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World J Hepatol. Feb 27, 2023; 15(2): 208-215
Published online Feb 27, 2023. doi: 10.4254/wjh.v15.i2.208
Clostridioides difficile infection in patients with nonalcoholic fatty liver disease-current status
Yana V Kiseleva, Roman V Maslennikov, Aida N Gadzhiakhmedova, Tatyana S Zharikova, Dmitry V Kalinin, Yury O Zharikov
Yana V Kiseleva, International School “Medicine of the Future”, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Russia
Roman V Maslennikov, Department of Internal Medicine, Gastroenterology and Hepatology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 119435, Russia
Roman V Maslennikov, Department of Internal Medicine, Сonsultative and Diagnostic Center No. 2, Moscow City Health Department, Moscow 107564, Russia
Aida N Gadzhiakhmedova, Tatyana S Zharikova, Yury O Zharikov, Department of Human Anatomy and Histology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia
Dmitry V Kalinin, Department of Pathology, A.V. Vishnevsky National Medical Research Center of Surgery, Moscow 115093, Russia
Author contributions: Kiseleva YV is responsible for conceptualization, supervision, manuscript first draft preparation, approved final draft; Maslennikov RV is responsible for supervision, data acquisition, approved final draft; Gadzhiakhmedova AN is responsible for data acquisition, visualization, manuscript writing and editing, approved final draft; Zharikova TS is responsible for data aquisiton, formal analysis, manuscript writing and editing, approved final draft; Kalinin DV is responsible for visualization, formal analysis, manuscript writing, review and editing, approved final draft; Zharikov YO is responsible for supervision, conceptualization, manuscript first draft preparation, review and editing, approved final draft.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yury O Zharikov, MD, PhD, Associate Professor, Surgeon, Department of Human Anatomy and Histology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Mokhovaya Street, 11s10, Moscow 125009, Russia. dr_zharikov@mail.ru
Received: October 23, 2022
Peer-review started: October 23, 2022
First decision: December 12, 2022
Revised: December 26, 2022
Accepted: January 31, 2023
Article in press: January 31, 2023
Published online: February 27, 2023
Abstract

Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease, leading to fibrosis, cirrhosis and hepatocellular carcinoma and also associated with increased cardiovascular disease mortality. The pathogenesis of NAFLD is not fully understood, although NAFLD is thought to be a hepatic form of metabolic syndrome. There is an increasing understanding of the role of microbiota disturbances in NAFLD pathogenesis, and as with many other conditions affecting the microbiota, NAFLD may be a novel risk factor for Clostridioides difficile (C. difficile) colonization (CDC) and C. difficile infection (CDI). CDI is an emerging nosocomial disease, and community-acquired cases of infection are growing, probably due to an increase in CDC rates. The association of NAFLD with CDI has been shown in only 4 studies to date, three of which included less than 1000 patients, although the frequency of NAFLD in these studies was observed in almost 20% of the total patient cohort. These data revealed that NAFLD is a risk factor for CDI development and, moreover, is a risk factor for intestinal complications of CDI. More studies are needed to investigate this association and move forward CDC and CDI screening efforts for this group of patients.

Keywords: Nonalcoholic fatty liver disease, Clostridioides difficile, Clostridioides difficile colonization, Clostridioides difficile infection, Minireview

Core Tip: The association of nonalcoholic fatty liver disease (NAFLD) with Clostridioides difficile (C. difficile) infection (CDI) has been shown in only 4 studies to date, three of which included less than 1000 patients, although the frequency of NAFLD in these studies was observed in almost 20% of the total patient cohort. These data revealed that NAFLD is a risk factor for CDI development and, moreover, is a risk factor for intestinal complications of CDI. More retrospective studies and systematic reviews are needed to examine this group of patients as a risk factor for CDI, make recommendations to prevent CDI, and effectively screen and diagnose C. difficile colonization within NAFLD patients.