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| |  Gallstones Associated With Nonalcoholic Steatohepatitis (Nash) and Metabolic Syndrome: Presented at ASCP By Lexa W. Lee NEW ORLEANS, LA -- October 24, 2007 -- Patients with symptomatic gallstones have a high prevalence of nonalcoholic steatohepatitis (NASH), as well as a significant association with metabolic syndrome, as suggested by a prospective study presented at the annual meeting of the American Society for Clinical Pathology (ASCP). NASH, the more progressive form of nonalcoholic fatty liver disease (NAFLD), has been associated with hepatocellular injury and progressive fibrosis. Symptomatic gallstones are often associated with obesity, hypertriglyceridaemia, insulin resistance, and type 2 diabetes mellitus, which may in turn be linked to NASH. Metabolic syndrome is characterised by three of the following criteria: increased waist circumference; hypertriglyceridaemia; hypercholesterolaemia; hypertension; and hyperglycaemia. To evaluate the prevalence of NASH and the metabolic syndrome in patients with symptomatic gallstones undergoing laparoscopic cholecystectomy, investigators led by Anurada Sekaran, MD, Consultant Pathologist, Asian Institute of Gastroenterology, Somajiguda, Hyderabad, India, performed a study of 88 patients. The simultaneous liver biopsies were performed during cholecystectomy between 2006 and 2007 There were no postoperative complications, Dr. Sekaran noted. Patients with significant alcohol intake, hepatitis B or C (virus-positive), autoimmune diseases, and Wilson's disease were excluded. The investigators compared the demographics, anthropometric measurements, liver function tests, lipid profile, and ultrasound findings of patients with and without NASH. Following the diagnosis of NASH, the liver biopsies were scored using the modified Brunt fibrosis score, and NAFLD Activity Score/NAS was used for steatosis/fatty change, lobular inflammation, and ballooning. Results show the following significant associations with the diagnosis of NASH in the biopsies by univariate analysis: steatosis (P <.0001), hepatocellular ballooning (P <.0001), lobular inflammation (P =.0128), fibrosis (P <.0001). In addition, multivariate logistic regression analysis showed the following associations with NASH: steatosis (P =.027), hepatocellular ballooning (P =.16), lobular inflammation (P =.002). NASH was associated with the metabolic syndrome; 34% of patients with NASH had a higher prevalence of diabetes than those without NASH (31.8% vs 17.9%), higher serum cholesterol (53% vs 33.1%), and serum triglycerides (29.4% vs 18.5%). Patients with symptomatic gall stones have a higher prevalence of NASH. An early diagnosis of NASH may help motivate patients to adopt a healthier lifestyle and prevent progression of the disease, the researchers concluded. They also noted that liver biopsy can be performed safely during laparoscopic cholecystectomy, and that histological evaluation helps in the early detection of cirrhosis. Dr. Sekaran said, "An earlier detection of NASH may allow us to follow these patients and see whether they proceed to cirrhosis. It means they can adopt lifestyle modifications which can prevent the further progression of NASH."
[Presentation title: Prevalence of Non-Alcoholic Steatohepatitis in Symptomatic Gallstone Patients: A Prospective Study. Poster 72]
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