Background: Non-alcoholic fatty liver disease (NAFLD) is becoming an epidemic in the United States. NAFLD is a spectrum of disease that includes steatosis and non-alcoholic steatohepatitis (NASH). This mirrors the obesity epidemic, which is thought to be an integral part of the pathogenesis of NAFLD. As a result of the rise of the prevalence of obesity, the number of bariatric surgery procedures performed across the United States has been increasing. This study investigates the hypothesis that steatosis and NASH improve after bariatric surgery.
Methods: All patients who underwent bariatric surgery from 1997 to 2002 were retrospectively reviewed. Any patients who underwent another surgical procedure with a concomitant liver biopsy were included in this study. Fisher’s exact test were utilized for statistical analysis.
Results: There were 37 patients (34 females) with an average age of 39.3 years (range 23 to 57), average age was with paired biopsies identified. All liver biopsies were performed from an average of 21 months (range 8-58) after the procedure. All patients had evidence of NAFLD at the first operation, and of those, 31 showed improvement at the time of second surgery (p<0.001) Preoperatively 34 had steatosis, of these, 28 (82%) had improvement, 5 demonstrated no change and 1 showed progression to NASH. There were 3 patients who had NASH at the original surgery. All three improved post operatively.
Conclusions: Bariatric surgery is an effective tool to help improve histology in those patients with NAFLD. Patients who are morbidly obese and have NAFLD should be considered for bariatric surgery.