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Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease.
Gastroenterology 2009; 137(2):532-40G

Abstract

BACKGROUND & AIMS

Severe obesity is implicated in development of nonalcoholic fatty liver disease (NAFLD). Bariatric surgery induces weight loss and increases survival time of obese patients, but little is known about its effects on liver damage. We performed a 5-year prospective study to evaluate fibrosis and nonalcoholic steatosis (NASH) in severely obese patients after bariatric surgery.

METHODS

Bariatric surgery was performed on 381 patients. Clinical and biological data, along with liver biopsies, were collected before and at 1 and 5 years after surgery.

RESULTS

Five years after surgery, levels of fibrosis increased significantly, but 95.7% of patients maintained a fibrosis score <or= F1. The percentage of patients with steatosis decreased from 37.4% before surgery to 16%, the NAFLD score from 1.97 to 1, ballooning from 0.2 to 0.1. Inflammation remained unchanged. The percentage of patients with probable or definite NASH decreased significantly over 5 years, from 27.4% to 14.2%. The kinetics of insulin resistance (IR) paralleled that of steatosis and ballooning; the greatest improvements occurred within the first year and were sustained 5 years later. Steatosis and ballooning occurred more frequently in patients with a refractory IR profile. In multivariate analysis, the refractory IR profile independently predicted the persistence of steatosis and ballooning 5 years later.

CONCLUSIONS

Five years after bariatric surgery for severe obesity, almost all patients had low levels of NAFLD, whereas fibrosis slightly increased. Steatosis and ballooning were closely linked to IR; long-term effects could be predicted by early improvement in IR.

Authors+Show Affiliations

Service d'Hépato-Gastroentérologie, CHRU de Lille, Université Lille 2, France. p-mathurin@chru-lille.frNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19409898

Citation

Mathurin, Philippe, et al. "Prospective Study of the Long-term Effects of Bariatric Surgery On Liver Injury in Patients Without Advanced Disease." Gastroenterology, vol. 137, no. 2, 2009, pp. 532-40.
Mathurin P, Hollebecque A, Arnalsteen L, et al. Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease. Gastroenterology. 2009;137(2):532-40.
Mathurin, P., Hollebecque, A., Arnalsteen, L., Buob, D., Leteurtre, E., Caiazzo, R., ... Pattou, F. (2009). Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease. Gastroenterology, 137(2), pp. 532-40. doi:10.1053/j.gastro.2009.04.052.
Mathurin P, et al. Prospective Study of the Long-term Effects of Bariatric Surgery On Liver Injury in Patients Without Advanced Disease. Gastroenterology. 2009;137(2):532-40. PubMed PMID: 19409898.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced disease. AU - Mathurin,Philippe, AU - Hollebecque,Antoine, AU - Arnalsteen,Laurent, AU - Buob,David, AU - Leteurtre,Emmanuelle, AU - Caiazzo,Robert, AU - Pigeyre,Marie, AU - Verkindt,Hélène, AU - Dharancy,Sébastien, AU - Louvet,Alexandre, AU - Romon,Monique, AU - Pattou,François, Y1 - 2009/05/04/ PY - 2008/07/31/received PY - 2009/03/16/revised PY - 2009/04/21/accepted PY - 2009/5/5/entrez PY - 2009/5/5/pubmed PY - 2009/8/14/medline SP - 532 EP - 40 JF - Gastroenterology JO - Gastroenterology VL - 137 IS - 2 N2 - BACKGROUND & AIMS: Severe obesity is implicated in development of nonalcoholic fatty liver disease (NAFLD). Bariatric surgery induces weight loss and increases survival time of obese patients, but little is known about its effects on liver damage. We performed a 5-year prospective study to evaluate fibrosis and nonalcoholic steatosis (NASH) in severely obese patients after bariatric surgery. METHODS: Bariatric surgery was performed on 381 patients. Clinical and biological data, along with liver biopsies, were collected before and at 1 and 5 years after surgery. RESULTS: Five years after surgery, levels of fibrosis increased significantly, but 95.7% of patients maintained a fibrosis score <or= F1. The percentage of patients with steatosis decreased from 37.4% before surgery to 16%, the NAFLD score from 1.97 to 1, ballooning from 0.2 to 0.1. Inflammation remained unchanged. The percentage of patients with probable or definite NASH decreased significantly over 5 years, from 27.4% to 14.2%. The kinetics of insulin resistance (IR) paralleled that of steatosis and ballooning; the greatest improvements occurred within the first year and were sustained 5 years later. Steatosis and ballooning occurred more frequently in patients with a refractory IR profile. In multivariate analysis, the refractory IR profile independently predicted the persistence of steatosis and ballooning 5 years later. CONCLUSIONS: Five years after bariatric surgery for severe obesity, almost all patients had low levels of NAFLD, whereas fibrosis slightly increased. Steatosis and ballooning were closely linked to IR; long-term effects could be predicted by early improvement in IR. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/19409898/Prospective_study_of_the_long_term_effects_of_bariatric_surgery_on_liver_injury_in_patients_without_advanced_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(09)00701-X DB - PRIME DP - Unbound Medicine ER -