Roux‐en‐Y Gastric Bypass Improves Liver Histology in Patients with Non‐Alcoholic Fatty Liver Disease

Abstract

Objectives: Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease in the United States and is prevalent in morbidly obese patients. While weight loss and treatment of risk factors are recommended, the reported effects of bariatric surgery on NAFLD are mixed. Research Methods and Procedures:We examined liver histology at the time of Roux-en-Y gastric bypass surgery and at elective incisional hernia repair after weight loss for 16 patients at one center. Slides were read by one pathologist, blinded to clinical data, using the Brunt criteria. Clinical and laboratory data were extracted from chart review. Alcohol use was ascertained by two interviews. Results: At baseline, the mean age was 44 years, 50% were women, 88% were white, and the mean BMI was 51 kg/m 2 . None had significant alcohol use. On initial biopsy, all patients showed steatosis, 94% had inflammation, 88% had ballooning degeneration, 88% had perisinusoidal fibrosis, and 81% had portal fibrosis. The mean time between the two biopsies was 305 Ϯ 131 (SD) days. The mean weight loss was 118 Ϯ 29 lb. Steatosis improved in 15 of 16 patients, with resolution in 13. Twelve of 15 patients with inflammation at baseline showed improvement, and 12 of 14 showed less ballooning. Six of 14 patients with perisinusoidal fibrosis and 6 of 13 with portal fibrosis showed improvement. No patient had worsening of steatosis, inflammation, ballooning, or fibrosis. Discussion: Our study shows improvement in all of the histological features of NAFLD after Roux-en-Y gastric bypass surgery-induced weight loss, despite significant histopathology at baseline and substantial weight loss.

Lipoprotein subclass metabolism in nonalcoholic steatohepatitis

“…Unfortunately, we had only 11 liver biopsies taken at 1 year follow-up. As expected (44)(45)(46), they consistently showed improved histology (data not shown).…”

Molecular Mechanisms and Therapeutic Targets in Steatosis and Steatohepatitis

“…In patients with obesity, dietary interventions associated with weight loss were accompanied by significant reductions of hepatic lipid contents, suggesting positive effects in the prevention of NAFLD Tamura et al, 2005;Westerbacka et al, 2005). Similar positive results were obtained with studies in which weight loss was induced by bariatric surgery (Clark et al, 2005;Mattar et al, 2005;Dixon et al, 2006;Dixon, 2007;Liu et al, 2007b). This increased insulin sensitivity also markedly improved the major components of the metabolic syndrome: glucose tolerance, hypertension, hypertriglyceridemia, and hypercholesterolemia (De Ridder et al, 2007).…”

Spectrum of Liver Disease in Type 2 Diabetes and Management of Patients With Diabetes and Liver Disease

“…However, saturated fatty acids increase insulin resistance, and for that reason a Mediterranean diet, i.e., a diet enriched with monounsaturated fatty acids and lowglycemic carbohydrates, seems reasonable (82,83). Recent studies have demonstrated that bariatric surgery either improves or completely reverses steatosis in patients with obesity with or without diabetes (141,144). Pharmacologic therapy.…”