Bariatric Surgery Reduces Features of Nonalcoholic Steatohepatitis in Morbidly Obese Patients
Abstract
Background & aims The effects of bariatric surgery in patients with nonalcoholic fatty liver disease (NASH) are not well established. We performed a prospective study to determine the biological and clinical effects of bariatric surgery in patients with NASH.Methods From May 1994 through May 2013, one hundred and nine morbidly obese patients with biopsy-proven NASH underwent bariatric surgery at the University Hospital of Lille, France (the Lille Bariatric Cohort). Clinical, biological, and histologic data were collected before and 1 year after surgery.Results One year after surgery, NASH had disappeared from 85% of the patients (95% confidence interval [CI]: 75.8%-92.2%). Compared with before surgery, patients had significant reductions in mean ± SD body mass index (BMI, from 49.3 ± 8.2 to 37.4 ± 7) and level of alanine aminotransferase (from 52.1 ± 25.7 IU/L to 25.1 ± 20 IU/L); mean levels of γ-glutamyltransferases were reduced from 51 IU/L before surgery (interquartile range [IQR], 34-87 IU/L) to 23 IU/L afterward (IQR, 14-33 IU/L) and mean insulin resistance index values were reduced from 3.6 ± 0.5 to 2.9 ± 0.5 (P < .01 for each comparison). NASH disappeared from a higher proportion of patients with mild NASH before surgery (94%) than severe NASH (70%) (P < .05) according to Brunt score. In histologic analysis, steatosis was detected in 60% of the tissue before surgery (IQR, 40%-80%) but only 10% 1 year after surgery (IQR, 2.5%-21.3%); the mean nonalcoholic fatty liver disease score was reduced from 5 (IQR, 4-5) to 1 (IQR, 1-2) (each P < .001). Hepatocellular ballooning was reduced in 84.2% of samples (n = 69; 95% CI: 74.4-91.3) and lobular inflammation in 67.1% (n = 55; 95% CI: 55.8-77.1). According to Metavir scores, fibrosis was reduced in 33.8% of patients (95% CI: 23.6%-45.2%). Patients whose NASH persisted 1 year after surgery (n = 12) had lost significantly less weight (change in BMI, 9.1 ± 1.5) than those without NASH (change in BMI, 12.3 ± 0.6) (P = .005). Patients who underwent laparoscopic gastric banding lost less weight (change in BMI, 6.4 ± 0.7) than those who underwent gastric bypass (change in BMI, 14.0 ± 0.5) (P < .0001), and a higher proportion had persistent NASH (30.4% vs 7.6% of those with gastric bypass; P = .015).Conclusions Bariatric surgery induced the disappearance of NASH from nearly 85% of patients and reduced the pathologic features of the disease after 1 year of follow-up. It could be a therapeutic option for appropriate morbidly obese patients with NASH who do not respond to lifestyle modifications. More studies are needed to determine the long-term effects of bariatric surgery in morbidly obese patients with NASH.
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The proportion achieving remission of MASLD induced by dietary weight loss of 10-15 kg is similar to that seen with very large weight losses post-bariatric surgery.
“The proportion achieving remission of MASLD induced by dietary weight loss of 10–15 kg is similar to that seen with very large weight losses post‐bariatric surgery.”
Up to 85% of those losing 25% of their initial body weight had remission of MASLD 1-year post-surgery.
“Up to 85% of those losing 25% of their initial body weight had remission of MASLD 1‐year post‐surgery.”
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- Authors
- Lassailly, G., Caiazzo, R., Buob, D., Pigeyre, M., Verkindt, H., Labreuche, J., Raverdy, V., Leteurtre, E., Dharancy, S., Louvet, A., Romon, M., Duhamel, A., Pattou, F., & Mathurin, P.
- Affiliations
- Inserm (FR)
- Université de Lille (FR)
- Corresponding author
- Pattou, François
- Mathurin, Philippe
- ORCID
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2015-08
- Volume
- 149
- Issue
- 2
- Pages
- 379-388
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W2021000378
- Semantic Scholar
- c6b4d739a30c475deddc671323ed38da61548c85
- Cited by
- 762
- References
- 41
- Citations by year
- 2026: 36 · 2025: 32 · 2024: 45 · 2023: 61 · 2022: 79 · 2021: 110 · 2020: 98 · 2019: 87 · 2018: 75 · 2017: 59 · 2016: 54 · 2015: 24 · 2014: 1 · 2013: 1
- FWCI
- 70.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Keywords
- bariatric surgery, nonalcoholic steatohepatitis, non-alcoholic fatty liver disease, morbid obesity, liver histopathology, steatosis, hepatocyte ballooning, lobular inflammation, insulin resistance, alanine aminotransferase, gamma-glutamyl transferase, NASH resolution, weight loss
- MeSH terms
- Adult, Alanine Transaminase, Female, Follow-Up Studies, France, gamma-Glutamyltransferase, Humans, Insulin Resistance, Liver, Male, Middle Aged, Obesity, Morbid, Risk Factors, Gastric Bypass, Weight Loss, Body Mass Index, Treatment Outcome, Bariatric Surgery, Non-alcoholic Fatty Liver Disease
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