Background: Non-alcoholic steatohepatitis (NASH) is a leading cause of cirrhosis in patients with morbid obesity. 90% of morbidly obese patients have non-alcoholic fatty liver disease (NAFLD) which can progress to NASH. Left untreated NASH can progress to hepatocellular carcinoma. Bariatric surgery has the potential to reduce this risk.
Methods: The NASH clinical risk score (NASHCRS based on hypertension, diabase, sleep apnea, AST/ALT, non-black) is a validated scoring system used to identify patients who are at increased risk of NASH. We identified patients who underwent sleeve gastrectomy or gastric bypass from 2015 to 2018 and stratified them into low-risk and high-risk for developing NASH based on their scores. We compared the baseline scores to their scores at 6 months, 1, and 2 years post-operatively.
Results: There were 837 patients included. There were 133 patients in the high-risk group with a mean pre-operative BMI of 45.54 kg/m2 and NASHCRS of 5.42. There were 704 patients in the low- risk group with a mean pre-operative BMI of 43.66 kg/m2 and NASHCRS of 2.39. We found that patients in the high-risk group had a statistically significant reduction of the NASHCRS at 6 months, 1, and 2 years (p-value <0.05) compared to pre-operative scores. Patients in the low-risk group did not have a significant reduction in NASHCRS
Conclusion: Patients at high risk for steatohepatitis show significant reduction in their NASHCRS as early as 6 months following bariatric surgery.
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