Non-alcoholic fatty liver disease in irritable bowel syndrome: More than a coincidence? - PubMed (original) (raw)

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Non-alcoholic fatty liver disease in irritable bowel syndrome: More than a coincidence?

Huw Purssell et al. World J Hepatol. 2021.

Abstract

Irritable bowel syndrome (IBS) and non-alcoholic fatty liver disease (NAFLD) are amongst the most common gastrointestinal and liver conditions encountered in primary and secondary care. Recently, there has been interest in the apparent co-incidence of NAFLD in patients with IBS mainly driven by improved understanding of their shared risk factors and pathophysiology. In this paper we summarize the shared risk factors which include; overlapping nutritional and dietary factors as well as shared putative mechanisms of pathophysiology. These include changes in the gut microbiome, gut permeability, immunity, small bowel bacterial overgrowth and bile acid metabolism. This paper describes how these shared risk factors and etiological factors may have practical clinical implications for these highly prevalent conditions. It also highlights some of the limitations of current epidemiological data relating to estimates of the overlapping prevalence of the two conditions which have resulted in inconsistent results and, therefore the need for further research. Early recognition and management of the overlap could potentially have impacts on treatment outcomes, compliance and morbidity of both conditions. Patients with known IBS who have abnormal liver function tests or significant risk factors for NAFLD should be investigated appropriately for this possibility. Similarly, IBS should be considered in patients with NAFLD and symptoms of abdominal pain associated with defecation, an altered bowel habit and bloating.

Keywords: Irritable bowel syndrome; Metabolic syndrome; Non-alcoholic fatty liver disease; Obesity; Pathophysiology; Prevalence.

©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.

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Conflict of interest statement

Conflict-of-interest statement: None of the authors have any conflicts of interest to disclose.

Figures

Figure 1

Figure 1

Schematic illustration summarizing associations and co-existing etiologies of irritable bowel syndrome and non-alcoholic fatty liver disease. IBS: Irritable bowel syndrome; NAFLD: Non-alcoholic fatty liver disease; IL: Interleukin.

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