy
A1 Fan, Tina
A1 Chu, Winnie Chiu-Wing
A1 Woo, Jean
A1 Chan, Anthony Wing-Hung
A1 Choi, Paul Cheung-Lung
A1 Chim, Angel Mei-Ling
A1 Lau, James Yun-Wong
A1 Chan, Francis Ka-Leung
A1 Sung, Joseph Jao-Yiu
A1 Chan, Henry Lik-Yuen
YR 2011
UL http://gut.bmj.com/content/60/6/829.abstract
AB Objective Non-alcoholic fatty liver disease (NAFLD) affects 20–40% of the general adult population. Due to shared risk factors, it is postulated that NAFLD patients have an increased risk of colorectal neoplasm and should be a target group for screening. The aim of this study was to examine the prevalence of colorectal neoplasm in NAFLD patients and the risk of colorectal neoplasm in relation to the severity of NAFLD histology.Design Cross-sectional study.Setting University hospital with case recruitment from the community and clinics.Patients Subjects aged 40–70 years were recruited for colonoscopic screening from two study cohorts: (1) community subjects; and (2) consecutive patients with biopsy proven NAFLD. In the community cohort, hepatic fat was measured by proton-magnetic resonance spectroscopy.Main outcome measures Prevalence of colorectal adenomas. Advanced colorectal neoplasm was defined as cancer or adenomas with villous architecture or high grade dysplasia.Results NAFLD patients (N=199) had a higher prevalence of colorectal adenomas (34.7% vs 21.5%; p=0.043) and advanced neoplasms (18.6% vs 5.5%; p=0.002) than healthy controls (N=181). Thirteen of 29 (45%) NAFLD patients with advanced neoplasms had isolated lesions in the right sided colon. Among patients with biopsy proven NAFLD, patients with non-alcoholic steatohepatitis (N=49) had a higher prevalence of adenomas (51.0% vs 25.6%; p=0.005) and advanced neoplasms (34.7% vs 14.0%; p=0.011) than those with simple steatosis (N=86). After adjusting for demographic and metabolic factors, non-alcoholic steatohepatitis remained associated with adenomas (adjusted OR 4.89, 95% CI 2.04 to 11.70) and advanced neoplasms (OR 5.34, 95% CI 1.92 to 14.84). In contrast, the prevalence of adenomas and advanced neoplasms was similar between patients with simple steatosis and control subjects.Conclusions Non-alcoholic steatohepatitis is associated with a high prevalence of colorectal adenomas and advanced neoplasms. The adenomas are found more commonly in the right sided colon. Colorectal cancer screening is strongly indicated in this high risk group.