Research has shown that weight loss surgery can benefit obese individuals in ways that go beyond shedding pounds, for example by causing early remission of type 2 diabetes. Now scientists have found that the surgery can also. Weight loss surgery can dramatically improve Fatty Liver Disease and even reverse some early stage liver damage. A Future Treatment by Choice or by Chance? Department of Emergency Medicine, The James Cook University Hospital, Middlesbrough TS4 3. BW, UK2. Department of Medicine, Wexham Park Hospital, Slough, Berkshire SL2 4. HL, UKCopyright . This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Morbid obesity is strongly associated with nonalcoholic fatty liver disease (NAFLD) which is one of the most common causes of chronic liver disease worldwide. Importantly. bariatric surgery is the best alternative option for weight reduction if lifestyle modifications and pharmacological therapy have not yielded long- term success. The current evidence suggests that bariatric surgery in these patients will decrease. NAFLD per se is not an indication for bariatric surgery. Further research is urgently needed to determine (i). NAFLD patients at high risk of developing liver cirrhosis (ii) the role of bariatric surgery in modulation of complications of NAFLD like. The outcomes of the future research will determine whether bariatric surgery will be one of the recommended choice for treatment. NAFLD. 1. Introduction. Liver Concerns Remain After Weight Loss. Although weight loss surgery can help. Researchers suspect that because obesity often causes liver damage, weight loss surgery patients may. Weight-loss surgery can reduce liver damage: Study shows reversal of early-stage liver. Study shows reversal of early-stage liver fibrosis after bariatric surgery. Weight Loss for a Healthy Liver. Weight loss was shown to be associated with improvements in liver enzymes and improvements of nonalcoholic fatty liver disease. Learn more about Weight loss surgery and fatty liver disease at hartfordhealthcare.org. Background & Aims. Weight loss in overweight or obese individuals results in marked improvement or resolution of hypertension, diabetes mellitus, and hyperlipidemia. However, the overall effect of weight loss on nonalcoholic. Autoimmune or inherited liver disease; Fast weight loss. Alvarez talks about the relationship between fatty liver and weight loss surgery. If you're struggling with obesity and would like to know more about Gastric Sleeve surgery, or how Dr Alvarez can help you visit. ![]() Nonalcoholic fatty liver disease (NAFLD) is an increasingly recognised condition that occurs in all age groups and ethnicities . Although first recognised in the 1. Over this time, an assortment of terms has been used to represent this curiosity, including fatty liver hepatitis, nonalcoholic Laennec’s disease, diabetes hepatitis, alcohol- like liver disease, steatonecrosis, and nonalcoholic steatohepatitis . NAFLD has become the term of choice and describes a broad spectrum of hepatic conditions, which vary histologically. At one end of the spectrum lies simple steatosis, a relatively benign condition . At the other end is nonalcoholic steatohepatitis (NASH), which is steatosis in the presence of necroinflammatory hepatocellular changes . Some patients may complain of malaise or right upper quadrant pain, with hepatomegaly being the only clinical observation . Those at the malign end of the NAFLD spectrum may demonstrate evidence of cirrhosis, bruising, varices, ascites, splenomegaly, jaundice, and encephalopathy . Identification of patients before they reach this point is therefore important, to avoid liver- related morbidity and mortality. A high index of clinical suspicion is needed to diagnose NAFLD, particularly in those whose serum liver function tests reveal an elevated ALT . Meticulous history taking and investigation is also needed to exclude excess alcoholism (> 1. However, negative imaging studies do not rule out NAFLD . Furthermore, these imaging techniques are unable to differentiate between simple benign steatosis, NASH, and the degree of fibrosis . NAFLD is not a condition that occurs in isolation. It is now known to have strong associations with insulin resistance . In light of these associations, NAFLD is often regarded as the hepatic manifestation of the metabolic syndrome . In the adult population, NAFLD is thought to affect up to 2. This trend is also mirrored in the children population; up to 2. Approximately 5% of those with NAFLD will progress to cirrhosis with nearly 2% will die from complications stemming from a cirrhotic liver . Individuals with NAFLD are also at a higher risk of all causes of mortality . Although no drugs are specifically licensed for the treatment of NAFLD, there is evidence to support the use of selected agents. Antiobesity medications such as Orlistat . Alongside the pharmacological approach to management run conservative measures, such as weight loss through dieting, exercise, and lifestyle modification, all of which have shown to improve liver histology in both adults . Rapid weight loss was thought to adversely affect the liver in NAFLD . It can lower the long- term morbidity of obesity by up to 4. Since obesity is the key cause of NAFLD, this paper will look at bariatric surgery as a means of treatment for NAFLD. Worldwide, the number of surgical bariatric procedures has risen by an estimated 7. Procedures can be divided into 3 broad categories based on their mechanism of action . The restrictive procedures most commonly performed are vertical banded gastroplasty, laparoscopic adjustable gastric banding, and sleeve gastrectomy; (2) malabsorptive procedures are less popular than restrictive procedures as they are more technically demanding to be performed and patients often develop nutritional deficiencies. Procedures aim to bypass a segment of the small bowel so that less food is absorbed (biliopancreatic diversion, biliopancreatic diversion with duodenal pouch); (3) hybrid procedure aims to restrict food intake by creating a small gastric pouch which also limits absorption by bypassing the proximal small bowel—the Roux- en- Y gastric bypass (RYGB). It leaves 9. 5% of the small bowel intact and so avoids many of the unwanted malabsorptive side effects such as diarrhoea and nutritional deficiencies. This is the most common surgical bariatric procedure performed. Potential Benefit of Bariatric Surgery as Treatment of NAFLDThere is a large body of evidence to support the fact that when performed by skilled surgeons, bariatric surgery is safe . Despite this, at present there is currently a lack of randomised controlled trials examining the effects of bariatric surgery on NAFLD; the only available studies are either retrospective or prospective cohort studies. We have searched the Medline for studies between 1. NAFLD. We have identified twenty- two studies and their findings were reviewed and presented in the subsequent discussion and categorised according to surgical technique implemented (Tables 1, 2, 3, and 4). In addition, we included a section about the pathophysiological changes that take place following bariatric surgery that potentially contribute towards the treatment of NAFLD. Table 1: Considerable studies showed that RYGB is associated with marked improvement in NAFLD. Table 2: Summary of studies of VBG and their effect on NAFLD. Table 3: Summary of studies of AGB and their effect on NAFLD. Table 4: Summary of studies of malabsorptive procedure and their effect on NAFLD. The Roux- en- Y Gastric Bypass. Considerable studies showed that RYGB is associated with marked improvement in NAFLD. For instance, twelve studies . The predominant findings across these studies beside successful weight loss were a histological improvement in steatosis, inflammation, and fibrosis following Roux- en- Y gastric bypass. However, five of the studies . This could be attributed to these patients already having a pre- existing degree of fibrosis which subsequently worsened by the surgical intervention, or due to a lack of adequate replacement of macro/micronutrients. The earliest of these studies, conducted by Silverman et al. Pre- RYGB biopsies revealed that 1. RYGB. One study participant developed new perisinusoidal fibrosis within the follow- up period. Barker et al. In all 1. NASH were no longer met on follow- up biopsy. As well as NASH resolution, subjects also displayed weight loss and an improvement in biochemical markers of metabolic syndrome, triglycerides, lipoprotein, and fasting glucose. Fibrosis was found to have worsened in 2 of the 1. In the study by Csendes et al. The solitary participant with normal preoperative liver histology remained normal on follow- up biopsy, 1. RYGB continued to have cirrhosis. Moretto et al. 3. Of the 4. 3 individuals to be fibrosis free on initial biopsy, 5 were found to have developed fibrosis on follow- up biopsy after the RYGB procedure. One patient developed fibrosis following RYGB, but no participant showed worsening of existing fibrosis or cirrhosis. Studies by Clark et al. Neither study showed evidence of worsening histopathology after RYGB. He concluded that obesity surgery successfully improves hepatic steatosis, inflammation, and fibrosis with no evidence to suggest worsening. Furuya et al. Furthermore, obesity- related comorbidities also improved and there was no evidence to suggest that RYGB led to worsening hepatic histology. The study looking at the effects of RYGB on NAFLD with the smallest cohort of study participants was conducted by Klein et al. They reported that RYGB surgery normalises the metabolic abnormalities involved in the pathogenesis of NAFLD and decreases the expression of hepatic factors involved in the progression of liver fibrosis and inflammation. They found that 8. Mattar et al. A liver biopsy was taken at the point of surgery and a follow- up biopsy was taken months later. They showed a reduction in the prevalence of metabolic syndrome from 7. Interestingly, another conclusion drawn from this study was that the RYGB group lost greater excess weight and a greater improvement in the grade of liver disease when compared to the two restrictive procedures. No participant in this study showed evidence of worsening liver histology on follow up biopsy (Table 1). Vertical Band Gastroplasty. Of the 4 studies found looking at the effects of vertical band gastroplasty (VBG) on NAFLD, the smallest was conducted by Ranlov and Hardt . After one year there was a significant regression of hepatic steatosis and the occurrence of steatosis had fallen from 7. The earliest of these studies was carried out by Luyckx et al. Steatosis was found to be markedly reduced following weight loss; 4. Despite these encouraging findings, an increase in the incidence of hepatocellular inflammation was noted on repeat biopsy, from 1. In a similar but more recent study, Stratopoulos et al. Although an overall decrease in fibrosis was observed on follow- up biopsy, 1. Indeed it appears that VGB has fallen out of favour in recent years; a recent prospective study comparing forms of restrictive bariatric procedures . Adjustable Gastric Banding. Adjustable gastric banding (AGB) is the second most frequently performed bariatric surgery worldwide . Liver Concerns Remain After Weight Loss Surgery. Weight loss surgery might be beneficial for the liver of certain obese individuals, but it also poses some surprising liver specific dangers. In addition to becoming increasingly common in our culture, obesity is also the number one risk factor for a majority of our nation. Contributing to the urgency for effective weight loss strategies, one of the problems compounded by obesity is fatty liver disease. Weight loss surgery is a medical procedure that is gaining popularity for obese individuals, especially if they have a fatty liver. Although weight loss surgery can help relieve liver inflammation and scarring related to obesity, it also harbors some unwanted liver implications. If you have already had or are considering weight loss surgery, make sure you know about the potential hazards posed to your liver. BMI computations to determine obesity are measured by using an adult. For most individuals, BMI correlates with the amount of fat in their bodies. Obesity is generally accepted to be equivalent to a BMI of 3. BMI of 4. 0 and up. According to the National Institutes of Health: More than 1 in 3 adults are considered to be obese. More than 1 in 2. There is no single cause of obesity and, likewise, there is no single approach to help prevent or treat it. Treatment may include a mix of behavioral treatment, diet, exercise and sometimes weight loss drugs. In some cases of extreme obesity, weight loss surgery may be an option. Weight Loss Surgery. Weight loss surgery involves making structural changes to the stomach and/or small intestine. The two most common types of surgical procedures used to promote weight loss are: Restrictive Surgery . In addition to rapid and dramatic weight loss, several types of obesity- related health conditions appear to improve following weight loss surgery such as: Obese people with diabetes have improved blood sugar levels following weight loss surgery. Obese people with non- alcoholic fatty liver disease have improved liver health, including a possible reversal of fibrosis, following weight loss surgery. Weight Loss Surgery Liver Warnings. Knowing that weight loss surgery can help those with non- alcoholic fatty liver disease may serve as a substantial motivation for those affected. However, there are also many potential hazards to having this type of stomach or small intestine altering procedure. For the individuals who are actually candidates for weight loss surgery, the following side effects are common: Gallstones . Researchers suspect that because obesity often causes liver damage, weight loss surgery patients may still have weakened livers that are more susceptible to harm from acetaminophen. Risk of Alcoholism . Researchers believe that certain types of weight loss surgery changes how the body digests and metabolizes alcohol, which can lead to an alcohol- use disorder. Drinking alcohol, especially excessive amounts, is a surefire route to liver damage. Weight loss surgery carries a long list of possible risks, but it can be a lifesaver for certain individuals. For those with a BMI of 4. If weight loss surgery is deemed the best choice, those undergoing this procedure must take extra care of their liver health . King, Ph. D, et al, Retrieved December 1. Journal of the American Medical Association, June 2. Overweight and Obesity Statistics, Retrieved December 1. National Institute of Diabetes and Digestive and Kidney Diseases, 2. Bariatric surgery and acetaminophen risk, Erin Allday, Retrieved December 1. Hearst Communications, Inc., 2. An Overview of Weight Loss Surgery, Retrieved December 1. Web. MD, LLC, 2. 01.
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