Bariatric Surgery Reduces Features of Nonalcoholic Steatohepatitis in Morbidly Obese Patients.
OBJECTIVE
The effects of bariatric surgery in patients with nonalcoholic fatty liver disease (NASH) are not well established. We performed a prospective study to determine the biological and clinical effects of bariatric surgery in patients with NASH.


METHODS
From May 1994 through May 2013, one hundred and nine morbidly obese patients with biopsy-proven NASH underwent bariatric surgery at the University Hospital of Lille, France (the Lille Bariatric Cohort). Clinical, biological, and histologic data were collected before and 1 year after surgery.


RESULTS
One year after surgery, NASH had disappeared from 85% of the patients (95% confidence interval [CI]: 75.8%-92.2%). Compared with before surgery, patients had significant reductions in mean ± SD body mass index (BMI, from 49.3 ± 8.2 to 37.4 ± 7) and level of alanine aminotransferase (from 52.1 ± 25.7 IU/L to 25.1 ± 20 IU/L); mean levels of γ-glutamyltransferases were reduced from 51 IU/L before surgery (interquartile range [IQR], 34-87 IU/L) to 23 IU/L afterward (IQR, 14-33 IU/L) and mean insulin resistance index values were reduced from 3.6 ± 0.5 to 2.9 ± 0.5 (P < .01 for each comparison). NASH disappeared from a higher proportion of patients with mild NASH before surgery (94%) than severe NASH (70%) (P < .05) according to Brunt score. In histologic analysis, steatosis was detected in 60% of the tissue before surgery (IQR, 40%-80%) but only 10% 1 year after surgery (IQR, 2.5%-21.3%); the mean nonalcoholic fatty liver disease score was reduced from 5 (IQR, 4-5) to 1 (IQR, 1-2) (each P < .001). Hepatocellular ballooning was reduced in 84.2% of samples (n = 69; 95% CI: 74.4-91.3) and lobular inflammation in 67.1% (n = 55; 95% CI: 55.8-77.1). According to Metavir scores, fibrosis was reduced in 33.8% of patients (95% CI: 23.6%-45.2%). Patients whose NASH persisted 1 year after surgery (n = 12) had lost significantly less weight (change in BMI, 9.1 ± 1.5) than those without NASH (change in BMI, 12.3 ± 0.6) (P = .005). Patients who underwent laparoscopic gastric banding lost less weight (change in BMI, 6.4 ± 0.7) than those who underwent gastric bypass (change in BMI, 14.0 ± 0.5) (P < .0001), and a higher proportion had persistent NASH (30.4% vs 7.6% of those with gastric bypass; P = .015).


CONCLUSIONS
Bariatric surgery induced the disappearance of NASH from nearly 85% of patients and reduced the pathologic features of the disease after 1 year of follow-up. It could be a therapeutic option for appropriate morbidly obese patients with NASH who do not respond to lifestyle modifications. More studies are needed to determine the long-term effects of bariatric surgery in morbidly obese patients with NASH.
Service d'Hépato-Gastroentérologie, Université Lille 2, France; Unité Inserm U 995, Université Lille 2, France.
Guillaume
G
Lassailly
Unité Inserm U 1011, Services de, Université Lille 2, France; Chirurgie Endocrinienne, Université Lille 2, France.
Robert
R
Caiazzo
d'Anatomie Pathologique, Université Lille 2, France.
David
D
Buob
de Nutrition, CHRU de Lille, Université Lille 2, France.
Marie
M
Pigeyre
Chirurgie Endocrinienne, Université Lille 2, France.
Hélène
H
Verkindt
Department of Biostatistics, Université Lille 2, France.
Julien
J
Labreuche
Chirurgie Endocrinienne, Université Lille 2, France.
Violeta
V
Raverdy
d'Anatomie Pathologique, Université Lille 2, France.
Emmanuelle
E
Leteurtre
Service d'Hépato-Gastroentérologie, Université Lille 2, France; Unité Inserm U 995, Université Lille 2, France.
Sébastien
S
Dharancy
Service d'Hépato-Gastroentérologie, Université Lille 2, France; Unité Inserm U 995, Université Lille 2, France.
Alexandre
A
Louvet
de Nutrition, CHRU de Lille, Université Lille 2, France.
Monique
M
Romon
Department of Biostatistics, Université Lille 2, France.
Alain
A
Duhamel
Unité Inserm U 1011, Services de, Université Lille 2, France; Chirurgie Endocrinienne, Université Lille 2, France. Electronic address: fpattou@univ-lille2.fr.
François
F
Pattou
Service d'Hépato-Gastroentérologie, Université Lille 2, France; Unité Inserm U 995, Université Lille 2, France. Electronic address: philippe.mathurin@chru-lille.fr.
Philippe
P
Mathurin
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D050110:Bariatric Surgery / Q000379:methods*; D015992:Body Mass Index; D005260:Female; D005500:Follow-Up Studies; D005602:France; D015390:Gastric Bypass; D006801:Humans; D007333:Insulin Resistance; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D009767:Obesity, Morbid / Q000097:blood / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome; D015431:Weight Loss; D005723:gamma-Glutamyltransferase / Q000097:blood
D005723:gamma-Glutamyltransferase; D000410:Alanine Transaminase
LAGB; NAFLD; Obesity; Weight-Reduction Surgery