Original ResearchFull Report: Clinical—LiverBariatric Surgery Reduces Features of Nonalcoholic Steatohepatitis in Morbidly Obese Patients
Section snippets
Outcomes
The primary outcome was the disappearance of NASH. The secondary outcomes were the changes between baseline and 1 year in the NAFLD activity score and in individual scores for hepatocellular ballooning, lobular and portal inflammation, steatosis, and fibrosis. Other outcomes were the changes between baseline and 1 year in clinical and biological parameters: BMI, alanine aminotransferase (ALT), γ-glutamyltransferase (GGT), serum triglycerides, total cholesterol, fasting blood glucose and fasting
Characteristics of Patients Before Bariatric Surgery
Histologic NASH was diagnosed in 115 of 1489 (7.7%) cases. Among NASH patients, 109 were included and 6 excluded due to poor quality of the liver biopsy (flow chart, Figure 1). Surgical procedures in 109 NASH patients included 70 (64.2%) gastric bypasses, 32 (29.4%) gastric bands, 6 (5.5%) sleeve gastrectomies, and 1 (0.9%) biliointestinal bypass.
The characteristics of the population are summarized in Table 1. A description of the cohort has also been presented in relation to the severity of
Discussion
This prospective study using a planned program of sequential liver biopsies showed that bariatric surgery induces disappearance of NASH in around 85% of cases and reduces fibrosis.
The major impact of NASH on the subsequent risk of cirrhosis emphasizes an urgent need for effective therapy to reverse NASH, an objective rarely obtained with available therapy. The limited efficacy of lifestyle therapy26 is related to the fact that the required minimal threshold of 10% weight loss9, 10 is rarely
Acknowledgments
We gratefully acknowledge Shirley Balik, Marie Clement, Aurelie Lobez, and Sarah Surmont, for their daily work on prospective data collection.
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This article has an accompanying continuing medical education activity on page e15. Learning Objective: Upon completion of this test, successful learners will be able to discuss the diagnosis of nonalcoholic steatohepatitis, calculate the Nonalcoholic Fatty Liver Disease Fibrosis Score, and discuss the impact of bariatric surgery on the natural history of nonalcoholic steatohepatitis.
Conflicts of interest The authors disclose no conflicts.
Funding This work was supported by grants from the French Ministry of Health (Programme Hospitalier de Recherche Clinique) and from the Conseil Régional Nord-Pas de Calais (ARCIR Obésité et Alcool), Agence National de la Recherche (European Genomic Institute for Diabetes, E.G.I.D., ANR-10-LABX-46), and European commission (FEDER).
Author names in bold designate shared co-first authorship.
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Authors share co-first authorship.