Changes in liver histology accompanying massive weight loss after gastroplasty for morbid obesity.
BACKGROUND
Nonalcoholic steatohepatitis (NASH) is common in morbid obesity. Our goal was to evaluate the alterations in liver histology and biochemistry before and after weight loss in 51 morbidly obese patients following Mason's vertical banded gastroplasty.


METHODS
Two biopsies were performed (on entry and after an average of 18 months), while 16 of these subjects had a third biopsy 17 months after the second.


RESULTS
On entry, steatosis and steatohepatitis (mostly grade 3) were present in 98.0% and fibrosis (mostly stage 2) in 94.1% of the subjects. After an excess weight loss of 66%, steatosis and steatohepatitis improved significantly (P<0.001). Although a significant overall decrease in fibrosis occurred (P=0.002), 21 patients (41.1%) did not change and only 6 patients (11.7%) increased in fibrosis. None developed cirrhosis. The decrease in steatohepatitis was significantly correlated (P=0.011) with the reduction of BMI. Fasting serum glucose, lipids, lipoproteins, transaminases, gamma-glutamyl transpeptidase, alkaline phosphatase and fibrinogen were also significantly improved at the time of the second biopsy. The third biopsy performed in 16 of the subjects showed further significant improvement in liver histology.


CONCLUSIONS
NASH improved significantly with massive weight loss in non-diabetic, non-alcoholic, morbidly obese subjects, while fibrosis improved in nearly half of the patients.
Stratopoulos
Charalabos
C
First Department of Surgery and Transplant Center, Evagelismos Hospital of Athens, Greece.
Papakonstantinou
Alexandros
A
Terzis
Ioannis
I
Spiliadi
Charis
C
Dimitriades
George
G
Komesidou
Vasiliki
V
Kitsanta
Panagiota
P
Argyrakos
Theodoros
T
Hadjiyannakis
Evagelos
E
D001706:Biopsy; D005234:Fatty Liver / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D005355:Fibrosis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D015391:Gastroplasty; D006505:Hepatitis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D009767:Obesity, Morbid / Q000150:complications / Q000473:pathology / Q000601:surgery*; D015431:Weight Loss / Q000502:physiology*