One Third of Patients with Chronic Inflammatory Bowel Diseases Develop Fatty Liver Disease
Non-alcoholic fatty liver disease affects nearly one third of people suffering from chronic inflammatory bowel diseases. This condition, characterized by an abnormal accumulation of fat in liver cells, represents a major public health issue due to its potential to progress to serious complications such as fibrosis, cirrhosis, or even liver cancer. Men are more frequently affected than women, a difference that raises questions about the influence of sex in the development of this pathology.
Chronic inflammatory bowel diseases, which include Crohn’s disease and ulcerative colitis, affect millions of people worldwide. These conditions, marked by persistent inflammation of the digestive tract, are often accompanied by extraintestinal manifestations, including liver damage. Among these, fatty liver disease occupies a prominent place.
Analysis of 34 studies conducted between 2001 and 2024 reveals that the prevalence of fatty liver disease in patients with chronic inflammatory bowel diseases reaches 32.3%. This proportion varies depending on the type of disease: it is 31.3% for Crohn’s disease and 27.1% for ulcerative colitis. Diagnostic methods also influence these figures. For example, the use of controlled attenuation parameter, a non-invasive technique, yields a higher prevalence, estimated at 36.6%, compared to 22.8% for liver biopsy, considered the gold standard but less frequently used due to its invasive nature.
Liver fibrosis, a serious complication where scar tissue accumulates in the liver, has also been studied. Approximately 7.3% of patients with chronic inflammatory bowel diseases have this condition, although this figure may vary depending on the diagnostic criteria used. Regional differences are also notable: Europe and the Americas show higher prevalences than West and Southeast Asia, where data remains limited.
The causes of this association between fatty liver disease and chronic inflammatory bowel diseases are multiple. Metabolic disturbances, such as insulin resistance, play a key role, as do changes in the gut microbiota, which influence inflammation and metabolism. Additionally, some treatments used to manage chronic inflammatory bowel diseases may promote fat accumulation in the liver.
New definitions of fatty liver disease, such as those related to metabolic dysfunction, reflect a better understanding of this disease, now considered a hepatic manifestation of metabolic syndrome. This terminological evolution underscores the importance of a comprehensive approach, integrating genetic, environmental, and lifestyle-related factors.
The results of this analysis also show that the prevalence of fatty liver disease has varied over time, with a peak observed between 2016 and 2019. However, this trend cannot be interpreted as a real increase in the disease due to methodological differences between studies. Disparities in diagnostic criteria, studied populations, and analysis methods largely explain these variations.
This study highlights the importance of systematic screening for fatty liver disease in patients with chronic inflammatory bowel diseases, particularly in men and those suffering from Crohn’s disease. The use of non-invasive methods, such as ultrasound or controlled attenuation parameter, is encouraged to facilitate this screening. Finally, the need for international standardization of definitions and diagnostic protocols is emphasized to improve the management of these patients.
Information and Sources
Scientific Reference
DOI: https://doi.org/10.1186/s43066-026-00519-2
Title: The global prevalence of non-alcoholic fatty liver disease and related terms in adults with inflammatory bowel disease: a systematic review and meta-analysis
Journal: Egyptian Liver Journal
Publisher: Springer Science and Business Media LLC
Authors: Seyed Mohamad Musavi; Ali Afrasiabi