Kamolyut Lapumnuaypol1, Napatt Kanjanahattakij1, David Pisarcik2, Charat Thongprayoon3, Karn Wijarnpreecha3, Wisit Cheungpasitporn4. 1. Department of Internal Medicine, Albert Einstein Medical Center. 2. Department of Internal Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania. 3. Department of Internal Medicine, Bassett Medical Center, Cooperstown, New York. 4. Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Mississippi, USA.
Abstract
BACKGROUND: Epidemiological studies have demonstrated an association between inflammatory bowel disease (IBD) and an increased risk for the development of nonalcoholic fatty liver disease (NAFLD). However, the risk of NAFLD in IBD patients who receive different medical treatments including glucocorticoids, immunomodulators, and tumor necrosis factor-α inhibitors remains unclear. We aimed to assess whether the use of certain IBD medications is associated with the development of NAFLD. MATERIALS AND METHODS: A systematic review was carried out in Medline, Embase, and Cochrane databases from inception through October 2017 to identify studies that assessed the association between the use of IBD medications and the risk of developing NAFLD. Effect estimates from the individual study were derived and combined using random-effect, generic inverse variance method of DerSimonian and Laird. RESULTS: Seven observational studies with a total of 1610 patients were enrolled. There was no significant association between the use of IBD medications and the incidence of NAFLD. The pooled odds ratios of NAFLD in patients who use biological agents, immunomodulators, methotrexate, and steroids were 0.85 [95% confidence interval (CI): 0.49-1.46], 1.19 (95% CI: 0.70-2.01), 3.62 (95% CI: 0.48-27.39), and 1.24 (95% CI: 0.85-1.82), respectively. Egger's regression asymmetry test was performed and showed no publication bias. CONCLUSION: Our study demonstrates no significant association between medications used in the treatment of IBD and the risk of developing NAFLD. The findings of our study suggest a complex, multifactorial relationship between IBD and the development of NAFLD beyond the scope of current pharmacological intervention.
BACKGROUND: Epidemiological studies have demonstrated an association between inflammatory bowel disease (IBD) and an increased risk for the development of nonalcoholic fatty liver disease (NAFLD). However, the risk of NAFLD in IBD patients who receive different medical treatments including glucocorticoids, immunomodulators, and tumor necrosis factor-α inhibitors remains unclear. We aimed to assess whether the use of certain IBD medications is associated with the development of NAFLD. MATERIALS AND METHODS: A systematic review was carried out in Medline, Embase, and Cochrane databases from inception through October 2017 to identify studies that assessed the association between the use of IBD medications and the risk of developing NAFLD. Effect estimates from the individual study were derived and combined using random-effect, generic inverse variance method of DerSimonian and Laird. RESULTS: Seven observational studies with a total of 1610 patients were enrolled. There was no significant association between the use of IBD medications and the incidence of NAFLD. The pooled odds ratios of NAFLD in patients who use biological agents, immunomodulators, methotrexate, and steroids were 0.85 [95% confidence interval (CI): 0.49-1.46], 1.19 (95% CI: 0.70-2.01), 3.62 (95% CI: 0.48-27.39), and 1.24 (95% CI: 0.85-1.82), respectively. Egger's regression asymmetry test was performed and showed no publication bias. CONCLUSION: Our study demonstrates no significant association between medications used in the treatment of IBD and the risk of developing NAFLD. The findings of our study suggest a complex, multifactorial relationship between IBD and the development of NAFLD beyond the scope of current pharmacological intervention.
Authors: Alisa Likhitsup; Jason Dundulis; Shaya Ansari; Sruthi Patibandla; Colleen Hutton; Kevin Kennedy; John H Helzberg; Rajiv Chhabra Journal: Ann Gastroenterol Date: 2019-07-22