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Table of Contents
Vol. 28, No. 1, 2010
Issue release date: May 2010
Section title: Liver and Metabolic Syndrome
Dig Dis 2010;28:274–279
(DOI:10.1159/000282102)

Surgical Treatment of Non-Alcoholic Steatohepatitis and Non-Alcoholic Fatty Liver Disease

Weiner R.A.
Department of Surgery, Krankenhaus Sachsenhausen, Frankfurt am Main, Germany

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Article / Publication Details

First-Page Preview
Abstract of Liver and Metabolic Syndrome

Published online: 5/7/2010

Number of Print Pages: 6
Number of Figures: 2
Number of Tables: 1

ISSN: 0257-2753 (Print)
eISSN: 1421-9875 (Online)

For additional information: http://www.karger.com/DDI

Abstract

Background: Overweight and obesity are the most significant risk factors for the development of hepatic steatosis, non-alcoholic steatohepatitis (NASH) and non-alcoholic fatty liver disease (NAFLD) in children and adults. Both have been increasingly implicated in the genesis of hepatic fibrosis and cirrhosis. However, no consensus exists about whether weight reduction may reverse this process. Methods: To assess the effect of obesity surgery on the histological evolution of NASH, diagnosed in 284 morbidly obese patients by routine liver biopsy (‘first’ biopsy) performed during bariatric surgery, we performed a ‘second’ biopsy after 18.6 ± 8.3 months in 116 patients (109 female, 7 male). 68 patients underwent Roux-en-Y gastric bypass, 38 adjustable gastric banding and 16 biliopancreatic diversion with duodenal switch (BPD-DS). The second biopsy was taken during CHE (102) and relaparoscopy for suspected complications and revisional surgeries (12). All primary and secondary surgical procedures were done laparoscopically without intraoperative or postoperative major complications. All comorbidities were recorded pre- und postoperatively. Results: From the first to the second biopsy, BMI decreased from 55.2 ± 8.3 to 30.5 ± 6.6 kg/m2, arterial hypertension decreased from 65 to 43%, and type 2 diabetes decreased from 42 to 2%. On the first biopsy, non-alcoholic fatty liver disease (NAFLD) type 3 was observed in 186 patients (65.5%) and type 4 in 82 (28.9%). The second biopsy revealed complete regression of NAFLD in 89 patients (82.8%) and only 16 (13.8%) still had NAFLD type 1 (mild steatosis without inflammation). These two patients with NAFLD type 3 had adjustable gastric banding with insufficient weight loss (EWL <50%) in history. Complete regression of necroinflammatory activity was observed in 108 patients (93.1%). Among the 12 patients presenting fibrosis in the first biopsy, complete remission was observed in 10 and improvement in 2. Two patients with ascites during BPD-DS showed complete remission within 9–15 months. Two continued to show the same degree of fibrosis without evidence of disease activity. No worsening of steatosis, necroinflammatory activity or fibrosis was observed in any of the patients, and none progressed to cirrhosis. Conclusion: Obesity surgery improves steatosis, necroinflammatory activity and hepatic fibrosis in patients with morbid obesity and NASH. The improvement of all obesity-related comorbidities can be confirmed.


  

Author Contacts

Prof. Dr. Rudolf A. Weiner
Department of Surgery, Krankenhaus Sachsenhausen
Schulstrasse 31
DE–60594 Frankfurt am Main (Germany)
Tel. +49 69 6605 1131, Fax +49 69 6605 1510, E-Mail rweiner@khs-ffm.de

  

Article Information

Published online: May 07, 2010
Number of Print Pages : 6
Number of Figures : 2, Number of Tables : 1, Number of References : 17

  

Publication Details

Digestive Diseases (Clinical Reviews)

Vol. 28, No. 1, Year 2010 (Cover Date: May 2010)

Journal Editor: Malfertheiner P. (Magdeburg)
ISSN: 0257-2753 (Print), eISSN: 1421-9875 (Online)

For additional information: http://www.karger.com/DDI


Article / Publication Details

First-Page Preview
Abstract of Liver and Metabolic Syndrome

Published online: 5/7/2010

Number of Print Pages: 6
Number of Figures: 2
Number of Tables: 1

ISSN: 0257-2753 (Print)
eISSN: 1421-9875 (Online)

For additional information: http://www.karger.com/DDI


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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