The Relationship Between Chronic Liver Disease And Small Bowel Mucosal Lesions

【Objectives】Lots of articles reported that a correlation analysis between chronic liver disease and gastrointestinal diseases because of the gut-liver axis. Many of animal and clinical studies have reported that intestinal mucosal lesions such as villous edema, erythema and ulcer might presented in patients with compensated liver cirrhosis. Then put forward the theory of " hepatogenic induced small bowel disease ".To study the association between liver and small intestinal and that small intestinal and liver.【Methods】1. After obtaining approval from the ethical review committee of the First Affiliated Hospital of Guangdong Pharmaceutical University, from August 2011 to August 2015, patients excluded cancer, primary intestinal disease and NSAID takers were divided into the liver cirrhosis group, simple fatty liver group, chronic hepatitis group(case group) and the group without liver disease(control group). Diagnostic criteria of liver cirrhosis, simple fatty liver, chronic hepatitis: by History, CT, B ultrasound, and clinical biochemical examination, in accordance with the " World Gastroenterology Organisation Global Guidelines:Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis ", " Integrated management of clinical diagnosis of hepatitis B virus-related cirrhosis, antiviral therapy and assessment " diagnostic criteria. Small intestinal mucosal Lewis score system was used to evaluate the severity of small intestinal mucosa in all patients. Clinical data were collected and the incidence and the Lewis score of small intestinal mucosal lesions in patients with liver cirrhosis, simple fatty liver, chronic hepatitis group and non liver disease group were compared. The correlation between liver score and small intestinal Lewis score were analyzed.2. After obtaining approval from the ethical review committee of the First Affiliated Hospital of Guangdong Pharmaceutical University, from August 2011 to August 2015. patients excluded chronic liver disease as fatty liver, liver cirrhosis, liver cancer and viral liver disease, hepatitis B carriers, cancer, and patients with severe diseases of heart and lung were divided into the small intestinal mucosal lesions group(case group) and the group without Small intestinal mucosal lesions(control group).Collected clinical data of patients, all patients were performed noninvasive score of liver function to determine whether liver function damage exists. The incidence of liver function damage and the six non invasive liver function score were compared between the small intestinal mucosal lesion group(case group) and the group without Small intestinal mucosal lesion(control group). The correlation of small intestinal Lewis score and liver score was analyzed.【Results】1. The intestinal mucosal lesions was found in 22(88.0%), 36(76.6%), 12(60.0%) and 78(31.7%) patients among liver cirrhosis group, simple fatty liver group, chronic hepatitis group and control group(P<0.001). Further analysis found in the cirrhosis group, simple fatty liver group, chronic hepatitis group, the intestinal mucosal lesions incidence was significantly higher than that in control group(P<0.001). In the liver cirrhosis group, simple fatty liver group, chronic hepatitis group, the incidences of villous edema were significantly higher than that in control group, but the incidences of intestinal ulcer. In liver cirrhosis group intestinal mucosa Lewis score was significantly higher than that in control group(mean difference ± standard error =-147.889 ± 46.106,P=0.021);simple fatty liver group intestinal mucosa Lewis score was significantly higher than that in control group(mean difference ± standard error =-82.472 ± 28.592,P=0.034); no correlation between in chronic hepatitis group and the control group(mean difference ± standard error =-20.289 ± 19.937,P=0.884).The villous edema mainly occurred in upper and middle intestine. However, the incidence of intestinal ulcer showed no significantly difference among three segments of the intestine. The Forns fibrosis index, FIB-4 scores, NAFLD-FS score and Child Pugh score were correlated positively with the Lewis score(R=0.247,P<0.001; R=0.244, P<0.001; R=0.223,P<0.001;R=0.284,P<0.001). But the APRI scoring system, S index, BARD score showed no correlation with the Lewis score.2. In intestinal mucosal lesions group, the incidence of liver function damage was significantly higher than that in control group(33.1% vs. 5.7%,P<0.001).In case group, the Forns fibrosis index, FIB-4 scores, NAFLD-FS score, APRI scoring system, S index, BARD score were significantly higher than that in control group(7.543±1.544 vs. 6.454±1.393,P<0.001; 1.803±1.287 vs. 1.181±0.566,P<0.001;-25.428±3.438 vs.-27.285±3.197,P<0.001; 0.351±0.578 vs. 0.222±0.106,P=0.017; 0.079±0.125 vs. 0.045±0.063,P=0.006; 2.05±0.729 vs. 1.87±0.708,P=0.039). Moreover, the Forns fibrosis index, FIB-4 scores, NAFLD-FS score were correlated positively with the Lewis score(R=0.155,P=0.008; R=0.161; P=0.006; R=0.148, P=0.011). However, the APRI scoring system, S index and BARD score showed no correlations with Lewis score. In intestinal mucosal lesions group, the ALT、AST were significantly higher than that in control group(20.61±13.859 vs. 16.97±8.963,P=0.006;22.83±9.570 vs. 20.00±7.101,P=0.004).【Conclusion】Liver cirrhosis, simple fatty liver and chronic hepatitis are risk factors for the occurrence of intestinal mucosal lesions, liver disease severity and intestinal mucosal lesions was positively. Similarly, small intestinal inflammatory change also contributed to the risk factors of liver function damage. Intestinal mucosal lesions and the degree of liver damage was positively correlated.