title: High prevalence of colorectal neoplasm in patients with non-alcoholic steatohepatitis.
abstract: OBJECTIVE
  Non-alcoholic fatty liver disease (NAFLD) affects 20-40% of the general adult population. Due to shared risk factors, it is postulated that NAFLD patients have an increased risk of colorectal neoplasm and should be a target group for screening. The aim of this study was to examine the prevalence of colorectal neoplasm in NAFLD patients and the risk of colorectal neoplasm in relation to the severity of NAFLD histology. Design Cross-sectional study.
  
  
  METHODS
  University hospital with case recruitment from the community and clinics.
  
  
  METHODS
  Subjects aged 40-70 years were recruited for colonoscopic screening from two study cohorts: (1) community subjects; and (2) consecutive patients with biopsy proven NAFLD. In the community cohort, hepatic fat was measured by proton-magnetic resonance spectroscopy.
  
  
  METHODS
  Prevalence of colorectal adenomas. Advanced colorectal neoplasm was defined as cancer or adenomas with villous architecture or high grade dysplasia.
  
  
  RESULTS
  NAFLD patients (N=199) had a higher prevalence of colorectal adenomas (34.7% vs 21.5%; p=0.043) and advanced neoplasms (18.6% vs 5.5%; p=0.002) than healthy controls (N=181). Thirteen of 29 (45%) NAFLD patients with advanced neoplasms had isolated lesions in the right sided colon. Among patients with biopsy proven NAFLD, patients with non-alcoholic steatohepatitis (N=49) had a higher prevalence of adenomas (51.0% vs 25.6%; p=0.005) and advanced neoplasms (34.7% vs 14.0%; p=0.011) than those with simple steatosis (N=86). After adjusting for demographic and metabolic factors, non-alcoholic steatohepatitis remained associated with adenomas (adjusted OR 4.89, 95% CI 2.04 to 11.70) and advanced neoplasms (OR 5.34, 95% CI 1.92 to 14.84). In contrast, the prevalence of adenomas and advanced neoplasms was similar between patients with simple steatosis and control subjects.
  
  
  CONCLUSIONS
  Non-alcoholic steatohepatitis is associated with a high prevalence of colorectal adenomas and advanced neoplasms. The adenomas are found more commonly in the right sided colon. Colorectal cancer screening is strongly indicated in this high risk group.
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong, China.
authors.forename: Vincent Wai-Sun
authors.initials: VW
authors.lastname: Wong
authors.forename: Grace Lai-Hung
authors.initials: GL
authors.lastname: Wong
authors.forename: Steven Woon-Choy
authors.initials: SW
authors.lastname: Tsang
authors.forename: Tina
authors.initials: T
authors.lastname: Fan
authors.forename: Winnie Chiu-Wing
authors.initials: WC
authors.lastname: Chu
authors.forename: Jean
authors.initials: J
authors.lastname: Woo
authors.forename: Anthony Wing-Hung
authors.initials: AW
authors.lastname: Chan
authors.forename: Paul Cheung-Lung
authors.initials: PC
authors.lastname: Choi
authors.forename: Angel Mei-Ling
authors.initials: AM
authors.lastname: Chim
authors.forename: James Yun-Wong
authors.initials: JY
authors.lastname: Lau
authors.forename: Francis Ka-Leung
authors.initials: FK
authors.lastname: Chan
authors.forename: Joseph Jao-Yiu
authors.initials: JJ
authors.lastname: Sung
authors.forename: Henry Lik-Yuen
authors.initials: HL
authors.lastname: Chan
mesh_terms: D000236:Adenoma / Q000209:etiology / Q000473:pathology; D000328:Adult; D000368:Aged; D001706:Biopsy; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D004812:Epidemiologic Methods; D005234:Fatty Liver / Q000150:complications / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D008099:Liver / Q000473:pathology; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease