Bariatric surgery should be the first line of treatment for nonalcoholic fatty liver disease (NAFLD) in patients with severe obesity, investigators said at the 2014 Digestive Disease Week (DDW) meeting. The 160-patient study showed that bariatric surgery and its related weight loss led to either complete or partial resolution of many cases of NAFLD-related steatosis, fibrosis, lobular inflammation, chronic portal inflammation and steatohepatitis.
“The extent of improvement we found surprised us,” said senior investigator Michel Murr, MD, director of bariatric surgery at the University of South Florida, Tampa. “Given the magnitude of improvement, we believe NAFLD patients with a body mass index [BMI] between 35 and 40 [kg/m2] should consider bariatric surgery, especially if they have not had success with medical treatments and diet modification.”
Dr. Murr’s team prospectively examined paired liver biopsies from 160 severely obese patients (mean preoperative BMI 52±10 kg/m2) who had undergone bariatric surgery between 1998 and 2003 and had histologically proven NAFLD. The time between the initial biopsy, which was taken intraoperatively, and the subsequent biopsy was a mean of 29 months (±22 months). The patients had a mean age of 46 years at the time of first biopsy, and 82% were women.
The first set of biopsies revealed steatosis in 78% of patients, lobular inflammation in 42%, chronic portal inflammation in 68%, steatohepatitis in 33%, grade 2 to 3 fibrosis in 41% and cirrhosis in 2%. At postoperative follow-up, patients had lost an average of 62% of excess body weight. Follow-up biopsies revealed complete resolution of steatohepatitis in 88% of patients (44 of 50) as well as resolution of 70% (82 of 118) of steatosis cases, 74% (46 of 62) of cases of lobular inflammation and 32% (32 of 99) of cases of chronic portal inflammation.
“More importantly, grade 2 and 3 fibrosis was resolved or improved in 65% of patients,” Dr. Murr noted.
Of 52 patients with preoperative grade 2 fibrosis, 31% (16 of 52) had complete resolution, 31% (16 of 52) had improvement and 29% (15 of 52) had no change in fibrosis grade. In 10 patients with grade 3 fibrosis, one individual experienced resolution and seven showed improvement in fibrosis. One of three patients with preoperative cirrhosis experienced improvement, Dr. Murr reported.
Lawrence Friedman, MD, chair of the DDW Council and chair of the Department of Medicine at Newton–Wellesley Hospital, Newton, Mass., said that most individuals with severe obesity (BMI >40 kg/m2) have NAFLD.
“Clearly, bariatric surgery is appropriate in these patients,” said Dr. Friedman, who was not involved in the research. “In less obese patients who have a BMI between 35 and 40 [kg/m2], I would say that having NAFLD should be a factor in the decision to proceed with surgery and should be weighed against the risks of bariatric surgery.”
This article was originally published by gastroendonews