Rate of Liver Disease Twice as High in Ulcerative Colitis Patients

Benjamin Click, MD

Patients with ulcerative colitis (UC) may be at an increased risk of nonalcoholic fatty liver disease (NALFD), nonalcoholic steatohepatitis (NASH) and nonalcoholic cirrhosis (NC), according to a study presented at Digestive Disease Week 2019.

In an analysis of more than 62,000,000, investigators from the Cleveland Clinic found that prevalence rates of NAFLD, NASH, and NC among patients with UC were more than double that of the general population.

After observing what appeared to be an increasing prevalence of liver disease in patients with UC in their own practices, investigators sought to determine if UC patients were at an increased risk of NAFLD, NASH, and NC.

"It's becoming an increasingly common finding in my clinical practice, it's also increasingly recognized that with ulcerative colitis the increased gut permeability and the inflammation that goes along with the disease process, as well as the medication we use that carry certain hepatotoxicity, may convey an increased risk for chronic liver disease in our patient populations," explained Benjamin Click, MD, study author and associate staff gastroenterologist at the Cleveland Clinic in an interview with MD Magazine.

Investigators used electronic health record data, obtained through a commercial database, from 26 major US heal care systems to identify patients with a diagnosis of UC from 1999 to 2018. Patients were identified with a Systemized Nomenclature of Medicine — Clinical Terms diagnosis of UC. Investigators used logistic regression of demographic and metabolic comorbidities to identify potential risk factors. Additionally, prevalence rates of first ever diagnosis of NAFLD, NASH, and NC after 30 days of UC diagnosis with the general population from the commercial database.

A total of 62,781,880 individuals were included within the database and investigators identified 125,380 (.2%) individuals with UC, 467,060 (0.74%) with NAFLD, 35,890 (0.06%) with NASH, and 169,700 (0.27%) with NC. The prevalence of NAFLD, NASH, and NC were significantly higher among individuals with UC than the general population group. In individuals with UC, 1.95% had NALFD, .23% had NASH, and 1.01% had a diagnosis of NC.

After comparing patients with UC patients with and without NAFLD, investigators found patients with NAFLD were more likely to be Caucasian with comorbid diabetes mellitus and hypertension. Investigators found no significant difference in sex or age when comparing patient groups.

UC patients with NASH were more likely to be Caucasian, 65 or older, with comorbid DM, obesity and HTN compared to patients without NASH. Investigators noted there was no significant sex differences. UC patients with NC were more likely to be males, African American, and elderly.

From their data, investigators concluded that the prevalence of NAFLD, NASH, and NC is significantly increased in UC compared to the general population. Within their conclusion, authors noted that additional studies were needed to assess the impact and interaction of IBD, medications, and the evolution of NAFLD.

“Patients with ulcerative colitis are at a significantly increased risk of nonalcoholic fatty liver disease compared to the general population is a critical take home point in terms of recognition and potentially treatment,” Click said.

This study, titled “Nonalcoholic liver disease significantly more prevalent in ulcerative colitis: a population-based study,” was presented at DDW 2019 in San Diego, CA.