Perez-Carreras M, Casis-Herce B, Rivera R, Fernandez I, Martinez-Montiel P, Villena V. Non-alcoholic fatty liver disease in patients with intestinal, pulmonary or skin diseases: Inflammatory cross-talk that needs a multidisciplinary approach. World J Gastroenterol 2021; 27(41): 7113-7124 [PMID: 34887631 DOI: 10.3748/wjg.v27.i41.7113]
Corresponding Author of This Article
Mercedes Perez-Carreras, MD, PhD, Associate Professor, Medical Specialist. Gastroenterology and Hepatology Unit, 12 de Octubre Universitary Hospital, Av. de Córdoba s/n, Madrid 28041, Spain. mpcarreras@salud.madrid.org
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Nov 7, 2021; 27(41): 7113-7124 Published online Nov 7, 2021. 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, Begoña Casis-Herce, Inmaculada Fernandez, Pilar Martinez-Montiel, Gastroenterology and Hepatology Unit, 12 de Octubre Universitary Hospital, Madrid 28041, Spain
Mercedes Perez-Carreras, Begoña Casis-Herce, Raquel Rivera, Inmaculada Fernandez, Pilar Martinez-Montiel, Victoria Villena, Faculty of Medicine, Complutense University, Madrid 28040, Spain
Raquel Rivera, Dermatology Department, 12 de Octubre Universitary Hospital, Madrid 28041, Spain
Victoria Villena, Pneumology Service, 12 de Octubre Universitary Hospital, Madrid 28041, Spain
Author contributions: Perez-Carreras M coordinated the review and wrote the majority of the article; Casis-Herce B and Martinez-Montiel P contributed to writing of the content on inflammatory bowel disease; Fernandez I contributed to writing of the content on non-alcoholic fatty liver disease; Rivera R contributed to writing of the content on psoriasis; Villena V contributed to writing of the content on obstructive apnea syndrome; and all authors have read and approve the final manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mercedes Perez-Carreras, MD, PhD, Associate Professor, Medical Specialist. Gastroenterology and Hepatology Unit, 12 de Octubre Universitary Hospital, Av. de Córdoba s/n, Madrid 28041, Spain. mpcarreras@salud.madrid.org
Received: May 20, 2021 Peer-review started: May 20, 2021 First decision: June 12, 2021 Revised: July 4, 2021 Accepted: September 16, 2021 Article in press: September 16, 2021 Published online: November 7, 2021
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.
Core Tip: 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 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. This article reviews the currently available literature on issues relating to the co-existence of NAFLD and inflammatory bowel disease, obstructive syndrome apnea or psoriasis, with particular focus on the prevalence, risk factors and impact on clinical multidisciplinary management.
