Prevalence of Non-Alcoholic Fatty Liver with Gall Stones Disease in Himalayan Population

ABSTRACT

Non-Alcoholic Fatty Liver Disease (NAFLD) is the hepatic pandemic of the 21st century. It is the amassing of fats in the hepatic tissue without significant alcohol intake that results in hepatic steatosis. Patients with gall bladder stones may have associated NAFLD as these ailments share similar factors like obesity, hypertriglyceridemia and diabetes mellitus. However, few, if any, reports are available about the association of NAFLD with gallstones in the hilly population. Hence, this study was conducted to find out the prevalence of NAFLD in patients with gall bladder stone disease.METHODSThis study was done in the Department of Surgery, Indira Gandhi Medical College, Shimla, from June 2017 to May 2019. A total of 300 patients of ultrasound proven gall bladder stones was studied for NAFLD by Fibroscan (transient elastography). Transient elastography (TE) is a noninvasive method that has been shown to be useful for the detection of liver steatosis and fibrosis. NAFLD was diagnosed based on the value of CAP (Controlled Attenuation Parameter) & degree of fibrosis was assessed based on liver stiffness measurement (LSM) value on TE. Steatosis was graded as S0, S1, S2, and S3 while fibrosis was graded as F0-F1, F1, F2, F3, and cirrhosis. Minimum cut-off CAP value for diagnosing NAFLD was 214 dB/m & significant fibrosis was taken with LSM value >7.5 kPa.RESULTSPatients of gall stone disease showed significant liver steatosis, suggestive of NAFLD in 189 patients (63%), based on CAP value; however, 111 patients (37%) did not have significant steatosis. In patients with NAFLD, 57 (30%) had mild steatosis (s1) while 39 (20.53%) & 24 (12.63%) had moderate (s2) and severe (s3) steatosis respectively. Similarity, 72 (24%) patients had significant fibrosis while 228 (76%) patients had no to insignificant fibrosis on TE, 51 (17%) patients had moderate fibrosis, while 14 (4.5%) and 8 (2.5%) patients had severe fibrosis & cirrhosis respectively.CONCLUSIONSHigh prevalence of NAFLD in patients of gall stone disease was observed. Most of the patients had mild NAFLD i.e. grade S1 steatosis & in addition, fibrosis was present in 24% patients of NAFLD with gall stone disease.