Nonalcoholic fatty liver disease (NAFLD) is the liver manifestation of metabolic syndrome in which obesity and resistance to the insulin action are the hallmark. Fat accumulation in the liver produces inflammation and chronic liver damage, known as non-alcoholic steatohepatitis (NASH). Nowadays, the best strategy to treat NAFLD and NASH is weight loss. Surgical procedures to treat obesity (bariatric surgery) have shown good results to reduce fat accumulation and even improve other obesity-related conditions. However, neither the benefits nor the harms of bariatric surgery in NASH have been assessed in any systematic review or meta-analysis of randomised clinical trials. The present Cochrane review attempted to evaluate the benefits and risks of bariatric surgery for NASH in obese patients, but as no randomised clinical trials fulfilling the inclusion criteria of the review protocol were found, the review was not able to address the pre-specified in the protocol aims. Prospective and retrospective cohort studies reported on beneficial effects on steatosis and inflammation, with potential increase of liver fibrosis, but the studies were too heterogenous and with a small number of patients. Hence, the data, which the latter studies contained, are with a high risk of bias, and a reliable summary of their data cannot be achieved. Due to the absence of trials, well-designed randomised trials to assess bariatric surgery as a safe and effective treatment of NASH are required.
"Although gastric bypass surgery produces the largest sustained weight loss compared with other bariatric procedures, Mathurin et al found no significant differences among the gastric band, bilio-intestinal and gastric bypass groups in terms of global NAFLD activity score (NAS), steatosis, inflammation or ballooning.31 As there is a lack of long-term outcome data about bariatric surgery as a specific treatment for NAFLD, bariatric surgery cannot be considered as a primary treatment for NASH.37 However, NICE guidance suggests that surgery should be considered as a treatment for obesity for patients with BMI >40 kg/m2 or between 35 and 40 kg/m2 with other significant disease that could be improved with weight loss. "
[Show abstract][Hide abstract] ABSTRACT: Non-alcoholic fatty liver disease (NAFLD) affects up to a third of the population in many developed countries. Between 10% and 30% of patients with NAFLD have non-alcoholic steatohepatitis (NASH) that can progress to cirrhosis. There are metabolic risk factors common to both NAFLD and cardiovascular disease, so patients with NASH have an increased risk of liver-related and cardiovascular death. Management of patients with NAFLD depends largely on the stage of disease, emphasising the importance of careful risk stratification. There are four main areas to focus on when thinking about management strategies in NAFLD: lifestyle modification, targeting the components of the metabolic syndrome, liver-directed pharmacotherapy for high risk patients and managing the complications of cirrhosis.
"Mummadi et al. found that steatosis, steatohepatitis, and fibrosis improve or completely resolve after bariatric surgery in a significant proportion of patients.104 However, a Cochrane review concluded that lack of RCTs or other high-quality clinical studies prevents definitive determination of benefits and risks of bariatric surgery as a treatment option for patients with NASH.105 "
[Show abstract][Hide abstract] ABSTRACT: Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in the Western world and its incidence is increasing rapidly. NAFLD is a spectrum ranging from simple steatosis, which is relatively benign hepatically, to nonalcoholic steatohepatitis (NASH), which can progress to cirrhosis. Obesity, insulin resistance, type 2 diabetes mellitus, and dyslipidemia are the most important risk factors for NAFLD. Due to heavy enrichment with metabolic risk factors, individuals with NAFLD are at significantly higher risk for cardiovascular disease. Individuals with NAFLD have higher incidence of type 2 diabetes. The diagnosis of NAFLD requires imaging evidence of hepatic steatosis in the absence of competing etiologies including significant alcohol consumption. Liver biopsy remains the gold standard for diagnosing NASH and for determining prognosis. Weight loss remains a cornerstone of treatment. Weight loss of ∼5% is believed to improve steatosis, whereas ∼10% weight loss is necessary to improve steatohepatitis. A number of pharmacologic therapies have been investigated to treat NASH, and agents such as vitamin E and thiazolidinediones have shown promise in select patient subgroups.
Annals of the New York Academy of Sciences 01/2013; 1281(1). DOI:10.1111/nyas.12016 · 4.38 Impact Factor
"Liver disease such as hepatosteatosis, non-alcoholic steatohepatitis (NASH), hepatic fibrosis, and cirrhosis are all associated with obesity . Bariatric surgery improves the histological appearance of the liver and can lead to regression of established liver disease . However, these data are often uncontrolled and some authors have reported worsening in fibrosis rates after bariatric surgery . "
[Show abstract][Hide abstract] ABSTRACT: Obesity is recognized as a global health crisis. Bariatric surgery offers a treatment that can reduce weight, induce remission of obesity-related diseases, and improve the quality of life. In this article, we outline the different options in bariatric surgery and summarize the recommendations for selecting and assessing potential candidates before proceeding to surgery. We present current data on post-surgical outcomes and evaluate the psychosocial and economic effects of bariatric surgery. Finally, we evaluate the complication rates and present recommendations for post-operative care.
BMC Medicine 01/2013; 11(1):8. DOI:10.1186/1741-7015-11-8 · 7.25 Impact Factor
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