Surgically induced weight loss by gastric bypass improves non alcoholic fatty liver disease in morbid obese patients
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Date
2012
Authors
Vargas, Víctor
Allende, Helena
Lecube Torelló, Albert
Salcedo, Maria Teresa
Baena-Fustegueras, Juan A
Fort, José Manuel
Rivero, Joaquín
Ferrer, Roser
Catalán, Roberto
Pardina, Eva
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Abstract
AIM: To evaluate the effects of surgical weight loss
(Roux-en-Y gastric bypass with a modified Fobi-Capella
technique) on non alcoholic fatty liver disease in obese
patients.
METHODS: A group of 26 morbidly obese patients
aged 45 ± 2 years and with a body mass index > 40
kg/m2 who underwent open surgical weight loss operations
had paired liver biopsies, the first at surgery and
the second after 16 ± 3 mo of weight loss. Biopsies
were evaluated and compared in a blinded fashion. The
presence of metabolic syndrome, anthropometric and
biochemical variables were also assessed at baseline
and at the time of the second biopsy.
RESULTS: Percentage of excess weight loss was
72.1% ± 6.6%. There was a reduction in prevalence of
metabolic syndrome from 57.7% (15 patients) to 7.7%
(2 patients) (P < 0.001). Any significance difference
was observed in aspartate aminotransferase or alanine
aminotransferase between pre and postsurgery. There
were improvements in steatosis (P < 0.001), lobular
(P < 0.001) and portal (P < 0.05) inflammation and
fibrosis (P < 0.001) at the second biopsy. There were
25 (96.1%) patients with non alcoholic steatohepatitis
(NASH) in their index biopsy and only four (15.3%)
of the repeat biopsies fulfilled the criteria for NASH.
The persistence of fibrosis (F > 1) was present in five
patients at second biopsy. Steatosis and fibrosis at surgery
were predictors of significant fibrosis postsurgery.
CONCLUSION: Restrictive mildly malabsorptive surgery
provides significant weight loss, resolution of
metabolic syndrome and associated abnormal liver histological
features in most obese patients.
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World Journal of Hepatology, 2012, vol.4, núm. 12, p. 382-388