Roux-en-Y gastric bypass improves the nonalcoholic steatohepatitis (NASH) of morbid obesity.
BACKGROUND
Hepatic steatosis and nonalcoholic steatohepatitis (NASH) have been increasingly implicated in the genesis of hepatic fibrosis and cirrhosis. However, no consensus exists about whether weight reduction may reverse this process.


METHODS
To assess the effect of Roux-en-Y gastric bypass (RYGBP) on the histological evolution of NASH diagnosed in 64 patients by routine liver biopsy ("first" biopsy) performed during surgery, we performed a "second" biopsy after 23.5 +/- 8.4 months in 16 patients (14 female, 2 male).


RESULTS
From the first to the second biopsy, BMI decreased from 53.4 +/- 8.8 kg/m2 to 31.1 +/- 4.7 kg/m2, arterial hypertension decreased from 75% to 43.8%, and type 2 diabetes decreased from 43.8% to zero. On the first biopsy, nonalcoholic fatty liver disease (NAFLD) type 3 was observed in 12 patients (75%) and type 4 in 4 (25%). The second biopsy revealed complete regression of NAFLD in 15 patients (93.7%) and only 1 (6.3%) had NAFLD type 1 (mild steatosis without inflammation). Complete regression of necroinflammatory activity was observed in all patients. Among the 4 patients presenting fibrosis in the first biopsy, complete remission was observed in 1 and improvement in 1. Two continued to show the same degree of fibrosis without evidence of disease activity. No worsening of steatosis, necroinflammatory activity or fibrosis was observed in any of the patients, and none progressed to cirrhosis.


CONCLUSIONS
RYGBP improves steatosis, necroinflammatory activity and hepatic fibrosis in patients with morbid obesity and NASH.
Alfa Institute of Gastroenterology, University Hospital, Belo Horizonte, Brazil.
Soraya Rodrigues
SR
de Almeida
Paulo Roberto Savassi
PR
Rocha
Marcelo Dias
MD
Sanches
Virgínia Hora Rios
VH
Leite
Rogério Augusto Pinto
RA
da Silva
Marco Túlio Costa
MT
Diniz
Maria de Fátima Haueisen Sander
Mde F
Diniz
Alexandre Lages Savassi
AL
Rocha
D000328:Adult; D000713:Anastomosis, Roux-en-Y; D005234:Fatty Liver / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000473:pathology