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Clinical Manifestations of Liver Disease in Diabetes Mellitus

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Gastrointestinal Complications of Diabetes

Part of the book series: Clinical Gastroenterology ((CG))

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Abstract

Non-alcoholic fatty liver disease (NAFLD) is becoming one of the most common causes of chronic liver disease worldwide and a major cause of liver-related morbidity and mortality.

NAFLD includes simple hepatic steatosis and non-alcoholic steatohepatitis (NASH), a condition where steatosis is associated with hepatic inflammation with or without fibrosis. Pathogenesis of these conditions is complex, but insulin resistance and obesity play a major role, together with emerging evidence for adipose tissue dysfunction, adipokines, and gut microbiota as important contributors. Non-alcoholic fatty liver disease and type 2 diabetes are common conditions that regularly co-exist and can act synergistically to drive adverse outcomes. It’s hard to predict the disease course in an individual. Most of the patients will have stable liver function and will not develop serious complications. But in some patients NASH may cause severe fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Subjects with compensated NAFLD-related cirrhosis have an annual overall mortality risk of 3.5–4%. All patients with decompensated liver cirrhosis should be evaluated for liver transplantation (LT). In Western countries, NASH is predicted to become the most frequent indication for LT in the next 20 years. NAFLD is becoming the major cause of HCC, with a steadily rising trend. Although HCC predominantly occurs in the setting of cirrhosis, the chance of HCC occurrence in non-cirrhotic liver is a worrisome aspect of NAFLD. Current knowledge of the pathways in hepatocarcinogenesis is still limited, so present interventions should be directed to prevention of metabolic syndrome and NAFLD, reducing the risk of HCC through lifestyle changes such as exercise and dietary modification.

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Abbreviations

ALP:

Alkaline phosphatase

ALT:

Alanin aminotransferase

AST:

Aspartate aminotransferase

AUROC:

Area under receiver operating characteristic

BMI:

Body mass index

C0:

Through level

Ca:

Calcium

CKD:

Chronic kidney disease

CMV:

Cytomegalo-virus

CNI:

Calcineurin inhibitors

CRP:

C reactive protein

CsA:

Cyclosporine

CTP score:

Child–Pugh–Turcotte score

CVD:

Cardiovascular disease

dL:

Decilitre

EB:

Oesophageal variceal bleeding

EBL:

Endoscopic band ligation

EBV:

Epstein–Barr virus

EEG:

Electroencephalography

eGFR:

Estimated glomerular filtration rate

F:

Fibrosis stage

GGT:

Gamma-glutamil transferase

GOV1:

Gastroesophageal varices type 1

GOV2:

Gastroesophageal varices type 2

HAV:

Hepatitis A virus

HBV:

Hepatitis B virus

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

HE:

Hepatic encephalopathy

HbA1c:

Hemoglobin A1c

HHV-8:

Human herpes virus 8

HIV:

Human immunodeficiency virus

HPS:

Hepatopulmonary syndrome

HRS:

Hepatorenal syndrome

HSV:

Herpes simplex virus

IFN:

Interferon

Ig:

Immunoglobuline

IGV:

Isolated gastric varices

IS:

Immunosuppressive

K:

Potassium

LDH:

Lactate dehydrogenase

LT:

Liver transplantation

MDRD:

Modification of diet in renal disease formula

MELD:

Model of end-stage liver disease

MeS:

Metabolic syndrome

Mg:

Magnesium

mg:

Milligram

MMF:

Mycophenolate mofetil

MR:

Magnetic resonance

MRCP:

Magnetic resonance cholangio-pancreatograph

MRE:

Magnetic resonance elastography

MSCT:

Multi-slice computed tomography

mTOR:

Mammalian target of rapamycin

Na:

Sodium

NAFLD:

Non-alcoholic fatty liver disease

NASH:

Non-alcoholic steatohepatitis

NSBB:

Non-selective beta blockers

OR:

Odds ratio

PCR:

Polymerase chain reaction

PET:

Positron emission tomography

PNPLA3:

Patatin-like phospholipase domain-containing 3

PPD:

Purified protein derivative

PPHTN:

Portopulmonary hypertension

PSC:

Primary sclerosing cholangitis

SBP:

Spontaneous bacterial peritonitis

T2DM:

Type 2 diabetes mellitus

Tac:

Tacrolimus

TE:

Transient elastography

TIPS:

Transhepatic portosystemic shunt

US:

United States

VDRL:

Venereal disease research laboratory

VZV:

Varicella zoster virus

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, University of Zagreb School of Medicine, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia

    Lucija Virović-Jukić

  2. Department of Gastroenterology and Hepatology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia

    Jelena Forgač & Doris Ogresta

  3. Department of Gastroenterology, University of Zagreb School of Medicine, University Hospital Merkur, Zagreb, Croatia

    Tajana Filipec-Kanižaj & Anna Mrzljak

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  1. Sestre milosrdnice University Hospital Center, University of Zagreb School of Medicine, Zagreb, Croatia

    Marko Duvnjak

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Virović-Jukić, L., Forgač, J., Ogresta, D., Filipec-Kanižaj, T., Mrzljak, A. (2018). Clinical Manifestations of Liver Disease in Diabetes Mellitus. In: Duvnjak, M., Smirčić-Duvnjak, L. (eds) Gastrointestinal Complications of Diabetes . Clinical Gastroenterology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-75856-5_21

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