Impaired Gallbladder Motility and Increased Gallbladder Wall Thickness in Patients with Nonalcoholic Fatty Liver Disease

BACKGROUND/AIMS: Nonalcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease worldwide. Along with the increase in the incidence of NAFLD and associated obesity, an increase in gallbladder disease (GD) has been noted. This has led to the identification of a new disease entity called fatty GD. There is a gap in the literature on the dynamics of gallbladder function in patients with NAFLD. METHODS: An observational case-control study, a total of 50 patients with biopsy proven NAFLD without gallbladder stone/sludge and 38 healthy comparison subjects were enrolled. Fasting, postprandial gallbladder volumes (PGV), gallbladder ejection fraction (GEF), and fasting gallbladder wall thickness (FGWT) were measured by real-time 2-dimensional ultrasonography. RESULTS: Fasting gallbladder wall thickness, fasting gallbladder volumes and PGV were significantly higher in patients with NAFLD than control subjects (P < 0.001, P = 0.006, and P < 0.001, respectively). Gallbladder ejection fraction was significantly lower in the NAFLD group than the controls (P = 0.008). The presence of NAFLD was an independent predictor for GEF, PGV, and FGWT. Also, steatosis grade was an independent predictor for GEF, and GEF was significantly lower in the nonalcoholic steatohepatitis (NASH) subgroup than the controls. CONCLUSIONS: Gallbladder dysfunction and increase in gallbladder wall thickness exists in asymptomatic (without stone/sludge and related symptoms) patients with NAFLD and are useful in identifying fatty GD. Measurement of these variables in NAFLD patients may be useful in identifying those at higher risk for GD.

Metabolic syndrome frequency in inflammatory bowel diseases

Metabolic syndrome [MetS] is a clinical condition characterized by central obesity, elevated triglycerides, low-high density lipoproteins, impaired fasting glucose, and hypertension. There is insufficient data on the prevalence of MetS in patients with inflammatory bowel disease [IBD]. This study sought to determine the prevalence of MetS in a Turkish cohort of patients with IBD and the association between insulin resistance [IR] and the MetS parameters, in this population. A total of 177 patients over 18 years of age [62 with Crohn's disease [CD] and 115 with ulcerative colitis [UC]] were enrolled in the study. The presence of at least three criteria of the International Diabetes Federation [IDF] was accepted for the diagnosis of MetS. The Homeostasis Model Assessment [HOMA] was used to determine IR. HOMA values < 1 were considered normal and values > 2.5 indicated a high probability of IR. MetS frequency was higher in patients n=34 [29.5%] with UC than in patients n=11 [17.7%] with CD [P < 0.01]. MetS was detected in 12 of the 117 patients [10.3%] with IBD, under 45 years of age, and in 33 of 60 patients [55%] over 45 years of age. HOMA value in n=31 patients [27%] with UC was > 2.5. Body mass index, insulin [P < 0.001], waist circumference, fasting plasma glucose, leukocyte count [P < 0.01], triglycerides, C-reactive protein, and uric acid values [P < 0.05] were significantly higher in UC patients with IR than those without IR. Frequent occurrence of MS with increasing age in IBD, particularly in UC, showed the importance of early diagnosis and treatment of cardiovascular disease risk factors in the long-term follow-up of these diseases