Abstract
The long-term effects of bariatric surgery on non-alcoholic steatohepatitis (NASH), focusing on liver injury and hepatocyte apoptosis, are not well-established. We here performed a longitudinal study with paired liver biopsies of nine morbidly obese women (median BMI: 42 [38.7; 45.1] kg/m2) with NASH with a median follow-up of 55 [44; 75] months after laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery. LRYGB surgery was associated with significant weight loss (median BMI loss −13.7 [−16.4; −9.5] kg/m2), improved hepatic steatosis in all patients (55.5% with total resolution), and resolution of hepatic inflammation and hepatocyte ballooning in 100 and 88.8% of cases, respectively. Alanine aminotransferase levels dropped to normal values while hepatic activated cleaved caspase-3 levels strongly decreased after a median follow-up of 55 months. Hepatocyte apoptosis, as evaluated by serum caspase-generated keratin-18 fragment, improved within the first year following LRYGB and these improvements persisted for at least 55 months. LRYGB in morbidly obese patients with NASH is thus associated with a long-lasting beneficial impact on hepatic steatohepatitis and hepatocyte death.
Highlights
Obesity represents a major health burden, as it is associated with a growing number of comorbidities (Must et al, 1999; Stevens et al, 2012)
We evaluated the long-term effects of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery on hepatic non-alcoholic steatohepatitis (NASH) features and liver injury in morbidly obese women with biopsy-proven NASH at the time of the surgery
84 morbidly patients with biopsyproven NASH diagnosed at time of bariatric surgery (LRYGB) were studied
Summary
Obesity represents a major health burden, as it is associated with a growing number of comorbidities (Must et al, 1999; Stevens et al, 2012). NAFLD includes a spectrum of liver abnormalities, ranging from simple steatosis to non-alcoholic steatohepatitis (NASH) and to liver cirrhosis, eventually leading to hepatocellular carcinoma (Tran and Gual, 2013; Yeh and Brunt, 2014). Regarding NASH, which is characterized by the presence of liver inflammation and injury (hepatocyte ballooning and apoptosis), recent reports indicate. A recent report, including a cohort of 109 morbidly obese patients with biopsy-proven NASH, has shown that bariatric surgery induced the disappearance of NASH in nearly 85% of patients and reduced the pathological features of the disease after 12 months of follow-up (Lassailly et al, 2015). We evaluated the long-term effects (median follow-up biopsy at 55 months) of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery on hepatic NASH features and liver injury (mainly hepatocyte apoptosis) in morbidly obese women with biopsy-proven NASH at the time of the surgery
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