Weight Loss Surgery Improved Nonalcoholic Fatty Liver Disease

Bariatric surgery in nonalcoholic fatty liver disease patients may reduce liver inflammation and fibrosis

(RxWiki News) Non-alcoholic fatty liver disease is a growing problem in the United States as obesity rates continue to grow. Now, researchers think they have found a great way to treat this liver condition.

A recent study showed that weight loss surgery greatly improved non-alcoholic fatty liver disease (NAFLD).

"If you are obese, discuss weight loss options with your doctor."

This study was led by Michel Murr, MD, director of Tampa General Hospital in Florida.

The researchers looked at the fatty livers of people who were markedly obese at the time of weight loss (bariatric) surgery and then at an average of 29 months later, when the patients needed further surgeries and the researchers could biopsy (surgically remove organ sample) their liver again, explained Andrew Taitano, MD, a surgeon at the same hospital and one of the study investigators.

Prior research has shown that people who are overweight or obese or who have diabetes often have NAFLD. This is also true for people who have high triglycerides or cholesterol. NAFLD means they have steatosis (fat in their cells in the liver), which can lead to steatohepatitis (inflammation and damage to the liver), fibrosis (scarring) and eventual cirrhosis (end-stage liver disease).

"Fat (or adipose) deposits throughout the body, including organs such as the liver. Depending on the amount of deposits, normal function may be impaired," said Andre F. Hall, MD, an OB/GYN at Birth and Women's Care, PA in Fayetteville, NC.

Between 1998 and 2003, Dr. Murr and team enrolled 152 patients undergoing bariatric surgery.

All of these patients had an initial biopsy that showed that 78 percent of the patients had steatosis, 42 percent had inflammation of the liver lobes, 68 percent had chronic portal inflammation, and 33 percent had steatohepatitis. Grade 2-3 fibrosis (indicating severity, of which 4 is the highest) was found in 41 percent of patients and had progressed to cirrhosis in 2 percent of patients.

On post-op biopsy, steatosis resolved in 70 percent of patients (82 of 118 patients); lobular inflammation resolved in 74 percent (46 of 62 patients); chronic portal inflammation resolved in 32 percent (32 of 99 patients); and steatohepatitis resolved in 88 percent (44 of 50 patients).

Fibrosis of any grade resolved in 21 percent and improved in another 23 percent of patients. Of the 10 patients with bridging fibrosis (Grade 3), one resolved and seven improved.

Cirrhosis improved in one of three patients who had the condition before surgery. These patients had early-stage cirrhosis, as late stage is not reversible, Dr. Taitano said in a telephone interview.

“Helping people lose weight by any means is important for the liver,” Dr. Taitano said. Sometimes diet and exercise or medication can help, but those methods lead to a more modest weight loss than with bariatric surgery, he said. With weight loss surgery, a patient can lose 80 to 100 pounds or more.

These researchers did not look at which type of bariatric surgery was done, Dr. Taitano said, although “gastric bypass is probably considered the gold standard."

Gastric bypass surgery makes the stomach smaller and allows food to bypass part of the small intestine. Gastric sleeve is another procedure during which about 75 percent to 80 percent of the stomach is removed. Gastric sleeve is becoming more popular, Dr. Taitano said.

As 10 to 45 percent of the general population has fatty liver, it’s a growing concern, Dr. Taitano said.

This study suggests that “bariatric surgery is the most effective strategy for fighting fatty liver,” he added.

"This study links weight loss surgery and reduced weight with improved findings in nonalcoholic fatty liver disease. I believe the key here is weight loss and not so much that it was surgically performed. I expect the same findings would have been noted in people that had similar weight loss without the additional risk of surgery," Dr. Hall told dailyRx News.

Dr. Murr and colleagues presented these findings at Digestive Disease Week in Chicago over the weekend. This study has not yet been peer-reviewed.

The authors did not disclose any conflicts of interest.

Review Date: 
May 5, 2014