Hepatic Steatosis After Intestinal Bypass—Prevention and Reversal by Metronidazole, Irrespective of Protein-Calorie Malnutrition

Abstract

Thirty-three patients were studied after intestinal bypass operations to determine if the postoperative hepatic steatosis could be related to bacterial overgrowth in the excluded segment, rather than to protein-calorie malnutrition. Metronidazole, a drug known to suppress anaerobic intestinal organisms, brought about improvement in the intestinal and systemic manifestations of the bypass enteropathy. When metronidazole was given at random intervals after surgery, the clinical improvement was associated with a reduction in hepatic steatosis in 12 of 12 patients. In 8 patients of this group, morphology reverted to normal within the first year. In contrast, without metronidazole treatment, steatosis increased in 12 of 17 patients during the postoperative period, only 1 reverted to normal in the first year, and in 9 of 12 patients the steatosis was still worse than at baseline during the second year after surgery. Additionally, in 9 patients, 3- or 4-mo periods with metronidazole were alternated repeatedly with drug-free intervals. Without metronidazole, steatosis increased in this group during 12 of 12 intervals, while in 12 of 13 periods with metronidazole, the steatosis diminished or disappeared. This improvement was evident despite concurrent progressive decreases in serum albumin levels during 5 of these 13 intervals. Overall, changes in hepatic fat content in the sequential liver biopsy specimens were found unrelated to weight loss rates or to plasma amino acid levels, and they inconsistently correlated to changes in serum albumin as indices of protein calorie nutrition. The data of this study suggest.that hepatic steatosis after an intestinal bypass operation is the result of a process related to the organisms colonizing the excluded intestinal segment, and that it is independent of protein-calorie malnutrition.