Surgically induced weight loss by gastric bypass improves non alcoholic fatty liver disease in morbid obese patients

AIM:To evaluate the effects of surgical weight loss(Roux-en-Y gastric bypass with a modified Fobi-Capella technique) on non alcoholic fatty liver disease in obese patients.METHODS:A group of 26 morbidly obese patients aged 45 ± 2 years and with a body mass index > 40 kg/m 2 who underwent open surgical weight loss operations had paired liver biopsies,the first at surgery and the second after 16 ± 3 mo of weight loss.Biopsies were evaluated and compared in a blinded fashion.The presence of metabolic syndrome,anthropometric and biochemical variables were also assessed at baseline and at the time of the second biopsy.RESULTS:Percentage of excess weight loss was 72.1% ± 6.6%.There was a reduction in prevalence of metabolic syndrome from 57.7%(15 patients) to 7.7%(2 patients)(P < 0.001).Any significance difference was observed in aspartate aminotransferase or alanine aminotransferase between pre and postsurgery.There were improvements in steatosis(P < 0.001),lobular(P < 0.001) and portal(P < 0.05) inflammation and fibrosis(P < 0.001) at the second biopsy.There were 25(96.1%) patients with non alcoholic steatohepatitis(NASH) in their index biopsy and only four(15.3%) of the repeat biopsies fulfilled the criteria for NASH.The persistence of fibrosis(F > 1) was present in five patients at second biopsy.Steatosis and fibrosis at surgery were predictors of significant fibrosis postsurgery.CONCLUSION:Restrictive mildly malabsorptive surgery provides significant weight loss,resolution of metabolic syndrome and associated abnormal liver histological features in most obese patients.