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Liver Int. 2017 Jan;37(1):141-147. doi: 10.1111/liv.13198. Epub 2016 Aug 25.

Intestinal gas and liver steatosis: a casual association? A prospective multicentre assessment.

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Gastroenterology Unit, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Milan, Italy.
Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
Gastroenterology Unit, Santa Maria della Misericordia Hospital, Perugia, Italy.
Department of Economy, University of Messina, Messina, Italy.
Department of Internal Medicine, Stanton Territorial Hospital, Yellowknife, NT, Canada.
Gastroenterology and Hepatology Section, Department of Medicine, University of Perugia Medical School, Perugia, Italy.



Excessive intestinal gas and liver steatosis are frequent sonographic findings. Both of these appear to be caused by variations of the gut microflora. We assessed the relationship between ultrasonographic detection of intestinal gas and liver steatosis.


This study included 204 consecutive patients (99 male; mean age 53.0 ± 15.6 years), who underwent ultrasonography for abdominal complaints or follow-up of benign lesions. Body mass index, biochemical liver markers, sonographic presence of liver steatosis and/or degree of intestinal gas interfering with the examination were collected. Both sonographic findings were assessed based on standardized criteria. The association between liver steatosis and intestinal gas was evaluated by means of univariate and multivariate analyses.


Eighty (39.2%) of patients showed moderate to large amounts of gas preventing an accurate evaluation of the liver or pancreas and 90 (44.1%) had liver steatosis. A significant correlation between the degree of intestinal gas and liver steatosis both in obese (r=.603; P<.001) and in nonobese patients (r=.555; P<.001) was found. Univariate analysis showed that intestinal gas, body mass index, aspartate transaminase, alanine transaminase, gamma-GT, age and sex were predictors of liver steatosis; only intestinal gas (OR 7.4; 95% CI 3.4-16.1) and body mass index (OR; 1.4, 95% CI 1.2-1.5), however, were independent predictors at multivariate analysis. The presence of excessive gas was also significantly correlated with liver steatosis coupled with elevated ALT (P = .001).


This study shows a significant correlation between excessive intestinal gas and liver steatosis. The reasons of this finding and its clinical implications remain to be defined.


bloating; intestinal gas; liver steatosis; transaminases; ultrasonography

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