Obesity is often associated with large deposits of fat cells in the liver. The fat cells can cause inflammation and damage to the liver cells which, in some cases, may even progress to irreversible scarring and cirrhosis. The condition is now referred to as “non-alcoholic fatty liver disease” or NAFLD. As the prevalence of serious obesity in the general population continues to rise, it seems clear that NAFLD will soon become a major new cause of liver failure in the population. The primary aim of this study was to determine whether weight loss, achieved through Roux-en-Y gastric bypass (RYGBP), improved the microscopic appearance of liver cells in patients with biopsy-proven NAFLD.
One hundred and forty-nine patients were identified from a surgical database as having RYGBP for obesity, together with liver biopsies. Thirty-five patients were found to have evidence of NAFLD at the time of surgery. Nineteen patients were contacted and underwent repeat liver biopsies. Biopsies were evaluated and compared in blinded fashion by an experienced atopathologist. Fasting lipids, insulin, glucose, hemoglobin A1c (HgbA1c), and liver enzymes were obtained. Significant improvements were observed in blood glucose, HgbA1C, lipids and insulin. Remarkably, pathologiocal examination of the repeat liver biopsies confirmed that the diagnostic critera for NAFLD were no longer found in 17/19 patients.
Comment
This study shows that weight loss induced by RYGP has a significant positive impact on the various tissue changes associated with NAFLD. In fact almost 90% of patients undergoing RYGP had complete resolution of their liver disease. These findings suggest that early intervention for serious weight problems in asssociation with NAFLD is essential. If surgery is delayed, then irreversible liver damage may occur in some patients.
Barker KB, Palekar NA, Bowers SP et al. Non-Alcoholic Steatohepatitis: Effect of Roux-en-Y Gastric Bypass Surgery. Am J Gastroenterol 2006, 101:368–373.
