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Cited by 9Bariatric Surgery and OutcomesLiver Disease Diagnosis and TreatmentLiver physiology and pathology

Effects of duodenal–jejunal bypass surgery in ameliorating nonalcoholic steatohepatitis in diet-induced obese rats

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Yu, Hsin-Hsien, Hsieh, Mao-Chih, Wu, Szu-Yuan, Sy, Edgar D, Shan, Yan-Shen·2019·Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy
DOI 10.2147/dmso.s190631PMC PMC6342211
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Abstract

Background: Duodenal–jejunal bypass (DJB) is an important component of many types of current bariatric surgery including Roux-en-Y gastric bypass, mini-gastric bypass, biliopancreatic diversion, duodenal switch, and DJB plus sleeve gastrectomy. Surgery is often observed to ameliorate nonalcoholic steatohepatitis (NASH), but without a clearly delineated mechanism. In this study, we investigated the effects of DJB in diet-induced obese rats with NASH. Materials and methods: Male Wistar rats were divided into four groups and fed the following diets over 6 months: A) normal chow (NC group, n=6); B) methionine–choline-deficient (MCD)–high-fat (HF) diet (HF group, n=6); C) MCD–HF diet for 3 months followed by DJB and MCD–HF diet for subsequent 3 months (DJB group, n=6); and D) MCD–HF diet for 3 months followed by treatment with pioglitazone (PGZ) with MCD–HF diet for subsequent 3 months (PGZ group, n=6). Body weight, glucose tolerance, the homeostatic model assessment-insulin resistance index, and lipid profiles were compared. Liver and visceral adipose tissue histology, inflammatory marker and hepatic stellate cell (HSC) activity, and hepatocyte autophagy were assessed. Results: Compared with the HF group, the DJB group showed improved body weight, insulin sensitivity, lipid metabolism, and steatosis severity. The DJB group exhibited a significantly lower nonalcoholic fatty liver disease activity score than the HF and PGZ group ( P <0.001 and P =0.003, respectively). Furthermore, DJB significantly reduced fat mass and adipocyte size. These effects were also observed in the PGZ group. Therefore, we speculated that the improvements induced by DJB are closely related to an alteration in insulin sensitivity. Moreover, DJB HSC activity and TNF-α expression and enhanced hepatocyte autophagy. Conclusion: DJB improves NASH through several mechanisms, particularly by altering insulin sensitivity, inflammatory responses, HSC activity, and hepatocyte autophagy. Keywords: duodenal–jejunal bypass, nonalcoholic steatohepatitis, insulin sensitivity, hepatic stellate cell activity, hepatocyte autophagy

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  • DJBL's effects on fibrosis remain inconclusive.

    “While DJBL appears to improve hepatic steatosis and metabolic markers, its effects on fibrosis remain inconclusive [101,102,103].”

    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 [101]

    The Results (‘DJB improved NASH and fibrotic reaction’; page unavailable) report that obvious fibrotic bundles had not developed, so the study could not establish whether the intervention prevents established fibrosis. It did find reduced fibrosis-related markers and suggested a possible preventive effect. Crucially, the rats underwent duodenal–jejunal bypass surgery (DJB), not treatment with a duodenal–jejunal bypass liner (DJBL), so the paper does not directly establish that DJBL’s effects are inconclusive. (LLM, conf=0.84)

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  • DJBL appears to improve hepatic steatosis and metabolic markers.

    “While DJBL appears to improve hepatic steatosis and metabolic markers, its effects on fibrosis remain inconclusive [101,102,103].”

    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 [101]

    The Results sections report reduced hepatic steatosis and improved glucose tolerance, insulin resistance, and triglycerides after surgical DJB in diet-induced obese rats. The claim concerns DJBL, a bypass liner, rather than the surgery tested here; the Introduction mentions liner studies but does not establish the same steatosis finding for DJBL. The Discussion notes that severe fibrosis had not developed, limiting conclusions about fibrosis. (LLM, conf=0.84)

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References 41 · Cited by 9

Research works printed but not linked: 35

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Authors
Yu, H.-H., Hsieh, M.-C., Wu, S.-Y., Sy, E. D., & Shan, Y.-S.
Affiliations
  • Wan Fang Hospital (TW)
  • National Cheng Kung University Hospital (TW)
Corresponding author
Shan, Yan-Shen
ORCID
Venue
Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy
Publisher
Informa UK Limited
Published
2019-01
Volume
Volume 12
Pages
149-159
ISSN
1178-7007 (ISSN-L)
DOI
10.2147/dmso.s190631
PMC
PMC6342211
OpenAlex
W2909387550
Cited by
9
References
41
Citations by year
2025: 2 · 2024: 2 · 2022: 2 · 2021: 2 · 2019: 1
FWCI
1.19
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Metabolic Syndrome and Obesity (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Hepatology › Liver physiology and pathology
Keywords
duodenal-jejunal bypass, nonalcoholic steatohepatitis, diet-induced obesity, insulin sensitivity, hepatic stellate cells, liver inflammation, TNF-α, non-alcoholic fatty liver disease, pioglitazone, methionine-choline-deficient diet, high-fat diet, visceral adipose tissue, bariatric surgery

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