Colonoscopic and histopathological findings in obese patients with fibroscan-detected hepatic steatosis: a cross-sectional study

Abstract Background Obesity and steatosis are increasingly linked to systemic and gut inflammation, yet the frequency of colitis in this population remains insufficiently defined. This study aimed to characterize the frequency and spectrum of colonic inflammatory, endoscopic, and histopathological findings, including inflammatory bowel disease (IBD), among obese patients with steatosis suggested by FibroScan. Methods This cross-sectional study included 130 obese adults with steatosis at Ain Shams University Hospitals. All patients underwent clinical assessment, laboratory investigations, FibroScan with controlled attenuation parameter (CAP) measurement, lower gastrointestinal endoscopy, and histopathological evaluation of biopsies. Results The mean age was 43.2 ± 17.09 years, and 72.31% were males. Mean body mass index was 38.7 ± 3.42 kg/m 2 and mean CAP was 256.9 ± 62.73 dB/m; steatosis grades were S1 in 43.07%, S2 in 19.23%, and S3 in 37.69%. Colitis was detected in 40% of patients, including mild colitis in 10%, moderate colitis in 23.08%, and severe colitis in 6.92%. Endoscopically, inflamed mucosa was the most common abnormal finding (30.77%). Histopathology showed nonspecific colitis in 24.6%, ulcerative colitis in 3.84%, Crohn’s disease in 2.31%, low-grade dysplasia in 8.46%, high-grade dysplasia in 2.31%, and cancer in 2.31%. Patients with steatosis had significantly higher AST, ALT, and ALP than those without steatosis (all P < 0.001). Conclusions Obese patients with steatosis had a considerable burden of colitis and clinically relevant colonic lesions, Obese patients with steatosis showed a considerable frequency of colitis and clinically relevant colonic lesions in this selected cohort. These findings describe the spectrum of colonic abnormalities observed among obese patients with FibroScan-detected steatosis and warrant further controlled studies to determine whether these findings differ from those in appropriate comparison populations.