Non-alcoholic steatohepatitis: effect of Roux-en-Y gastric bypass surgery.
OBJECTIVE
Non-alcoholic steatohepatitis (NASH) is an increasingly prevalent problem. Treatment options are still under investigation. The primary aim of the study was to determine whether weight loss, achieved through Roux-en-Y gastric bypass (RYGBP), improved histopathology in obese patients with biopsy proven NASH.


METHODS
One hundred and forty-nine patients were identified from a surgical database as having RYGBP for obesity and concomitant intra-operative liver biopsies from October 2001 to September 2003. Thirty-five patients were found to have evidence of NASH at the time of surgery. Nineteen patients were contacted and underwent repeat percutaneous liver biopsies. Biopsies were evaluated and compared in blinded fashion by an experienced hepatopathologist. Fasting lipid panel, insulin and glucose, hemoglobin A1c (HgbA1c), and liver enzymes were obtained.


RESULTS
Significant differences were noted in the following variables pre- and post-bypass surgery: body mass index 46.8-28.8 kg/m2 (p < 0.001); body weight in kilograms 132.1-79.7 (p < 0.001); glucose 102.9-94.1 mg/dL (p = 0.015); Hgb A1c 5.79-5.15% (p = 0.026); high density lipoprotein 45.7-64.4 mg/dL (p < 0.001); low density lipoprotein 112-88.6 mg/dL (p = 0.003); triglycerides 132.1-97 mg/dL (p = 0.013). Significant improvements in steatosis, lobular inflammation, portal, and lobular fibrosis were noted. Histopathologic criteria for NASH were no longer found in 17/19 patients (89%).


CONCLUSIONS
Weight loss after gastric bypass surgery in obese patients with NASH results in significant improvement in glucose, HgbA1c. and lipid profiles. Furthermore, RYGBP results in significant improvement in the histological features of NASH with resolution of disease in a majority of these patients.
Barker
Kevin B
KB
Wilford Hall Medical Center, San Antonio, Texas, USA.
Palekar
Nicole A
NA
Bowers
Steven P
SP
Goldberg
Joel E
JE
Pulcini
Joseph P
JP
Harrison
Stephen A
SA
D000328:Adult; D000713:Anastomosis, Roux-en-Y; D015415:Biomarkers / Q000097:blood; D001707:Biopsy, Needle; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D018450:Disease Progression; D005234:Fatty Liver / Q000097:blood / Q000150:complications* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D006801:Humans; D008075:Lipoproteins, HDL / Q000097:blood; D008077:Lipoproteins, LDL / Q000097:blood; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
D015415:Biomarkers; D001786:Blood Glucose; D008075:Lipoproteins, HDL; D008077:Lipoproteins, LDL