Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Wednesday, 10 / 23 / 2019

Welcome to JCTH

scover V7I2  
 
 

Table of Contents

Editorial

Risk Factors for Colorectal Adenoma – Acknowledging the Burden of NAFLD
Marko Duvnjak, Sanja Stojsavljević, Lucija Virović Jukić, Lea Smirčić Duvnjak
Abstract ] [ Html ] [ PDF Full-text ] 97-98 Doi: 10.14218/JCTH.2019.00022

Original Article

Association between NAFLD and Risk of Colorectal Adenoma in Chinese Han Population
Yuan Li, Shousheng Liu, Yuqiang Gao, Huan Ma, Shuhui Zhan, Yan Yang, Yongning Xin, Shiying Xuan
Abstract ] [ Html ] [ PDF Full-text ] 99-105 Doi: 10.14218/JCTH.2019.00010

Spectrum, Manifestations and Outcomes of Dengue Infection in Individuals with and without Liver Disease
Anand V. Kulkarni, Ashok K. Choudhury, Madhumita Premkumar, Priyanka Jain, Ekta Gupta, Shiv Kumar Sarin
Abstract ] [ Html ] [ PDF Full-text ] 106-111 Doi: 10.14218/JCTH.2018.00047

Metabolic Acidosis in Critically Ill Cirrhotic Patients with Acute Kidney Injury
Dan-Qin Sun, Lai Zhang, Chen-Fei Zheng, Wen-Yue Liu, Kenneth I. Zheng, Xiao-Ming Chen, Ming-Hua Zheng, Wei-Jie Yuan
Abstract ] [ Html ] [ PDF Full-text ] 112-121 Doi: 10.14218/JCTH.2019.00013

Transplantation of HCV Viremic Livers into HCV Viremic Recipients Followed by Direct-acting Antiviral Therapy
Nikhil Kapila, Kawtar Al Khalloufi, Gianina Flocco, K.V. Narayanan Menon, Christina Lindenmeyer, Diego Reino, Jason M. Vanatta, Samer Ebaid, Andreas Tzakis, Xaralambos Bobby Zervos
Abstract ] [ Html ] [ PDF Full-text ] 122-126 Doi: 10.14218/JCTH.2019.00014

Practical Use of Transient Elastography in Screening for Nonalcoholic Steatohepatitis in a Japanese Population
Haruka Hirono, Kazuhiko Watanabe, Katsuhiko Hasegawa, Shogo Ohkoshi
Abstract ] [ Html ] [ PDF Full-text ] 127-131 Doi: 10.14218/JCTH.2018.00048

Characteristics and Outcomes of Acetaminophen Overdose and Hepatotoxicity in Thailand
Natthiya Pholmoo, Chalermrat Bunchorntavakul
Abstract ] [ Html ] [ PDF Full-text ] 132-139 Doi: 10.14218/JCTH.2018.00066

Review Article

Diagnostic and Therapeutic Strategies for Peritoneal Tuberculosis: A Review
David C. Wu, Leon D. Averbukh, George Y. Wu
Abstract ] [ Html ] [ PDF Full-text ] 140-148 Doi: 10.14218/JCTH.2018.00062

Biliary Mucinous Cystadenoma: A Review of the Literature
Leon D. Averbukh, David C. Wu, Woo Cheal Cho, George Y. Wu
Abstract ] [ Html ] [ PDF Full-text ] 149-153 Doi: 10.14218/JCTH.2019.00017

Update on Management of Portal Vein Thrombosis and the Role of Novel Anticoagulants
Matthew Wu, Michael Schuster, Micheal Tadros
Abstract ] [ Html ] [ PDF Full-text ] 154-164 Doi: 10.14218/JCTH.2018.00057

Hepatitis B Vaccine and Immunoglobulin: Key Concepts
Saibal Das, Kirubakaran Ramakrishnan, Sapan Kumar Behera, Mahalakshmi Ganesapandian, Alphienes Stanley Xavier, Sandhiya Selvarajan
Abstract ] [ Html ] [ PDF Full-text ] 165-171 Doi: 10.14218/JCTH.2018.00037

HCV Extrahepatic Manifestations
Lucija Kuna, Jelena Jakab, Robert Smolic, George Y Wu, Martina Smolic
Abstract ] [ Html ] [ PDF Full-text ] 172-182 Doi: 10.14218/JCTH.2018.00049

Role of Radiotherapy in the Treatment of Hepatocellular Carcinoma
Chien Pong Chen
Abstract ] [ Html ] [ PDF Full-text ] 183-190 Doi: 10.14218/JCTH.2018.00060

Case Report

A Mimic of Hepatic Encephalopathy: Two Cases of Cryptococcal Meningitis in North America
Peng-Sheng Ting, Anant Agarwalla, Tinsay A. Woreta
Abstract ] [ Html ] [ PDF Full-text ] 191-193 Doi: 10.14218/JCTH.2019.00005

EDITORIAL

Risk Factors for Colorectal Adenoma – Acknowledging the Burden of NAFLD

Marko Duvnjak1, Sanja Stojsavljević*,2, Lucija Virović Jukić1,2 and Lea Smirčić Duvnjak1,3

1School of Medicine, University of Zagreb, Zagreb, Croatia
2Department of Gastroenterology and Hepatology, Sisters of Charity University Hospital Center, Zagreb, Croatia
3Department of Endocrinology and Metabolic Diseases, Vuk Vrhovac University Clinic for Diabetes, Merkur University Hospital, Zagreb, Croatia
*Correspondence to: Sanja Stojsavljević, Department of Gastroenterology and Hepatology, Sisters of Charity University Hospital Center, Vinogradska cesta 29, Zagreb 10000, Croatia. Tel: +385-1-3787-178, Fax: +385-1-3769-067, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2019;7(2):97-98 DOI: 10.14218/JCTH.2019.00022
Received: June 25, 2019 Accepted: June 25, 2019 Published online: June 29, 2019

Global trends of diet have changed in Western and Eastern countries, featuring foods that are highly processed, contain saturated fat and carry excessive carbohydrate calories. This, accompanied by lower levels of physical activity, due to a more sedentary lifestyle, and the overweight/obesity epidemic, is the reason we are facing a rise in occurrence of new cases of metabolic syndrome. Furthermore, patients are at substantial risk of developing the well-known complications related to each of the components of metabolic syndrome, those being insulin resistance/diabetes mellitus, arterial hypertension, hyperlipidemia and visceral obesity.1

Nonalcoholic fatty liver disease (NAFLD), traditionally regarded as a liver presentation of metabolic syndrome, represents a wide spectrum of liver conditions, ranging from liver steatosis through nonalcoholic steatohepatitis and advanced liver diseases, such as decompensated cirrhosis and hepatocellular carcinoma. NAFLD is also recognized as a risk factor for extrahepatic gastrointestinal (colon, esophagus, stomach, pancreas) and extraintestinal sites of malignancies (kidney in men, breast in women). Patients with NAFLD present with insulin resistance, namely higher levels of circulating insulin effect the insulin/insulin-like growth factor axis that affects cell growth through a potentially carcinogenic pathway, and generally express an adipocytokine profile that promotes a chronic proinflammatory state.2 This could represent a link between obesity and promotion of gastrointestinal cancers but more studies are needed to clearly define the entire pathological pathway.3

Colorectal cancer (CRC) represents a great health burden worldwide. As such, it is imperative to design an ideal screening plan to detect early CRC and identify precancerous colorectal adenomas (CRAs), in order to reduce the incidence, morbidity, and mortality rates of CRC. The risk factors for CRC include age, family history of CRC, alcohol consumption, smoking, and increased red meat consumption.4 Various screening guidelines for CRC have been proposed by different scientific and clinical societies/organizations, and implemented in the affiliated geographic regions.5–7 They all recognize high and low risk groups, mostly depending on the previously mentioned risk factors, but metabolic syndrome and NAFLD, with the aforementioned obesity epidemic have to be taken more seriously in account when creating new guidelines and recommendations. The adoption of future screening programs will be affected by such, but first we must address the lack of adequate noninvasive indicators for CRA.

Li et al.7, recently published a retrospective study on 1089 patients (Chinese Hun population), that underwent colonoscopy due to gastrointestinal symptoms (abdominal pain, bowel habit changes, hematochesia, constipation) and iron deficiency anemia. The study participants were divided into groups based on the presence of NAFLD and finding of CRA. The study design addressed the relationship of NAFLD and CRA, recognizing NAFLD as an important risk factor for development of colorectal malignancies. NAFLD was diagnosed in 53.2% of patients in the CRA group versus 43.8 % in the control (non-NAFLD) group, representing a statistically significant between-group difference (p = 0.008). The controlled attenuation parameter (CAP), which indicated liver steatosis measurement obtained with FibroScan, was also significantly higher in the NAFLD group than in the control group (p = 0.002). Interestingly, multifactorial logistic regression analysis showed that sex, NAFLD, CAP, body mass index, triglycerides, serum aspartate aminotransferase, and fasting plasma glucose were the main risk factors tightly associated with the development of CRA. Regarding sex differences, in males, the NAFLD occurrence and CAP values of the CRA group were significantly higher than in the control group (p = 0.018, p < 0.001), which was not observed for the females (all p > 0.05). Independent risk factors of CRA identified for men were NAFLD, CAP, body mass index, serum aspartate aminotransferase, and fasting plasma glucose; for women, the factors were triglycerides and fasting plasma glucose.

While the data of Li et al.8 clearly showed the importance of NAFLD as a risk factor for CRA occurrence, there were some limitations to the study itself. The NAFLD diagnosis was not achieved by liver biopsy but via noninvasive methods (ultrasound) and patient selection was limited to patients with gastrointestinal symptoms (excluding general asymptomatic population), which could have led to increased incidence of reported CRA. These limitations are common to most studies, but a previous extensive meta-analysis of observational studies that was conducted by Mantovani et al.,9 involving asymptomatic adults predominantly of Asian descent who underwent screening colonoscopy, suggested that NAFLD is associated with a moderately increased prevalence and incidence of CRA and CRC (random effects odds ratio = 1.4, 95% confidence interval: 1.24–1.57; I2 = 78.8%), irrespective of the methods used for diagnosing NAFLD (ultrasonography, liver biopsy, proton magnetic resonance spectroscopy). Although the work of Mantovani et al.,9 did not show a clear sex difference for NAFLD-related CRAs, as did the study by Li et al.,8 the authors suggested that NAFLD may be associated with a higher risk of multiple CRA and more cancers located in the right colon.

Conclusions from the above mentioned studies have potential clinical implication, namely that the diagnosis of NAFLD could identify a subset of individuals who are at higher risk and thus need more careful surveillance; although, more extensive studies are needed to fill the remaining knowledge gaps. Wong et al.10 evaluated the higher cost effectiveness of different CRC screening methods (colonoscopy, fecal immunochemical test, flexible sigmoidoscopy) and advocated for a more stringent plan of colonoscopy screening, comprised of screens every 10 years starting at age 50 for patients diagnosed with NAFLD and a positive family history. We expect more epidemiological studies from the East and the West to be carried out, as they could back up the findings for cost effectiveness of more meticulous screening programs for NAFLD patients, which could have significant impacts on clinical and epidemiological outcomes. Nevertheless, the questions have been raised as to whether we are adequately acknowledging the burden of NAFLD in CRA and CRC screening, and whether we are on the right path to obtain appropriate answers.

Abbreviations
CAP: controlled attenuation parameter

CRA: colorectal adenoma

CRC: colorectal cancer

NAFLD: nonalcoholic fatty liver disease

Declarations
Conflict of interest
The authors have no conflict of interests related to this publication.

Authors’ contributions
Article conception and design (MD, SS), acquisition of data (SS, LVJ), analysis and interpretation of data (MD, SS, LVJ, LSD); drafting of the manuscript (MD, SS), critical revision of the manuscript for important intellectual content (MD, LVJ, LSD), administrative and technical support (MD).

References
1 Cornier MA, Dabelea D, Hernandez TL, Lindstrom RC, Steig AJ, Stob NR. The metabolic syndrome. Endocr Rev 2008;29:777-822
2 Stojsavljević S, Gomerčić Palčić M, Virović Jukić L, Smirčić Duvnjak L, Duvnjak M. Adipokines and proinflammatory cytokines, the key mediators in the pathogenesis of nonalcoholic fatty liver disease. World J Gastroenterol 2014;20:18070-18091
3 Tilg H, Moschen AR. Mechanisms behind the link between obesity and gastrointestinal cancers. Best Pract Res Clin Gastroenterol 2014;28:599-610
4 Tao S, Hoffmeister M, Brenner H. Development and validation of a scoring system to identify individuals at high risk for advanced colorectal neoplasms who should undergo colonoscopy screening. Clin Gastroenterol Hepatol 2014;12:478-485
5 Sung JJ, Ng SC, Chan FK, Chiu HM, Kim HS, Matsuda T. An updated Asia Pacific Consensus Recommendations on colorectal cancer screening. Gut 2015;64:121-132
6 Provenzale D, Gupta S, Ahnen DJ, Markowitz AJ, Chung DC, Mayer RJ. NCCN Guidelines Insights: Colorectal Cancer Screening, Version 1.2018. J Natl Compr Canc Netw 2018;16:939-949
7 von Karsa L, Patnick J, Segnan N, Atkin W, Halloran S, Lansdorp-Vogelaar I. European guidelines for quality assurance in colorectal cancer screening and diagnosis: overview and introduction to the full supplement publication. Endoscopy 2013;45:51-59
8 Li Y, Liu S, Gao Y, Ma H, Zhan S, Yang Y. Association between NAFLD and risk of colorectal adenoma in Chinese Han population. J Clin Transl Hepatol 2019;7:99-105
9 Mantovani A, Dauriz M, Byrne CD, Lonardo A, Zoppini G, Bonora E. Association between nonalcoholic fatty liver disease and colorectal tumours in asymptomatic adults undergoing screening colonoscopy: a systematic review and meta-analysis. Metabolism 2018;87:1-12
10 Wong MC, Ching JY, Chan VC, Lam TY, Luk AK, Wong SH. Screening strategies for colorectal cancer among patients with nonalcoholic fatty liver disease and family history. Int J Cancer 2016;138:576-583

 

 

 

Journal of Clinical and Translational Hepatology 2019 vol. 7, 97-98  [ Html ] [ PDF Full-text ]

 

© The Authors 2018. This article is published under the terms of the Creative Commons Attribution-Noncommercial License (CC BY-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

 

ORIGINAL ARTICLE

Association between NAFLD and Risk of Colorectal Adenoma in Chinese Han Population

Yuan Li1, Shousheng Liu3,4, Yuqiang Gao1, Huan Ma1, Shuhui Zhan1, Yan Yang1, Yongning Xin*,1,2,4 and Shiying Xuan*,1,4

1Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao, China
2Department of Infectious Disease, Qingdao Municipal Hospital, Qingdao, China
3Central Laboratories, Qingdao Municipal Hospital, Qingdao, China
4Digestive Disease Key Laboratory of Qingdao, Qingdao, China
*Correspondence to: Shiying Xuan, Department of Gastroenterology, Qingdao Municipal Hospital, 1 Jiaozhou Road, Qingdao 266011, Shandong, China. Tel: +86-532-88905508, Fax: +86-532-88905293, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. ; Yongning Xin, Department of Gastroenterology, Qingdao Municipal Hospital, 1 Jiaozhou Road, Qingdao, Shandong 266011, China. Tel: +86-532-82789463, Fax: +86-532-85968434, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2019;7(2):99-105 DOI: 10.14218/JCTH.2019.00010
Received: February 13, 2019 Accepted: April 12, 2019 Published online: May 4, 2019

Abstract

Background and Aims: Colorectal cancer is associated with non-alcoholic fatty liver disease (NAFLD) and other metabolic syndromes, such as obesity, abnormal blood glucose, and dyslipidemia. The relationship of NAFLD and colorectal adenoma, which is the precursor of colorectal cancer, is worthy of discussion. The aim of this study was to investigate the association between colorectal adenoma and NAFLD, colorectal adenoma and metabolic syndrome in a Chinese Han population.

Methods: This retrospective study analyzed the relationship between NAFLD and colorectal adenoma in 1089 patients in Qingdao municipal hospital. Subjects were divided into a colorectal adenoma group (n = 267) and a control group (n = 822). NAFLD and the controlled attenuation parameter (CAP) value were determined by abdominal ultrasound and FibroScan.

Results: Patients with NAFLD in the colorectal adenoma group and the control group represented 142 cases (53.2%) and 360 cases (43.8%), respectively. The mean CAP value in the colorectal adenoma group was significantly higher than that in the control group. The values of body mass index, triglyceride, high-density lipoprotein cholesterol, aspartate aminotransferase, fasting plasma glucose, and uric acid were also significantly higher in the colorectal adenoma group than in the control group. Multifactor logistic regression analysis showed that the sex, NAFLD, CAP, body mass index, triglyceride, aspartate aminotransferase, and fasting plasma glucose were significant risk factors for colorectal adenoma. Besides, NAFLD and CAP value were significant risk factors for colorectal adenoma in males but not in females.

Conclusions: NAFLD and metabolic syndrome were tightly associated with the risk of colorectal adenoma in this Chinese Han population. The effect of NAFLD on colorectal adenoma was prominent in males rather than in females.

Keywords

Non-alcoholic fatty liver disease (NAFLD), Colorectal adenoma, Metabolic syndrome, Controlled attenuation parameter (CAP)

 

 

 

 

Journal of Clinical and Translational Hepatology 2019 vol. 7, 99-105  [ Html ] [ PDF Full-text ]

 

© The Authors 2019. This article is published under the terms of the Creative Commons Attribution-Noncommercial License (CC BY-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

 

 logo

You are here: Home Vol 7 Issue 2