A New Ultrasound Method to Study the Relations Between Ileocecal Valve Incontinence and Inflammation in Metabolic Associated Steatotic Liver Disease

Background: Gut dysbiosis may trigger inflammation and steatohepatitis (SH) in subjects with metabolic associated steatotic liver disease (MASLD). Both incidence and impact of ileocecal valve (ICV) dysfunction as cause of small intestine bacterial overgrowth in MASLD remain unknown because of the unmet need of non-radiology dependent diagnostic procedures. Methods: Exploiting water as contrast medium and a hydro colon machine (Clean Colon Srl, Monza, Italy) for automated retrograde gentle colonic irrigation, we developed a new abdominal ultrasound procedure for diagnosis of ICV incontinence and we present the results of a pilot feasibility study for the assessment of its relationship with triggering of inflammation in steatotic liver disease. Results: Consecutive patients (32) performing colonic irrigation in colonoscopy preparation underwent concomitant abdominal ultrasound examination. Patients were predominantly males (59%) with body mass index (BMI) 26,6±2,6 kg/m2 and liver steatosis was present in half of the patients. Liver stiffness was 26,6±2,6 kPa, while serum transaminases ALT and AST were 33,1±9,5 and 25,9±8,4 U.I., respectively. The procedure that lasted a mean of 27min (range 20-35 min) was well tolerated in all, but 2 males with large prostate hypertrophy. Three ICV continence patterns (A - Early reflux, already at small water volume without evident cecum distension; B - Late reflux, after evident cecum distension; C - No reflux, either early or late after overall water irrigation and significant cecum distension) were observed during water irrigation (4266 ml mean, range 2000-8000 ml). ICV continence was significantly associated with IBS, steatosis, and liver stiffness (all p ≤ 0.0001). Furthermore, IBS (OR 3.97), steatosis (OR 3.30), and liver stiffness (OR 2.43 per unit increase) were also independently associated with dichotomization of impaired ICV continence.A 35-year-old male with SIBO and LS = 8.7 kPa underwent a liver biopsy showing histologically-determined high level of steatosis (S3), hepatocyte ballooning, lobular inflammation (Grade 6/8) in absence of fibrosis (Stage 0/4 F0).Conclusion: This proof-of-concept study indicates that an easy and quick mini-invasive diagnosis of ICV incontinence is feasible using water as contrast medium during abdominal ultrasound examination. Preliminary results suggest that this new technique is worth of being validated in prospective studies investigating the impact ICV incontinence as possible co-factor of steatohepatitis in patients with MAFLD.