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Background: Non-alcoholic fatty liver disease (NAFLD) and its inflammatory and progressive subtype non-alcoholic steatohepatitis (NASH) have emerged as a major health burden. NAFLD and Gallstone disease (GD) share common pathophysiologic and risk factors. Currently there are no recommendations regarding screening of NAFLD in patients at increased risk. Moreover, non invasive methods to diagnose NAFLD are unreliable and liver biopsy is the only method for assessing the presence and extension of this condition. Firm recommendations of when to perform a liver biopsy in the routine clinical evaluations have not been developed. In this study our aim was to assess the prevalence of and factors associated with NAFLD in a cohort of patients operated for symptomatic GD and to evaluate the usefulness of routine liver biopsy as a screening method.
Methods: We prospectively evaluated 95 consecutive patients referred for cholecystectomy due to symptomatic GD between January 1st 2005 and June 30th 2006. All patients had a liver biopsy performed at the end of a standard laparoscopic cholecystectomy. Demographics, anthropometric measurements, family history, risk factors, laboratory tests and abdominal ultrasound were registered and analyzed. Patients with a positive serology for hepatitis B or C virus, those with a history of alcohol ingestion greater than 150 gr/day, autoimmune hepatitis or other liver disease where excluded.
Results: Twenty-nine patients (30.5%) were male and 66 (69.4%) were female. Mean age was 52.15 ± 16.82 years (range 2- 84 years) Forty-three patients (45%) had normal biopsies (Group A) while 52 patients (55%) had histological findings compatible with NAFLD (Group B). The patients in the later group where further classified according to the system proposed by Brunt as follows: stage I 51.93%, stage II 28.84%, stage III 19.23% and cirrhosis 3.15%. Patients in group B were older, had a higher body mass index, higher prevalence of diabetes, higher glicosilated hemoglobin levels, serum cholesterol and serum triglycerides than those in group A although they were not statistically significant. There were no complications secondary to the liver biopsies. Discussion: In our series, our findings show that more than 50% of patients with GD have associated NAFLD. Awareness of this association may result in an earlier diagnosis of NAFLD in patients with GD. Moreover, the fact that NAFLD is highly prevalent in patients with GD may justify routine liver biopsy in all patients undergoing laparoscopic cholecistectomy. Laparoscopic liver biopsy is a safe and effective method to establish the diagnosis and stage of NAFLD in patients with GD.

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