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Effects of bariatric surgery on nonalcoholic fatty liver disease: Preliminary findings after 2 years
Abstract
Background and Aim: Although nonalcoholic fatty liver disease (NAFLD) is very common among morbidly obese patients, the effect of weight loss after bariatric surgery on inflammation and fibrosis related to NAFLD is still a matter of debate. The aim of this study was to evaluate the impact of Roux‐en‐Y gastric bypass (RYGB) surgery on NAFLD with a follow up of 2 years. Methods: Eighteen consecutive NAFLD patients with body mass index >40 kg/m 2 undergoing gastroplasty with RYGB were enrolled, and wedge liver biopsy was obtained at the operation. After 2 years, these patients underwent percutaneous liver biopsy. Results: At baseline, 67% of patients had nonalcoholic steatohepatitis (NASH) and 33% had steatosis, according to the NASH Clinical Research Network Scoring System (NAS) for biopsy. Cirrhosis was present in 5.5% of the patients with NASH. After a mean excess weight loss of 60%, steatosis disappeared in 84% and fibrosis disappeared in 75% of the patients. Hepatocellular ballooning disappeared in 50%. A slight lobular inflammatory infiltrate remained in 81%, apparently unrelated to fatty degeneration. As liver biochemical variables had been found within normal limits in 92.3% of patients at initial biopsy, no difference was found 2 years later. Lipid profile and blood sugar plasma concentration were closer to normal in all patients after 2 years (P < 0.05). Conclusions: Aspects of NAFLD including steatohepatitis improved significantly with massive weight loss at 2 years after RYGB surgery. No patient in this series had progression of hepatic fibrosis.
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“RYGB achieved steatosis remission in 89–95% of patients, especially in those with moderate-to-severe baseline steatosis (grades 2 and 3) [114,115,116,117].”
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 [116]
In the citing paper
“RYGB also reduced MASH severity by 75–88.9%, with 38% of patients achieving full remission [114,116], while VSG achieved 100% resolution [118].”
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 [116]
In the citing paper
“RYGB also reduced MASH severity by 75–88.9%, with 38% of patients achieving full remission [114,116], while VSG achieved 100% resolution [118].”
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 [116]
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Salman, M. A., Mikhail, H. M. S., Nafea, M. A., Sultan, A. A. E. A., Elshafey, H. E., Tourky, M. S., Awad, A., Abouelregal, T. E., Ahmed, R. A., Ashoush, O. A., et al. (2020) · Surgical Endoscopy · doi:10.1007/s00464-020-07498-4 · Cited by 42
Pharmacological and non-pharmacological treatment of non-alcoholic fatty liver disease
Kaser, S., Ebenbichler, C. F., & Tilg, H. (2010) · International Journal of Clinical Practice · doi:10.1111/j.1742-1241.2009.02327.x · Cited by 42
Schneck, A., Anty, R., Patouraux, S., Bonnafous, S., Rousseau, D., Lebeaupin, C., Bailly-maitre, B., Sans, A., Tran, A., Gugenheim, J., et al. (2016) · Frontiers in Physiology · doi:10.3389/fphys.2016.00344 · Cited by 37
“, 2006) and fibrosis (Clark et al., 2005; Mattar et al., 2005; Barker et al., 2006; Furuya et al., 2007) after LRYGB surgery.”
InfluentialVAT fat is bad for the liver, SAT fat is not!
Fan, J., & Farrell, G. C. (2008) · Journal of Gastroenterology and Hepatology · doi:10.1111/j.1440-1746.2008.05474.x · Cited by 39
Mechanisms of nonalcoholic fatty liver disease and implications for surgery
Kaufmann, B. K., Reca, A., Wang, B., Friess, H., Feldstein, A. E., & Hartmann, D. (2020) · Langenbeck s Archives of Surgery · doi:10.1007/s00423-020-01965-1 · Cited by 39
“Still, when sufficient weight loss was achieved, a reversal of NASH after Roux-en-Y gastric bypass was shown [106, 107].”
BackgroundThe Incapacity of the Surgeon to Identify NASH in Bariatric Surgery Makes Biopsy Mandatory
Teixeira, A. R. F., Bellodi‐Privato, M., Carvalheira, J. B. C., Pilla, V. F., Pareja, J. C., & D′Albuquerque, L. A. C. (2009) · Obesity Surgery · doi:10.1007/s11695-009-9980-x · Cited by 36
“gastric bypass. They found that steatohepatitis improved significantly with massive weight loss at 2 years after surgery, and no patient in this series had progression of hepatic fibrosis [ 16 ].”
BackgroundMolecular mechanisms of nonalcoholic fatty liver disease: Potential role for 12-lipoxygenase
Samala, N. R., Tersey, S. A., Chalasani, N., Anderson, R. M., & Mirmira, R. G. (2017) · Journal of Diabetes and its Complications · doi:10.1016/j.jdiacomp.2017.07.014 · Cited by 36
Chaim, F. D. M., Pascoal, L. B., Chaim, F. H. M., Palma, B. B., Damázio, T. A., da Costa, L. B. E., de Carvalho, R. B., Cazzo, E., Gestic, M. A., Utrini, M. P., et al. (2020) · Scientific Reports · doi:10.1038/s41598-020-65556-2 · Cited by 36
Reversal of fibrosis in patients with nonalcoholic steatohepatosis after gastric bypass surgery
Parker, B., Wu, J., You, J., Barnes, D., Yerian, L., Kirwan, J., Schauer, P., & Sessler, D. (2017) · BMC Obesity · doi:10.1186/s40608-017-0168-y · Cited by 34
“demonstrated improved steatosis and fibrosis in 18 patients after 24 months [18].”
BackgroundBariatric surgery, obesity and liver transplantation
Ahmed, Z., Khan, M. A., Vazquez‐Montesino, L. M., & Ahmed, A. (2022) · Translational Gastroenterology and Hepatology · doi:10.21037/tgh-2020-14 · Cited by 32
Obesity and colorectal liver metastases: Mechanisms and management
Pathak, S., Pandanaboyana, S., Daniels, I. R., Smart, N. J., & Prasad, R. K. (2016) · Surgical Oncology · doi:10.1016/j.suronc.2016.05.021 · Cited by 29
The Global Nonalcoholic Fatty Liver Disease Epidemic: What a Radiologist Needs to Know
Pereira, K., Salsamendi, J. T., & Casillas, J. (2015) · Journal of Clinical Imaging Science · doi:10.4103/2156-7514.157860 · Cited by 29
Nonalcoholic fatty liver disease and bariatric surgery
Stephen, S., Baranova, A. V., & Younossi, Z. M. (2012) · Expert Review of Gastroenterology & Hepatology · doi:10.1586/egh.11.97 · Cited by 29
Nonalcoholic fatty liver disease in severely obese individuals: The influence of bariatric surgery
de Andrade, A. R. C. F., Cotrim, H. P., Alves, E. S., Soares, D. A., Rocha, R., Almeida, A. D. M., Almeida, C. G., & de Freitas, L. A. (2008) · Annals of Hepatology · doi:10.1016/s1665-2681(19)31838-1 · Cited by 29
Safety and efficacy of bariatric surgery in patients with advanced fibrosis
Singh, T., Kochhar, G. S., Goh, G. B., Schauer, P. R., Brethauer, S. A., Kroh, M., Aminian, A., López, R., Dasarathy, S., & McCullough, A. J. (2016) · International Journal of Obesity · doi:10.1038/ijo.2016.212 · Cited by 28
The role of bariatric surgery in nonalcoholic fatty liver disease and nonalcoholic steatohepatitis
Shouhed, D., Steggerda, J. A., Burch, M. A., & Noureddin, M. (2017) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2017.1355731 · Cited by 28
Indikation und Prinzipien der metabolischen Chirurgie
Weiner, R. A. (2010) · Der Chirurg · doi:10.1007/s00104-009-1859-9 · Cited by 30
The impact of bariatric surgery on nonalcoholic fatty liver disease
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Bariatric surgery and nonalcoholic fatty liver disease
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Nonalcoholic Fatty Liver Disease: A Nutritional Approach
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Nonalcoholic Fatty Liver Disease and Type 2 Diabetes Mellitus: The Hidden Epidemic
Ismail, M. H. (2011) · The American Journal of the Medical Sciences · doi:10.1097/maj.0b013e3182018598 · Cited by 26
Pimentel, S. K., Strobel, R., Gonçalves, C. G., Sakamoto, D. G., Ivano, F. H., & Coelho, J. C. U. (2010) · Arquivos de Gastroenterologia · doi:10.1590/s0004-28032010000200010 · Cited by 26
Advances in the surgical treatment of morbid obesity.
Stefater, M., Kohli, R., & Inge, T. (2013) · Molecular Aspects of Medicine · doi:10.1016/j.mam.2012.10.006 · Cited by 27
The Effects of Metabolic Surgery on Fatty Liver Disease and Nonalcoholic Steatohepatitis
Clanton, J., & Subichin, M. P. (2016) · Surgical Clinics of North America · doi:10.1016/j.suc.2016.03.008 · Cited by 27
Metadata
- Authors
- Furuya, C. K., De Oliveira, C. P. M. S., De Mello, E. S., Faintuch, J., Raskovski, A., Matsuda, M., Vezozzo, D. C. P., Halpern, A., Garrido, A. B., Alves, V. A. F., & Carrilho, F. J.
- Affiliations
- Universidade de São Paulo (BR)
- Corresponding author
- De Oliveira, Claudia P M S
- Venue
- Journal of Gastroenterology and Hepatology
- Publisher
- Wiley
- Published
- 2007-03-20
- Volume
- 22
- Issue
- 4
- Pages
- 510-514
- ISSN
- 0815-9319 (ISSN-L)
- 1440-1746
- OpenAlex
- W2067021370
- Cited by
- 193
- References
- 26
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 4 · 2023: 8 · 2022: 5 · 2021: 7 · 2020: 8 · 2019: 11 · 2018: 13 · 2017: 13 · 2016: 14 · 2015: 18 · 2014: 10 · 2013: 10 · 2012: 11
- FWCI
- 15.94
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Hepatology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
- Keywords
- non-alcoholic fatty liver disease, Roux-en-Y gastric bypass, bariatric surgery, morbid obesity, weight loss, nonalcoholic steatohepatitis, hepatic steatosis, liver fibrosis, liver biopsy, hepatocyte ballooning, liver cirrhosis, lipid profile, blood glucose
- MeSH terms
- Adult, Biopsy, Fatty Liver, Female, Follow-Up Studies, gamma-Glutamyltransferase, Humans, Lipids, Liver, Liver Cirrhosis, Male, Middle Aged, Obesity, Morbid, Comorbidity, Body Mass Index, Bariatric Surgery
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