Effect on Liver Enzymes of Biliopancreatic Diversion: 4 Years of Follow-Up

Abstract

Background: Elevated serum aminotransferase levels are commonly associated with obesity and with a progression to chronic liver disease. Bariatric surgery is the most effective strategy to achieve weight loss. Methods: We conducted the present study with the aim of evaluating the influence of biliopancreatic diversion (BPD) on liver enzymes levels during 4 years in morbid obese patients with normal aminotransferase (n = 65) and in morbid obese patients with high aminotransferase basal levels (n = 50). Results: A decrease in alanine aminotransferase and aspartate aminotransferase activities was significant after biliopancreatic diversion. The basal percentage of high aminotransferase levels and percentage of ratio ALT/AST <1 also decreased significantly at 1-, 2-, 3- and 4-years of follow-up in both groups. ALT (52 to 20%), AST (42 to 10%) and ALT/AST (80 to 22%) in patients with normal aminotransferase. ALT (82 to 20%), AST (70 to 6%) and ALT/AST (90 to 20%) in patients with elevated transaminase basal levels. Bariatric surgery was associated with a significant and sustained decrease in body weight in both groups. Serum trasnaminases level changes were positively correlated to body weight changes during follow-up. Conclusion: BPD is an effective method of achieving sustainable weight loss and reduced aminotransferase levels and enzyme ratios of liver damage.

The effect of the magnitude of weight loss on non-alcoholic fatty liver disease: A systematic review and meta-analysis

“…Diabetes and hypertension affected 24% and 35% of participants among 32 and 17 studies, respectively, that reported on these characteristics. Nine studies tested a weight loss medication [31][32][33][34][35][36][37][38]42] and eight a form of bariatric surgery [24][25][26][27][28][29][30]43], with the remaining testing an energyrestricted diet with or without an exercise program (Table 1 and Table S1). The median follow-up was 6 months (IQR: 6, range: 0.5 to 48) with bariatric studies having generally longer follow-up (median: 17 months) than other interventions (median: 6 months).…”

Nonalcoholic fatty liver disease and bariatric surgery: a comprehensive review

“…In a retrospective cohort study evaluating the influence of duodenal switch surgery on liver enzyme levels over a four-year period, among morbidly obese patients with normal aminotransferase and high baseline aminotransferase levels, Aller et al 154 reported that significant decreases in ALT and AST activity levels occurred. The baseline percentages of high aminotransferase levels and the percentage of ALT/AST ratios that were < 1 were also found to be significantly lower at the one, two, three and four-year follow-ups in both groups.…”

Bariatric Surgery and Liver Disease: General Considerations and Role of the Gut–Liver Axis

“…As a particular example of early post-surgery modifications, LABG has been shown to induce a preferential mobilization of visceral fat, mainly in the first eight weeks [ 104 ]. Moreover, evidence suggests that BPD (with either Scopinaro’s technique or duodenal switch) is often characterized by a transient worsening of AST levels and hepatocellular necrosis in the first two–six months, promptly followed by a significant reduction of both these parameters and the improvement in histological features of NAFLD and NASH [ 134 , 135 , 136 , 137 , 138 ]. The rate of weight loss at two months, preoperative body weight, glucose levels and hepatic histology seemed to be useful in identifying patients at increased risk of acute liver damage, thus prompting the need for enhanced surveillance [ 134 ].…”