Liver pathology in morbidly obese patients undergoing Roux-en-Y gastric bypass surgery.
BACKGROUND
Non-alcoholic fatty liver disease is common. However, little is known about liver disease in the morbidly obese.


METHODS
75 subjects (78% female, mean BMI 57 [40-108]) who had intra-operative liver biopsies at the time of Roux-en-Y gastric bypass surgery were studied.


RESULTS
84% of subjects had steatosis while only about 20% had moderate to severe inflammation and fibrosis. 8% had bridging fibrosis or cirrhosis. The presence of fibrosis correlated strongly with the presence of inflammation (p < 0.001) and steatosis (p = 0.0011), but weakly with ALT (p = 0.02) and not with AST (p = 0.12) or with BMI (p = 0.34). Steatosis correlated with AST (p = 0.04) and ALT (p = 0.055), but not with BMI.


CONCLUSIONS
Liver disease is not rare in the morbidly obese. The exact causes and mechanisms that lead from the very common isolated steatosis to inflammation and fibrosis remain unclear. Intra-operative liver biopsies during bariatric surgery may be helpful to screen for the presence of steatohepatitis and fibrosis.
Gholam
Pierre M
PM
Department of Medicine, Theodore Van Itallie Obesity Research and Treatment Center, St Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, NY, USA. NYCGIDOC@aol.com
Kotler
Donald P
DP
Flancbaum
Louis J
LJ
D000293:Adolescent; D000328:Adult; D000713:Anastomosis, Roux-en-Y; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies