{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:08:54Z","timestamp":1792080534131,"version":"4.4.0"},"reference-count":40,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2022,5,6]],"date-time":"2022-05-06T00:00:00Z","timestamp":1651795200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background and Purpose: Chronic inflammatory bowel diseases (IBD) frequently affect extraintestinal organs including the liver. Since limited evidence suggests the presence of liver disease in IBD patients, we studied the frequency of hepatic steatosis and fibrosis in these patients and characterized disease-related factors. Methods: In this retrospective, cross-sectional, hospital-based, single-center study, consecutive patients with Crohn\u2019s disease (CD) and ulcerative colitis (UC) were included who had undergone routine abdominal ultrasound including transhepatic elastography. Hepatic steatosis was diagnosed by hyperechogenicity on B-mode ultrasound and by measuring controlled attenuation parameter (CAP). Hepatic fibrosis was assumed if transhepatic elastography yielded a stiffness &gt; 7 kPa. Results: 132 patients (60% CD) with a median disease duration of 10 years were included. Steatosis assessed by B-mode ultrasound and CAP correlated well. Of the IBD patients, 30.3% had non-alcoholic fatty liver (NAFL). Factors associated with NAFL were age, BMI, duration of disease, as well as serum activities of aspartate-aminotransferase (AST) and gamma-glutamyl-transpeptidase (GGT). In multivariate analysis, only disease duration was independently associated with hepatic steatosis. Hepatic fibrosis was found in 10 (8%) of all IBD patients, predominantly in patients with CD (10\/11). Conclusions: Pure hepatic steatosis is common in both CD and UC, whereas hepatic fibrosis occurs predominantly in CD patients. Association of disease duration with NAFLD suggests a contribution of IBD-related pathogenetic factors. Longitudinal studies are needed to better understand the impact of IBD on hepatic disorders.<\/jats:p>","DOI":"10.3390\/jcm11092623","type":"journal-article","created":{"date-parts":[[2022,5,6]],"date-time":"2022-05-06T14:49:38Z","timestamp":1651848578000},"page":"2623","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Hepatic Steatosis and Fibrosis in Chronic Inflammatory Bowel Disease"],"prefix":"10.3390","volume":"11","author":[{"given":"Claudia","family":"Veltkamp","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Transplantation Medicine, University Hospital Essen, Hufelandstra\u00dfe 55, 45147 Essen, Germany"},{"name":"Department of Internal Medicine, Salem Hospital, 69121 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Lan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Salem Hospital, 69121 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni","family":"Korompoki","sequence":"additional","affiliation":[{"name":"Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl-Heinz","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Salem Hospital, 69121 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hartmut","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Transplantation Medicine, University Hospital Essen, Hufelandstra\u00dfe 55, 45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helmut K.","family":"Seitz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Salem Hospital, 69121 Heidelberg, Germany"},{"name":"Centre of Liver- and Alcohol Diseases, Ethianum Clinic, 69115 Heidelberg, Germany"},{"name":"Faculty of Medicine, University of Heidelberg, 69117 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1016\/j.immuni.2019.03.017","article-title":"Cytokine Networks in the Pathophysiology of Inflammatory Bowel Disease","volume":"50","author":"Friedrich","year":"2019","journal-title":"Immunity"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1982","DOI":"10.1097\/MIB.0000000000000392","article-title":"Extraintestinal Manifestations of Inflammatory Bowel Disease","volume":"21","author":"Vavricka","year":"2015","journal-title":"Inflamm. Bowel. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1177\/2050640620950093","article-title":"Assessment of extraintestinal manifestations in inflammatory bowel diseases: A systematic review and a proposed guide for clinical trials","volume":"8","author":"Guillo","year":"2020","journal-title":"United Eur. Gastroenterol. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/apt.12794","article-title":"Systematic review: The epidemiology of the hepatobiliary manifestations in patients with inflammatory bowel disease","volume":"40","author":"Gizard","year":"2014","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1097\/MEG.0000000000000532","article-title":"Primary sclerosing cholangitis associated with inflammatory bowel disease: An update","volume":"28","author":"Rossi","year":"2016","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2063","DOI":"10.1056\/NEJMra1503519","article-title":"Cause, Pathogenesis, and Treatment of Nonalcoholic Steatohepatitis","volume":"377","author":"Diehl","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/hep.28431","article-title":"Global epidemiology of nonalcoholic fatty liver disease-Meta-analytic assessment of prevalence, incidence, and outcomes","volume":"64","author":"Younossi","year":"2016","journal-title":"Hepatology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"8294","DOI":"10.3748\/wjg.v22.i37.8294","article-title":"Hepatocellular carcinoma in patients with non-alcoholic fatty liver disease","volume":"22","author":"Wong","year":"2016","journal-title":"World J. Gastroenterol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1097\/MEG.0000000000001679","article-title":"Non-alcoholic fatty liver disease in inflammatory bowel disease patients","volume":"32","author":"Karaivazoglou","year":"2020","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2708","DOI":"10.1111\/j.1572-0241.2007.01526.x","article-title":"The severity of ultrasonographic findings in nonalcoholic fatty liver disease reflects the metabolic syndrome and visceral fat accumulation","volume":"102","author":"Hamaguchi","year":"2007","journal-title":"Am. J. Gastroenterol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"49","DOI":"10.2147\/HMER.S7394","article-title":"Liver stiffness: A novel parameter for the diagnosis of liver disease","volume":"2","author":"Mueller","year":"2010","journal-title":"Hepat. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1093\/ibd\/izy200","article-title":"Screening for Nonalcoholic Fatty Liver Disease in Inflammatory Bowel Diseases: A Cohort Study Using Transient Elastography","volume":"25","author":"Restellini","year":"2019","journal-title":"Inflamm. Bowel. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1022","DOI":"10.1016\/j.jhep.2016.12.022","article-title":"Individual patient data meta-analysis of controlled attenuation parameter (CAP) technology for assessing steatosis","volume":"66","author":"Karlas","year":"2017","journal-title":"J. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1097\/MEG.0b013e3283499252","article-title":"Prospective noninvasive analysis of hepatic fibrosis in patients with Crohn\u2019s disease: Correlation of transient elastography and laboratory-based markers","volume":"23","author":"Schirren","year":"2011","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1002\/hep.29367","article-title":"The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases","volume":"67","author":"Chalasani","year":"2018","journal-title":"Hepatology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"7604939","DOI":"10.1155\/2019\/7604939","article-title":"Frequency of Hepatobiliary Manifestations and Concomitant Liver Disease in Inflammatory Bowel Disease Patients","volume":"2019","author":"Silva","year":"2019","journal-title":"Biomed. Res. Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e279","DOI":"10.1016\/j.crohns.2012.10.015","article-title":"Risk factors of non-alcoholic fatty liver disease in patients with inflammatory bowel disease","volume":"7","author":"Sourianarayanane","year":"2013","journal-title":"J. Crohns. Colitis"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"5676","DOI":"10.3748\/wjg.v25.i37.5676","article-title":"Nonalcoholic fatty liver disease in patients with inflammatory bowel disease: Beyond the natural history","volume":"25","author":"Paduano","year":"2019","journal-title":"World J. Gastroenterol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1093\/ibd\/izaa189","article-title":"Prevalence of Nonalcoholic Fatty Liver Disease in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis","volume":"27","author":"Lin","year":"2021","journal-title":"Inflamm. Bowel. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1136\/gut.31.4.468","article-title":"Liver histology and follow up of 68 patients with ulcerative colitis and normal liver function tests","volume":"31","author":"Glaumann","year":"1990","journal-title":"Gut"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Gr\u0105t, K., Gr\u0105t, M., and Rowi\u0144ski, O. (2020). Usefulness of Different Imaging Modalities in Evaluation of Patients with Non-Alcoholic Fatty Liver Disease. Biomedicines, 8.","DOI":"10.3390\/biomedicines8090298"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1053\/gast.2001.22547","article-title":"Continuous stimulation by normal luminal bacteria is essential for the development and perpetuation of colitis in Tg(epsilon26) mice","volume":"120","author":"Veltkamp","year":"2001","journal-title":"Gastroenterology"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1038\/s41572-018-0014-7","article-title":"Alcoholic liver disease","volume":"4","author":"Seitz","year":"2018","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"498","DOI":"10.3389\/fphys.2016.00498","article-title":"Vitamin D Signaling through Induction of Paneth Cell Defensins Maintains Gut Microbiota and Improves Metabolic Disorders and Hepatic Steatosis in Animal Models","volume":"7","author":"Su","year":"2016","journal-title":"Front. Physiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1038\/s41591-019-0495-2","article-title":"Supplementation with Akkermansia muciniphila in overweight and obese human volunteers: A proof-of-concept exploratory study","volume":"25","author":"Depommier","year":"2019","journal-title":"Nat. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1016\/j.metabol.2015.12.012","article-title":"The multiple-hit pathogenesis of non-alcoholic fatty liver disease (NAFLD)","volume":"65","author":"Buzzetti","year":"2016","journal-title":"Metabolism"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S8","DOI":"10.1097\/01.mcg.0000123993.13937.ec","article-title":"The overlap of inflammatory bowel disease and diverticular disease","volume":"38","author":"Peppercorn","year":"2004","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_28","first-page":"274","article-title":"The Interrelationship Among Non-Alcoholic Fatty Liver Disease, Colonic Diverticulosis and Metabolic Syndrome","volume":"30","author":"Milovanovic","year":"2021","journal-title":"J. Gastrointestin. Liver Dis."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Adams, L.C., L\u00fcbbe, F., Bressem, K., Wagner, M., Hamm, B., and Makowski, M.R. (2018). Non-alcoholic fatty liver disease in underweight patients with inflammatory bowel disease: A case-control study. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0206450"},{"key":"ref_30","first-page":"719","article-title":"Tumor Incidence in Patients with Non-Alcoholic Fatty Liver Disease","volume":"117","author":"Huber","year":"2020","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"575","DOI":"10.3109\/00365521.2011.647412","article-title":"Evaluation of liver fibrosis by transient elastography (Fibroscan\u00ae) in patients with inflammatory bowel disease treated with methotrexate: A multicentric trial","volume":"47","author":"Taxonera","year":"2012","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Jobanputra, P., Amarasena, R., Maggs, F., Homer, D., Bowman, S., Rankin, E., Filer, A., Raza, K., and Jubb, R. (2008). Hepatotoxicity associated with sulfasalazine in inflammatory arthritis: A case series from a local surveillance of serious adverse events. BMC Musculoskelet. Disord., 9.","DOI":"10.1186\/1471-2474-9-48"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1056\/NEJM200011163432007","article-title":"Cytokines in alcoholic and nonalcoholic steatohepatitis","volume":"343","author":"Tilg","year":"2000","journal-title":"N. Engl. J. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1677\/JOE-07-0234","article-title":"Infliximab reverses steatosis and improves insulin signal transduction in liver of rats fed a high-fat diet","volume":"194","author":"Barbuio","year":"2007","journal-title":"J. Endocrinol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.3899\/jrheum.110763","article-title":"Hepatic steatosis and disease activity in subjects with psoriatic arthritis receiving tumor necrosis factor-\u03b1 blockers","volume":"39","author":"Iervolino","year":"2012","journal-title":"J. Rheumatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1016\/j.crohns.2013.12.006","article-title":"Detection of liver injury in IBD using transient elastography","volume":"8","author":"Thin","year":"2014","journal-title":"J. Crohns. Colitis"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3186","DOI":"10.1007\/s10620-020-06588-6","article-title":"Nonalcoholic Fatty Liver Disease Is Common in IBD Patients However Progression to Hepatic Fibrosis by Noninvasive Markers Is Rare","volume":"66","author":"Ritaccio","year":"2021","journal-title":"Dig. Dis. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1097\/SGA.0000000000000461","article-title":"Ulcerative Colitis as an Independent Risk Factor for Hepatic Steatosis","volume":"43","author":"Mancina","year":"2020","journal-title":"Gastroenterol. Nurs."},{"key":"ref_39","first-page":"140","article-title":"Secondary causes of fatty liver disease - an update on pathogenesis, diagnosis and treatment strategies","volume":"145","author":"Keitel","year":"2020","journal-title":"Dtsch. Med. Wochenschr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.jhep.2017.09.003","article-title":"Genetics and epigenetics of NAFLD and NASH: Clinical impact","volume":"68","author":"Eslam","year":"2018","journal-title":"J. Hepatol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/9\/2623\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:07:12Z","timestamp":1760137632000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/9\/2623"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,6]]},"references-count":40,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["jcm11092623"],"URL":"https:\/\/doi.org\/10.3390\/jcm11092623","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,6]]}}}