A clinical-morphological study on cholestatic presentation of nonalcoholic fatty liver disease

• Published in: Digestive diseases and sciences Vol. 50; no. 6; pp. 1130 - 1135
• Main Authors: SORRENTINO, P, TARANTINO, G, PERRELLA, A, MICHELI, P, PERRELLA, O, CONCA, P
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01.06.2005; Springer Nature B.V
• Subjects: Aged; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Cholestasis, Intrahepatic - etiology; Cholestasis, Intrahepatic - physiopathology; Diabetes Complications - complications; Disease Progression; Fatty Liver - complications; Fatty Liver - physiopathology; Female; Gastroenterology. Liver. Pancreas. Abdomen; Human bacterial diseases; Humans; Infectious diseases; Liver Cirrhosis - etiology; Liver Cirrhosis - pathology; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Obesity - complications; Other diseases. Semiology; NAFLD; liver; Cholangitis; Hepatic disease; Histology; Biliary tract disease; NASH; Infection; Symptomatology; cholestasis; Non alcoholic steatohepatitis; Cholostasis; Bacteriosis; Digestive diseases; Inaugural sign
• DOI: 10.1007/s10620-005-2719-1
• ISSN: 0163-2116

To determine the association among the clinical, biochemical, and histological features of cholestasis, we analyzed all the relevant data of the patients recorded in our non-alcoholic fatty liver disease (NAFLD) database. We selected 20 NAFLD patients with abnormal transaminase levels, with both alkaline phosphatase >500 U/L and gamma-glutamyl transpeptidase >250 U/L. Their histological features were compared with those of a group of patients with NAFLD matched for sex, age, and body mass index and of a group of patients matched for sex, body mass index and histological NAFLD grading/staging. Cases and controls satisfied, on histology, the criteria for NASH. The presence of cholestasis in our patients was correlated with injury of the bile duct epithelium, characterized by cholangitis, swelling, variable bile duct loss, and bile stasis. Compared to NAFLD patients of similar age, sex, and body mass index, the cholestatic group had total and severe histological liver impairment. When we analyzed the group of patients histologically identified on the basis of identical stage and grade severity, we could not find any evidence of significant bile damage, compared to cases, despite the control group's significantly older age. NAFLD patients with biochemical cholestasis have a histological picture of bile damage; they have more advanced histological impairment than patients matched for age, sex and body mass index.