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Bariatric Surgery Provides Long-term Resolution of Nonalcoholic Steatohepatitis and Regression of Fibrosis
Open accessAbstract
Background and Aims Studies are needed to determine the long-term effects of bariatric surgery for patients with nonalcoholic steatohepatitis (NASH). We evaluated sequential liver samples, collected the time of bariatric surgery and 1 and 5 years later, to assess the long-term effects of bariatric surgery in patients with NASH. Methods We performed a prospective study of 180 severely obese patients with biopsy-proven NASH, defined by the NASH clinical research network histologic scores. The patients underwent bariatric surgery at a single center in France and were followed for 5 years. We obtained liver samples from 125 of 169 patients (76%) having reached 1 year and 64 of 94 patients (68%) having reached 5 years after surgery. The primary endpoint was the resolution of NASH without worsening of fibrosis at 5 years. Secondary end points were improvement in fibrosis (reduction of ≥1 stage) at 5 years and regression of fibrosis and NASH at 1 and 5 years. Results At 5 years after bariatric surgery, NASH was resolved, without worsening fibrosis, in samples from 84% of patients (n = 64; 95% confidence interval, 73.1%-92.2%). Fibrosis decreased, compared with baseline, in samples from 70.2% of patients (95% CI, 56.6%-81.6%). Fibrosis disappeared from samples from 56% of all patients (95% CI, 42.4%-69.3%) and from samples from 45.5% of patients with baseline bridging fibrosis. Persistence of NASH was associated with no decrease in fibrosis and less weight loss (reduction in body mass index of 6.3 ± 4.1 kg/m 2 in patients with persistent NASH vs reduction of 13.4 ± 7.4 kg/m 2 ; P = .017 with resolution of NASH). Resolution of NASH was observed at 1 year after bariatric surgery in biopsies from 84% of patients, with no significant recurrence between 1 and 5 years ( P = .17). Fibrosis began to decrease by 1 year after surgery and continued to decrease until 5 years ( P < .001). Conclusions In a long-term follow-up of patients with NASH who underwent bariatric surgery, we observed resolution of NASH in liver samples from 84% of patients 5 years later. The reduction of fibrosis is progressive, beginning during the first year and continuing through 5 years.
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“In an observational study, MASH was resolved in 84% of 180 individuals with class 2 obesity and MASH 5 years after Roux-en-Y gastric bypass (66%), sleeve gastrectomy (12%) or gastric banding (22%).”
From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [443]
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“Pioglitazone therapy, GLP-1 RA therapy, and metabolic surgery have all been shown to reduce NASH activity; pioglitazone therapy and metabolic surgery may also improve hepatic fi brosis (188,292 -298).”
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“Wound healing in the liver is dynamic and reversible,105 with ample evidence of fibrosis regression after effective treatment of viral hepatitis, and even following bariatric surgery in patients with NASH.106”
From An integrated view of anti-inflammatory and antifibrotic targets for the treatment of NASH (2023) · cites this paper as [106]
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“One of the most promising developments in the field is the growing consensus that liver fibrosis can be a reversible process under certain conditions, particularly if the underlying cause of injury is removed (84–86).”
From Targeting macrophages in liver fibrosis (2026) · cites this paper as [85]
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“Procedures like Roux-en-Y gastric bypass (RYGB) and vertical sleeve gastrectomy (VSG) are associated with significant metabolic improvements and reductions in NAFLD severity [13,14,15], including reductions in liver fat, liver enzymes, and fibrosis [16,17,18].”
From Impact of Bariatric Surgery and Endoscopic Therapies on Liver Health in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Review (2025) · cites this paper as [16]
In the citing paper
“The reduction of fibrosis is progressive, beginning during the first year and continuing through 5 years [4,127].”
From Hepatic Insulin Resistance and Steatosis in Metabolic Dysfunction-Associated Steatotic Liver Disease: New Insights into Mechanisms and Clinical Implications (2025) · cites this paper as [127]
In the citing paper
“In a long-term follow-up study of patients with MASH who underwent bariatric surgery, the resolution of MASH in liver samples was observed from 84% of patients 5 years later.”
From Hepatic Insulin Resistance and Steatosis in Metabolic Dysfunction-Associated Steatotic Liver Disease: New Insights into Mechanisms and Clinical Implications (2025) · cites this paper as [127]
In the citing paper
“Weight loss either through lifestyle intervention68 or bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy)69,70 improves the lipid profile by reducing total TAGs, and increasing PC, PE and HDL concentrations.125”
From Lipid metabolism in MASLD and MASH: From mechanism to the clinic (2024) · cites this paper as [70]
In the citing paper
“Nevertheless, these interventions suggest that, like HCV and HBV, MASH fibrosis is reversible in non-cirrhotic liver, but unlike in HCV and HBV there is no evidence yet that cirrhosis in MASH is reversible (259).”
From Found in translation—Fibrosis in metabolic dysfunction–associated steatohepatitis (MASH) (2023) · cites this paper as [259]
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Citations
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Metadata
- Authors
- Lassailly, G., Caiazzo, R., Ntandja-Wandji, L.-C., Gnemmi, V., Baud, G., Verkindt, H., Ningarhari, M., Louvet, A., Leteurtre, E., Raverdy, V., Dharancy, S., Pattou, F., & Mathurin, P.
- Affiliations
- Inserm (FR)
- Centre National de la Recherche Scientifique (FR)
- Corresponding author
- Pattou, François
- Mathurin, Philippe
- ORCID
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2020-10
- Volume
- 159
- Issue
- 4
- Pages
- 1290-1301.e5
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W3034346518
- Cited by
- 622
- References
- 27
- Citations by year
- 2026: 93 · 2025: 105 · 2024: 109 · 2023: 106 · 2022: 108 · 2021: 89 · 2020: 11
- FWCI
- 56.22
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Gastroenterology (acceptedVersion, other-oa)
- PubMed (publishedVersion)
- HAL (submittedVersion, cc-by-nc)
- HAL (submittedVersion)
- LillOA (Université de Lille (University Of Lille)) (submittedVersion, other-oa)
- Funders
- European Regional Development Fund
- Agence Nationale de la Recherche (ANR-10-LABX-46, ANR-16-RHUS-0006)
- Ministère des Affaires Sociales et de la Santé
- European Commission
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Keywords
- bariatric surgery, nonalcoholic steatohepatitis, liver fibrosis regression, obesity, long-term outcomes, weight loss, NASH resolution, liver biopsy histology, bridging fibrosis, metabolic surgery, liver cancer risk, liver transplantation risk
- MeSH terms
- Adult, Biopsy, Female, Follow-Up Studies, France, Humans, Liver, Liver Cirrhosis, Male, Middle Aged, Obesity, Morbid, Prospective Studies, Remission Induction, Time Factors, Weight Loss, Treatment Outcome, Bariatric Surgery, Non-alcoholic Fatty Liver Disease
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