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Bariatric Surgery Improves Histological Features of Nonalcoholic Fatty Liver Disease and Liver Fibrosis
Andrew a. Taitano*1, Michael Markow2, Jon E. Finan2, Donald E. Wheeler2, John Paul Gonzalvo1, Michel M. Murr1
1Bariatric Surgery, University of South Florida, Tampa, FL; 2Pathology and Cell Biology, University of South Florida, Tampa, FL

Introduction
Nonalcoholic fatty liver disease (NAFLD) is prevalent in bariatric patients. We sought to determine the effects of surgically-induced weight loss on the histological features of NAFLD in patients undergoing bariatric surgery.
Methods
A blinded pathologist reviewed all liver biopsies done during the index bariatric procedure and any liver biopsies done during subsequent abdominal operations from 1998-2013. Biopsies were examined using H&E, trichrome and iron stains and graded using the Brunt classification. Data for analysis was collected prospectively and included demographics and weight loss.
Results
Paired biopsies for 152 patients (82% women) were included. Mean interval between biopsies was 29±22 months. Mean age was 46±11 years. Mean pre-op BMI was 52±10 kg/m2; mean excess body weight loss was 62±22% at the time of the subsequent biopsy.
The findings on the initial biopsy were steatosis (78%) lobular inflammation (42%), chronic portal inflammation (68%). Steatohepatitis was present in 33%. Fibrosis (Grade 2-3) was present in 41%, and cirrhosis was present in 2%.
On post-op biopsy, steatosis resolved in 70% (82/118); lobular inflammation resolved in 74% (46/62); chronic portal inflammation resolved in 32% (32/99) and steatohepatitis resolved in 88% (44/50). Fibrosis of any grade resolved in 21% and improved in another 23% of patients. Specifically, Grade 2 fibrosis was present in 52 patients pre-op; 16 (31%) resolved, 16 (31%) improved, and 15 (29%) did not worsen post-op. Of the 10 patients with bridging fibrosis (Grade 3), one resolved and seven improved. Cirrhosis improved in one of three patients who had it preoperatively.
Conclusion
Bariatric surgery improves liver histology in severely obese patients and is associated with resolution of steatosis or steatohepatitis in the majority of patients. More importantly, Grade 2 or 3 (bridging) fibrosis is resolved or improved in 65% of patients. Bariatric surgery should be considered as the treatment of choice of NAFLD in severely obese patients.


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