Authors:

Abstract

Introduction: Metabolic syndrome independently has a significant alliance with both non-alcoholic fatty liver disease (NAFLD) and gall stone disease (GSD). NAFLD can present variably in different individuals from simple steatosis to non-alcoholic steatohepatitis (NASH). For establishing a valid prognosis, it is essential to differentiate appropriately between the presence and absence of NASH. Hence, the present study aimed to assess the prevalence and severity of NAFLD in GSD by using Fibroscan with Controlled Attenuation Parameter (CAP).

Methods: A hundred patients of GSD who were being evaluated for cholecystectomy and were negative for HBV and HCV infection, with no history of alcohol intake or documented liver cirrhosis were evaluated prospectively. Diagnosis and severity of NAFLD were assessed by CAP. Necroinflammation was assessed by levels of transaminases; hepatic fibrosis and cirrhosis were measured on Fibroscan.

Results: Of 100 patients, NAFLD prevalence was 77% on CAP. On fibro scan, 17 had mild fibrosis, 8 had significant fibrosis and 1 had evidence of cirrhosis. Significant necro-inflammation was present in 16 patients. Body mass index > 25kg/m² and central abdominal obesity was a strong predictor of steatosis in GSD with NAFLD (p 0.041, 0.029 respectively). Central abdominal obesity and low levels of high-density lipoprotein were a strong predictor of fibrosis in NAFLD (p 0.040, 0.037 respectively).

Conclusions: A higher prevalence of NAFLD (77%) was observed in patients with GSD which might have bearing on the surgical management. The observations of the study recommend that health awareness and lifestyle modifications should be advised to patients with GSD as they may be having concomitant NAFLD which may in due course of time evolve into cirrhosis if ignored.  

Keywords: Non-alcoholic steatohepatitis, NASH, NAFLD, hepatic steatosis, fatty liver, metabolic syndrome