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Surgical treatment of non-alcoholic steatohepatitis and non-alcoholic fatty liver disease.
Dig Dis. 2010; 28(1):274-9.DD

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/m(2), 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.

Authors+Show Affiliations

Department of Surgery, Krankenhaus Sachsenhausen, Frankfurt am Main, Germany. rweiner@khs-ffm.de

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20460923

Citation

Weiner, R A.. "Surgical Treatment of Non-alcoholic Steatohepatitis and Non-alcoholic Fatty Liver Disease." Digestive Diseases (Basel, Switzerland), vol. 28, no. 1, 2010, pp. 274-9.
Weiner RA. Surgical treatment of non-alcoholic steatohepatitis and non-alcoholic fatty liver disease. Dig Dis. 2010;28(1):274-9.
Weiner, R. A. (2010). Surgical treatment of non-alcoholic steatohepatitis and non-alcoholic fatty liver disease. Digestive Diseases (Basel, Switzerland), 28(1), 274-9. https://doi.org/10.1159/000282102
Weiner RA. Surgical Treatment of Non-alcoholic Steatohepatitis and Non-alcoholic Fatty Liver Disease. Dig Dis. 2010;28(1):274-9. PubMed PMID: 20460923.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical treatment of non-alcoholic steatohepatitis and non-alcoholic fatty liver disease. A1 - Weiner,R A, Y1 - 2010/05/07/ PY - 2010/5/13/entrez PY - 2010/5/13/pubmed PY - 2010/9/11/medline SP - 274 EP - 9 JF - Digestive diseases (Basel, Switzerland) JO - Dig Dis VL - 28 IS - 1 N2 - 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/m(2), 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. SN - 1421-9875 UR - https://www.unboundmedicine.com/medline/citation/20460923/Surgical_treatment_of_non_alcoholic_steatohepatitis_and_non_alcoholic_fatty_liver_disease_ L2 - https://www.karger.com?DOI=10.1159/000282102 DB - PRIME DP - Unbound Medicine ER -