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Vol. 28, No. 1, 2010
Issue release date: May 2010

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

Weiner R.A.
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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.

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  1. Mendez MA, Monteiro CA, Popkin BM: Overweight exceeds underweight among women in most developed countries. Am J Clin Nutr 2005;81:714–721.
  2. Olshansky SJ, Passaro DJ, Hershow RC, et al: A potential decline in life expectancy in the United States in the 21st century. N Engl J Med 2005;352:1138–1145.
  3. European Charter on Counteracting Obesity. (accessed January 16, 2007).
  4. Statistisches Bundesamt Deutschland (2004): Mikrozensus 2003. Statistisches Bundesamt Deutschland.
  5. Dixon JB, Bhathal PS, O’Brien PE: Weight loss and non-alcoholic fatty liver disease: falls in gamma-glutamyl transferase concentrations are associated with histologic improvement. Obes Surg 2006;16:1278–1286.
  6. Furuya CK Jr, de Oliveira CP, de Mello ES, Faintuch J, Raskovski A, Matsuda M, Vezozzo DC, Halpern A, Garrido AB Jr, Alves VA, Carrilho FJ: Effects of bariatric surgery on nonalcoholic fatty liver disease: preliminary findings after 2 years. J Gastroenterol Hepatol 2007;22:510–514.
  7. Arun J, Clements RH, Lazenby AJ, Leeth RR, Abrams GA: The prevalence of nonalcoholic steatohepatitis is greater in morbidly obese men compared to women. Obes Surg 2006;16:1351–1358.
  8. Arun J, Jhala N, Lazenby AJ, Clements R, Abrams GA: Influence of liver biopsy heterogeneity and diagnosis of nonalcoholic steatohepatitis in subjects undergoing gastric bypass. Obes Surg 2007;17:155–161.
  9. Liew PL, Lee WJ, Lee YC, Wang HH, Wang W, Lin YC: Hepatic histopathology of morbid obesity: concurrence of other forms of chronic liver disease. Obes Surg 2006;16:1584–1593.
  10. de Almeida SR, Rocha PR, Sanches MD, Leite VH, da Silva RA, Diniz MT, Diniz Mde F, Rocha AL: Roux-en-Y gastric bypass improves the nonalcoholic steatohepatitis (NASH) of morbid obesity. Obes Surg 2006;16:270–278.
  11. Larson SP, Bowers SP, Palekar NA, Ward JA, Pulcini JP, Harrison SA: Histopathologic variability between the right and left lobes of the liver in morbidly obese patients undergoing Roux-en-Y bypass. Clin Gastroenterol Hepatol 2007;5:1329–1332.
  12. Liu X, Lazenby AJ, Clements RH, Jhala N, Abrams GA: Resolution of nonalcoholic steatohepatits after gastric bypass surgery. Obes Surg 2007;17:486–492.
  13. Wang Y, Liu J: Plasma ghrelin modulation in gastric band operation and sleeve gastrectomy. Obes Surg 2009;19:357–362.
  14. Garcia-Fuentes E, Garrido-Sanchez L, Garcia-Almeida JM, Garcia-Arnes J, Gallego-Perales JL, Rivas-Marin J, Morcillo S, Cardona I, Soriguer F: Different effect of laparoscopic Roux-en-Y gastric bypass and open biliopancreatic diversion of Scopinaro on serum PYY and ghrelin levels. Obes Surg 2008;18:1424–1429.
  15. Roth CL, Reinehr T, Schernthaner GH, Kopp HP, Kriwanek S, Schernthaner G: Ghrelin and obestatin levels in severely obese women before and after weight loss after Roux-en-Y gastric bypass surgery. Obes Surg 2009;19:29–35.
  16. Sangiao-Alvarellos S, Vázquez MJ, Varela L, Nogueiras R, Saha AK, Cordido F, López M, Diéguez C: Central ghrelin regulates peripheral lipid metabolism in a growth hormone-independent fashion. Endocrinology 2009;150:4562–4574.
  17. Teixeira AR, Bellodi-Privato M, Carvalheira JB, Pilla VF, Pareja JC, D’Albuquerque LA: The Incapacity of the Surgeon to Identify NASH in Bariatric Surgery Makes Biopsy Mandatory. Obes Surg 2009;19:1678–1684.

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