Nonalcoholic Fatty Liver Disease Treated by Gastroplasty

Abstract

Nonalcoholic steatohepatitis (NASH), which is the most severe histologic form of nonalcoholic fatty liver disease (NAFLD), is emerging as the most common clinically important form of liver disease in obese patients. The prevalence of NASH may increase with the rise in the rate of obesity and metabolic syndrome in affluent communities. The aim of this work is to describe clinical and histopathologic findings and correlate liver tissue damage to the length of duration of the obesity in the group of patients who underwent surgery as obesity treatment. Eighty-seven severely or morbidly obese patients underwent gastroplasty. Each patient was evaluated with complete clinical and laboratory medical assessment together with wedge liver biopsy taken from 59 unselected patients during the surgery. Patients were followed up for 41 months. Repeat liver biopsy was taken from 10 patients. Pathologic analysis recorded the presence and degree of steatosis, portal and lobular inflammation and fibrosis. Age, body mass index (BMI), and laboratory assessment correlated with pathologic data. Male patients showed more pronounced metabolic syndrome and fatty liver damage. Patients who become obese in childhood or as teenagers showed no differences in metabolic syndrome and NAFLD in mature age. There was statistically significant association between BMA, elevated transaminases, NAFLD, and fibrosis. Significant weight reduction was observed within first year after surgery, was slower in the second year, and stabilized within third year. Remarkable improvement followed in biological markers of metabolic syndrome. Ninety-six percent of initial liver biopsies had steatosis; 16% developed steatohepatitis and mild perivenular fibrosis. Significant improvement of the degenerative and inflammatory hepatic lesions in repeated biopsies and liver function readings was noted within 8 months after surgery. Obesity is a major and independent risk factor for the metabolic syndrome, NAFLD, NASH, and fibrosis. Surgical treatment improves metabolic abnormalities and hepatic lesions in long-term observations.

Nonalcoholic fatty liver disease and bariatric surgery: a comprehensive review

“…Jaskiewicz et al 145 conducted a study on 10 individuals who underwent a wedge biopsy during gastroplasty and had a new repeat biopsy eight months later. They observed significant improvements of the degenerative and inflammatory hepatic lesions in the repeat biopsies and liver function readings, eight months after the surgery.…”

Molecular Mechanisms and Therapeutic Targets in Steatosis and Steatohepatitis

“…There are, however, some concerns about the effects of rapid weight loss, which was reported to enhance portal inflammation and fibrosis (Andersen et al, 1991). Results from follow-up studies were not conclusive about the risk of disease progression after bariatric surgery (Kral et al, 2004;Jaskiewicz et al, 2006;De Ridder et al, 2007;Furuya et al, 2007).…”

Role of bariatric surgery in treatment of non-alcoholic fatty liver disease

“…10 However, Results from different studies show that the prevalence of NAFLD varies between 16.7% and 96% in morbidly obese patients subjected to bariatric surgery. [10][11][12][13][14][15][16][17][18][19][20][21][22] The wide range of NAFLD prevalence depends on the biochemical criteria and the method sensitivity used to detect NAFLD. 8,23 Furthermore, NASH, as a progressive manifestation of NAFLD, occurs in 7.3% to 98% of such patients.…”

“…8,23 Furthermore, NASH, as a progressive manifestation of NAFLD, occurs in 7.3% to 98% of such patients. 10,12,13,17,18,[20][21][22][24][25][26][27][28][29][30] The study which reported NASH in 98% of their patients, indicated that the mean super obese state (Mean BMI 52.8 kg ⁄m 2 ) in their population is the reason of high NASH prevalence. 30 Another study concluded that the differences in NASH prevalence can be explained by the histological criteria used to diagnose NASH.…”

“…30 Another study concluded that the differences in NASH prevalence can be explained by the histological criteria used to diagnose NASH. 22 Ethnicity affects NAFLD prevalence as well. 23 In a study on morbid obese patients underwent BS, African-American patients had lower NAFLD and NASH rate than Non-Hispanic whites and Hispanics.…”