Opinion Review
Copyright ©The Author(s) 2021.
World J Hepatol. Dec 27, 2021; 13(12): 1816-1827
Published online Dec 27, 2021. doi: 10.4254/wjh.v13.i12.1816
Table 1 Summarizes the literature on the co-existing prevalence of irritable bowel syndrome and non-alcoholic fatty liver disease to date
Population studied
Study design
No. patients
Criteria for IBS diagnosis
IBS subtypes
Criteria for NAFLD diagnosis
Prevalence of NAFLD in IBS/ IBS in NAFLD
Hasanain et al[15]IBSCross sectional study100 patients with IBSRome IIIIBS-C: 45%; IBS-D: 23%; IBS-M: 32%,Ultrasound; No history of alcohol exposure; No exposure to steatogenic medications; Negative viral screen74% of those with IBS had co-existing NAFLDModerate/severe NAFLD significantly associated with moderate/severe IBS (OR: 2.4, 95%CI: 1.3-62.7, P = 0.026)
Shin et al[16]Healthy individuals via NHANESCross sectional study2345 patients with IBSRome IVIBS-C: 1023; IBS-D: 1322Raised ALT or AST; Absence of excessive alcohol; Negative viral hepatitis screenPrevalence of NAFLD in IBS-D: 12.9% (95%CI: 9.8-15.9); IBS-C: 9.0% (95%CI: 7.0-11.0)NAFLD associated with diarrhoea vs normal bowel pattern (OR: 1.340, 95%CI: 1.007-1.784) and constipation (OR: 1.445, 95%CI: 1.028-2.031)
Arasteh et al[17]IBSCohort study1067 patients with IBSRome IVIBS-D: 57 (5.3%); IBS-C: 380 (35.6%); IBS-U: 630 (59%)Not documented3.7%Liver disease not associated with IBS (Coefficient: 0.26, OR: 1.30, 95%CI: 0.92-1.82)
Lee et al[19]IBS vs controlRetrospective, cross sectional, case control study83 IBS patients; 260 age and sex matched controlRome IIIIBS-C: 14.8%; IBS-D: 49.4%; IBS-M: 31.3%; IBS-U: 4.5%Investigated raised ALT, GGT, AST and features of metabolic syndrome 16.9% of IBS patients had raised ALT; 24.1% had raised GGTSignificantly higher ALT in patients with IBS (16.9% vs 7.7%; P = 0.015); Significantly higher GGT in patients with IBS (24.1% vs 11.5%; P = 0.037); Significantly higher prevalence of metabolic syndrome in patients with IBS (32.5% vs 12.7%; P < 0.001)
Sarmini et al[73]IBS vs control Observational study637942Clinical diagnosisNot documentedNot documentedNot availablePatients with IBS significantly more likely to develop NAFLD compared to non-IBS group (OR: 3.204, 95%CI: 3.130-3.279, P < 0.001)
Singh et al[24]NAFLDRetrospective analysis632Clinical diagnosisNot documentedUltrasound; Alcohol consumption < 20 g/d; Normal aetiological liver screen186 (29.4%) patients with NAFLD had clinical diagnosis of IBSIBS symptoms are highly prevalent in those with NAFLD
Jones-Pauley et al[22]NAFLDCross-sectional study130Rome IVNot documentedNot documented38 (29.2%) patients with NAFLD met Rome IV IBS criteriaHigh prevalence of IBS in patients with NAFLD; Significant increase in prevalence of depression (18.4% vs 5.4%, P = 0.01) and anxiety (31.6% vs 9.8%, P = 0.002) in those with co-existing IBS compared to those with NAFLD without IBS