Abstract
Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are increasingly common cause of chronic liver disease worldwide. The diagnosis of NASH is challenging as most affected patients are symptom-free and the role of routine screening is not clearly established. Most patients with severe obesity who undergo bariatric surgery have NAFLD, which is associated insulin resistance, type 2 diabetes mellitus (T2DM), hypertension, and obesity-related dyslipidemia. The effective treatment for NAFLD is weight reduction through lifestyle modifications, antiobesity medication, or bariatric surgery. Among these treatments, bariatric surgery is the most reliable method for achieving substantial, sustained weight loss. This procedure is safe when performed by a skilled surgeon, and the benefits include reduced weight, improved quality of life, decreased obesity-related comorbidities, and increased life expectancy. Further research is urgently needed to determine the best use of bariatric surgery with NAFLD patients at high risk of developing liver cirrhosis and its role in modulating complications of NAFLD, such as T2DM and cardiovascular disease. The current evidence suggests that bariatric surgery for patients with severe obesity decreases the grade of steatosis, hepatic inflammation, and fibrosis. However, further long-term studies are required to confirm the true effects before recommending bariatric surgery as a potential treatment for NASH.
Highlights
In recent years, the obese population has been rapidly increasing because of increases in diets rich in saturated fat and processed carbohydrates and sedentary lifestyles
The American Association for the Study of Liver Diseases (AASLD), American College of Gastroenterology (AGG), and American Gastroenterological Association (AGA) recommend that foregut bariatric surgery should not be contraindicated in otherwise eligible obese individuals with Non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH)
The current evidence suggests that bariatric surgery for patients with severe obesity decreases the grade of steatosis, hepatic inflammation, and fibrosis
Summary
The obese population has been rapidly increasing because of increases in diets rich in saturated fat and processed carbohydrates and sedentary lifestyles. MEDICAL TREATMENT OF NAFLD Past studies investigating lifestyle changes, such as diet, exercise, and behavior modification that resulted in weight loss of 5–10%, have shown that these changes can improve steatosis in some patients [7, 9]. ROUX-EN-Y GASTRIC BYPASS Bariatric surgery has a positive effect on obesity-related diseases in addition to reducing body weight. Because of this, it has been more recently termed metabolic surgery. Post-operatively, patients who undergo RYGB have shown a marked reduction in hepatic lipid content and improved hepatic insulin sensitivity well before significant weight loss occurs These benefits to the liver are directly related to at least two enteroendocrine cells-synthesized gut peptides GLP-1 and peptide YY [26,27,28,29].
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