Abstract
Morbid obesity is strongly associated with nonalcoholic fatty liver disease (NAFLD) which is one of the most common causes of chronic liver disease worldwide. The current best treatment of NAFLD and NASH is weight reduction through life style modifications, antiobesity medication, and bariatric surgery. Importantly, bariatric surgery is the best alternative option for weight reduction if lifestyle modifications and pharmacological therapy have not yielded long-term success. Bariatric surgery is an effective treatment option for individuals who are grossly obese and associated with marked decrease in obesity-related morbidity and mortality. The most common performed bariatric surgery is Roux-en-Y gastric bypass (RYGB). The current evidence suggests that bariatric surgery in these patients will decrease the grade of steatosis, hepatic inflammation, and fibrosis. NAFLD per se is not an indication for bariatric surgery. Further research is urgently needed to determine (i) the benefit of bariatric surgery in NAFLD patients at high risk of developing liver cirrhosis (ii) the role of bariatric surgery in modulation of complications of NAFLD like diabetes and cardiovascular disease. The outcomes of the future research will determine whether bariatric surgery will be one of the recommended choice for treatment of the most progressive type of NAFLD.
Highlights
Nonalcoholic fatty liver disease (NAFLD) is an increasingly recognised condition that occurs in all age groups and ethnicities [1]
Furuya et al [28] discovered that two years a er Roux-en-Y gastric bypass (RYGB) in 18 morbidly obese patients, all of whom had some degree of NAFLD, a mean excess weight loss of 60% was observed as well as an elimination of steatosis in 84% and an elimination of brosis in 75% of patients in the study
Obesity-related comorbidities improved and there was no evidence to suggest that RYGB led to worsening hepatic histology. e study looking at the effects of RYGB on NAFLD with the smallest cohort of study participants was conducted by Klein et al [24]. ey reported that RYGB surgery normalises the metabolic abnormalities involved in the pathogenesis of NAFLD and decreases the expression of hepatic factors involved in the progression of liver brosis and in ammation
Summary
Nonalcoholic fatty liver disease (NAFLD) is an increasingly recognised condition that occurs in all age groups and ethnicities [1]. Weiner [30] demonstrated that using one of three bariatric surgical measures (RYGB or adjustable gastric banding and biliopancreatic diversions with duodenal switch) resulted in an improvement in all obesity-related comorbidities, as well as a complete regression of NAFLD in 83% of the study cohort. T 4: Summary of studies of malabsorptive procedure and their effect on NAFLD
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