Clinical characteristics of de novo nonalcoholic fatty liver disease following pancreaticoduodenectomy (original) (raw)

Abstract

Background

Hepatic steatosis may develop after pancreatic resection, but its clinicopathological features remain unclear. We explored the clinical characteristics of newly appearing nonalcoholic fatty liver disease (NAFLD) after pancreaticoduodenectomy (PD), designated as de novo NAFLD after PD.

Methods

Of 83 patients who underwent PD between 2001 and 2006, the patients with regular alcohol consumption after PD (n = 3), those who were unavailable for regular abdominal computed tomography follow-up (n = 12), and those who died within 6 months of PD (n = 8) were excluded from the study. In the remaining 60 patients, the prevalence and clinical features of de novo NAFLD after PD were examined.

Results

NAFLD developed after PD in 14 (23%) patients in our cohort. Liver biopsy was performed in 8 patients and all showed typical steatohepatitis. Compared with the patients who had conventional nonalcoholic steatohepatitis (NASH), patients with post-PD de novo NASH demonstrated significant decreases in body mass index and lower levels of serum albumin, cholesterol, apolipoprotein B, and homeostasis model assessment for insulin resistance. Multivariate logistic regression analysis revealed that pancreatic head cancer was associated with an increased risk of developing NAFLD after PD (odds ratio 12.0, 95% confidence interval 2.0–71.4, P = 0.006). Increased dosage of oral pancreatic enzymes significantly ameliorated the steatosis, as well as leading to the recovery of body weight loss and resolution of the biochemical abnormalities.

Conclusions

De novo NAFLD/NASH after PD is characterized by non-obesity and lack of hyperlipidemia and insulin resistance and is associated with pancreatic exocrine insufficiency. In such patients, intensifying pancreatic enzyme supplementation may be useful.

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Abbreviations

ALT:

Alanine aminotransferase

apoB:

Apolipoprotein B

AST:

Aspartate aminotransferase

BMI:

Body mass index

CT:

Computed tomography

γGT:

Gamma-glutamyltransferase

HbA1c:

Hemoglobin A1c

HBV:

Hepatitis B virus

HCV:

Hepatitis C virus

HDL:

High-density lipoprotein

HOMA-IR:

Homeostasis model assessment for insulin resistance

MCD:

Methionine- and choline-deficient diet

NAFLD:

Nonalcoholic fatty liver disease

NAS:

NAFLD activity score

NASH:

Nonalcoholic steatohepatitis

PD:

Pancreaticoduodenectomy

VLDL:

Very-low-density lipoprotein

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Acknowledgments

We thank Mr. Hideyasu Fujii and Dr. Takefumi Kimura for their help and Mr. Trevor Ralph for his editorial assistance. The authors have declared that no financial support exists.

Conflict of interest

The authors have declared that no conflict of interest exists.

Author information

Authors and Affiliations

  1. Department of Metabolic Regulation, Institute on Aging and Adaptation, Shinshu University Graduate School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
    Naoki Tanaka & Toshifumi Aoyama
  2. Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
    Naoki Tanaka, Tadanobu Nagaya, Michiharu Komatsu & Eiji Tanaka
  3. Department of Gastroenterology, Showa Inan General Hospital, Komegane, Japan
    Akira Horiuchi
  4. Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
    Takahide Yokoyama & Shin-ichi Miyagawa
  5. Department of Surgery, Iida Municipal Hospital, Iida, Japan
    Gengo Kaneko & Naoto Horigome
  6. Department of Gastroenterology, Iida Municipal Hospital, Iida, Japan
    Takahiro Yamaura
  7. Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
    Kenji Sano

Authors

  1. Naoki Tanaka
  2. Akira Horiuchi
  3. Takahide Yokoyama
  4. Gengo Kaneko
  5. Naoto Horigome
  6. Takahiro Yamaura
  7. Tadanobu Nagaya
  8. Michiharu Komatsu
  9. Kenji Sano
  10. Shin-ichi Miyagawa
  11. Toshifumi Aoyama
  12. Eiji Tanaka

Corresponding author

Correspondence toNaoki Tanaka.

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Tanaka, N., Horiuchi, A., Yokoyama, T. et al. Clinical characteristics of de novo nonalcoholic fatty liver disease following pancreaticoduodenectomy.J Gastroenterol 46, 758–768 (2011). https://doi.org/10.1007/s00535-011-0370-5

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