Racial differences in prevalence and severity of non-alcoholic fatty liver disease.

The aim of this review is to assess the evidence regarding racial differences in the prevalence and severity of nonalcoholic fatty liver disease (NAFLD). We reviewed the published literature that reported prevalence, severity, and genetic associations of NAFLD in different ethnic groups. The metabolic syndrome (MetS) has been associated with NAFLD, but each component of the MetS is present in various races in different percentages and their effect on NAFLD appears to be dissimilar. An elevated triglyceride (TG) level seems to have the strongest association with NAFLD. The latter is more prevalent in Hispanic patients; Blacks have lower TG levels and a lower NAFLD prevalence, compared to Caucasians or Hispanics. The severity of liver fibrosis is lower in some, but not all biopsy-based studies of Black patients. No study has evaluated the severity of liver disease controlling for the individual components of MetS, especially TG. Important racial differences in the prevalence of selected genetic polymorphisms, particularly PNPLA-3 and MBOAT7 have been documented, together with their effects on the prevalence of liver steatosis and fibrosis. Data on overall and liver mortality have found no significant differences according to race/ethnicity, with the possible exception of one paper reporting lower cirrhosis mortality in Black patients. We conclude that NAFLD is more prevalent in Hispanics and less in Blacks. This is supported by differences in key genetic polymorphisms associated with hepatic fat storage. However, there is presently insufficient evidence to firmly conclude that race, per se, plays a role in the development of liver fibrosis and its complications. Further studies, appropriately controlled for diet, exercise, and individual MetS parameters are needed.

Persistent Encephalopathy in a Noncirrhotic Patient: Do not Shun This Shunt.

A portosystemic venous shunt is the formation of an abnormal connection between the portal vein and a systemic vein, allowing blood to bypass the liver. Portosystemic shunts are usually believed to be due to portal hypertension in the setting of underlying hepatic disease. We report a case of large, spontaneous intrahepatic portosystemic shunt in a noncirrhotic patient contributing to recurrent hepatic encephalopathy, also known as type B encephalopathy. Management of portosystemic encephalopathy involves occlusion of the shunt by endovascular management.

Ileal artery pseudoaneurysm: a rare cause of gastrointestinal bleed.

Aorto-enteric fistulas are life-threatening conditions that occur commonly between the aorta and duodenum. Our case describes a fistula between the ileal artery and small bowel. To our knowledge, ileal artery fistulas are more commonly described in surgical cases, unlike our case. This case emphasizes early diagnosis of an aorto-enteric fistula causing life-threatening gastrointestinal bleeding to improve morbidity and survival.

The Effects of Hepatic Steatosis on the Natural History of HBV Infection.

Fatty liver prevalence is increasing and becoming a global health burden. Chronic hepatitis B infection (CHB) is one of the most common chronic viral infections. Steatosis in CHB patients increases risk of cirrhosis and hepatocellular carcinoma. Data from studies on the interaction between CHB and nonalcoholic fatty liver disease are not conclusive. Liver biopsy is the gold standard for diagnosis of fatty liver; however, noninvasive diagnostic tests have been developed to diagnose and predict fibrosis in CHB/NAFLD. Treatment guidelines are not clear.