PREVALENCE BETWEEN NON-ALCOHOLIC FATTY LIVER DISEASE AND VESICULAR LITHIASIC DISEASE
Federico B. Roesch Dietlen*, Peter Grube-Pagola, Alfonso Gerardo Pérez-Morales, Fernando Diaz-Roesch, Mercedes Amieva-Balmori, Karla Rocío García-Zermeño, Alejandro Fonseca-Pouchoulen, Jose M. Remes Troche
Fisiologia Digestiva, Instituto de Investigaciones Medico Biologicas, Veracruz, Mexico
Background: Non-alcoholic fatty liver disease and gallstone disease have common risk factors. There are studies that confirm the high frequency of fatty liver disease, however in our population there are few studies that determine the usefulness of liver biopsy in patients with cholelithiasis Aim: To evaluate the prevalence of nonalcoholic fatty liver disease in patients with vesicular lithiasic disease. Material and Methods: We performed a prospective observational and analytical study of patients with cholelithiasis who underwent laparoscopic cholecystectomy and liver biopsy during the procedure, in 2 hospitals in Veracruz during the period 2015 to 2017, with prior consent form. We analyzed: anthropometric characteristics, laboratory studies and conventional ultrasound (US), risk factors and histopathological study of liver biopsy, analyzed in our Institute, according to the Evaluation System for injuries Hepatics of the Group of clinical study and research of the Non-Alcoholic Fatty Liver. Results: We studied 106 patients who were classified into 3 groups: a) Normal liver, 31 cases (29%) with an age of 42 ± 13.8 years, with predominance of the female gender in 87% and BMI 25.4 ± 3.65 kg/m2, in 64.6% there was more than one risk factor, multiparity and dyslipidemia prevailing, with average glucose, cholesterol, HDL, aminotransferases, proteins and albuminas being normal; the US showed normal hepatic image in all cases. The group b) Steatosis, included 54 cases (50.9%), with age 54.5 + 15.7 years, female gender (72%), BMI of 28 ±4.3 kg/m2, 61.1% had risk factors predominating dyslipidemia, obesity and hypertension, laboratory studies revealed elevation of ALT 56.6 ± 59.4u/l, AST 35.76 ± 2.3u/l, with normal glycemia, HDL cholesterol, proteins and albumins, the US showed hepatic steatosis in 54% of which in the biopsy found inflammation in 16.6% and cirrhosis in 3.7%. In group c) Esteatohepatitis: 21 cases (19%), age 54±10years, predominance of female gender (81%), BMI of 28.8 ± 4.9kg/m2, 95% had risk factors predominating dyslipidemia, multiparity, DM and obesity. The laboratory tests showed elevation of ALT 70± 26.4u /l, double the AST 36.76 ± 17.28 u/l and elevation of glucose 119.24 ± 34.31 mg /dl and the US detected in 81% suggestive alterations, the biopsy showed inflammation in 76%, with fibrosis in 38%. and liver cirrhosis 4.7% Conclusions: Liver biopsy in patients with gallstone disease confirmed the presence of steatosis in 51% of cases and steatohepatitis in 20%. These results confirm the importance of performing a liver biopsy during laparoscopic cholecystectomy, since both entities are related to common risk factors, as well as for the best management of this disease.
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