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Review
. 2021 Nov 7;27(41):7113-7124.
doi: 10.3748/wjg.v27.i41.7113.

Non-alcoholic fatty liver disease in patients with intestinal, pulmonary or skin diseases: Inflammatory cross-talk that needs a multidisciplinary approach

Mercedes Perez-Carreras  1 , Begoña Casis-Herce  1 , Raquel Rivera  2 , Inmaculada Fernandez  1 , Pilar Martinez-Montiel  1 , Victoria Villena  2
Affiliations
Review

Non-alcoholic fatty liver disease in patients with intestinal, pulmonary or skin diseases: Inflammatory cross-talk that needs a multidisciplinary approach

Mercedes Perez-Carreras et al. World J Gastroenterol. .

Abstract

Non-alcoholic fatty liver disease (NAFLD) is currently considered the most common cause of liver disease. Its prevalence is increasing in parallel with the obesity and type 2 diabetes mellitus (DM2) epidemics in developed countries. Several recent studies have suggested that NAFLD may be the hepatic manifestation of a systemic inflammatory metabolic disease that also affects other organs, such as intestine, lungs, skin and vascular endothelium. It appears that local and systemic proinflammatory/anti-inflammatory cytokine imbalance, together with insulin resistance and changes in the intestinal microbiota, are pathogenic mechanisms shared by NAFLD and other comorbidities. NAFLD is more common in patients with extrahepatic diseases such as inflammatory bowel disease (IBD), obstructive syndrome apnea (OSA) and psoriasis than in the general population. Furthermore, there is evidence that this association has a negative impact on the severity of liver lesions. Specific risk characteristics for NAFLD have been identified in populations with IBD (i.e. age, obesity, DM2, previous bowel surgery, IBD evolution time, methotrexate treatment), OSA (i.e. obesity, DM2, OSA severity, increased transaminases) and psoriasis (i.e. age, metabolic factors, severe psoriasis, arthropathy, elevated transaminases, methotrexate treatment). These specific phenotypes might be used by gastroenterologists, pneumologists and dermatologists to create screening algorithms for NAFLD. Such algorithms should include non-invasive markers of fibrosis used in NAFLD to select subjects for referral to the hepatologist. Prospective, controlled studies in NAFLD patients with extrahepatic comorbidities are required to demonstrate a causal relationship and also that appropriate multidisciplinary management improves these patients' prognosis and survival.

Keywords: Inflammatory bowel disease; Liver fibrosis; Metabolic syndrome; Non-alcoholic fatty liver disease; Obstructive sleep apnea; Psoriasis.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Potential pathogenic factors contributing to the co-existence of non-alcoholic fatty liver disease and extrahepatic comorbidities (i.e. inflammatory bowel disease, obstructive syndrome apnea and psoriasis). IBD: Inflammatory bowel disease; NAFLD: Non-alcoholic fatty liver disease; OSA: Obstructive syndrome apnea; VAT: Visceral adipose tissue.
Figure 2
Figure 2
Non-alcoholic fatty liver disease and extrahepatic comorbidities (i.e. inflammatory bowel disease, obstructive syndrome apnea and psoriasis) risk phenotypes. ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; IBD: Inflammatory bowel disease; NAFLD: Non-alcoholic fatty liver disease; OSA: Obstructive syndrome apnea.
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