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Bariatric Surgery Provides Long-term Resolution of Nonalcoholic Steatohepatitis and Regression of Fibrosis.
- Source :
-
Gastroenterology [Gastroenterology] 2020 Oct; Vol. 159 (4), pp. 1290-1301.e5. Date of Electronic Publication: 2020 Jun 15. - Publication Year :
- 2020
-
Abstract
- Background and Aims: Studies are needed to determine the long-term effects of bariatric surgery for patients with nonalcoholic steatohepatitis (NASH). We evaluated sequential liver samples, collected the time of bariatric surgery and 1 and 5 years later, to assess the long-term effects of bariatric surgery in patients with NASH.<br />Methods: We performed a prospective study of 180 severely obese patients with biopsy-proven NASH, defined by the NASH clinical research network histologic scores. The patients underwent bariatric surgery at a single center in France and were followed for 5 years. We obtained liver samples from 125 of 169 patients (76%) having reached 1 year and 64 of 94 patients (68%) having reached 5 years after surgery. The primary endpoint was the resolution of NASH without worsening of fibrosis at 5 years. Secondary end points were improvement in fibrosis (reduction of ≥1 stage) at 5 years and regression of fibrosis and NASH at 1 and 5 years.<br />Results: At 5 years after bariatric surgery, NASH was resolved, without worsening fibrosis, in samples from 84% of patients (n = 64; 95% confidence interval, 73.1%-92.2%). Fibrosis decreased, compared with baseline, in samples from 70.2% of patients (95% CI, 56.6%-81.6%). Fibrosis disappeared from samples from 56% of all patients (95% CI, 42.4%-69.3%) and from samples from 45.5% of patients with baseline bridging fibrosis. Persistence of NASH was associated with no decrease in fibrosis and less weight loss (reduction in body mass index of 6.3 ± 4.1 kg/m <superscript>2</superscript> in patients with persistent NASH vs reduction of 13.4 ± 7.4 kg/m <superscript>2</superscript> ; P = .017 with resolution of NASH). Resolution of NASH was observed at 1 year after bariatric surgery in biopsies from 84% of patients, with no significant recurrence between 1 and 5 years (P = .17). Fibrosis began to decrease by 1 year after surgery and continued to decrease until 5 years (P < .001).<br />Conclusions: In a long-term follow-up of patients with NASH who underwent bariatric surgery, we observed resolution of NASH in liver samples from 84% of patients 5 years later. The reduction of fibrosis is progressive, beginning during the first year and continuing through 5 years.<br /> (Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Biopsy
Female
Follow-Up Studies
France
Humans
Liver Cirrhosis etiology
Male
Middle Aged
Non-alcoholic Fatty Liver Disease etiology
Obesity, Morbid complications
Obesity, Morbid diagnosis
Prospective Studies
Remission Induction
Time Factors
Treatment Outcome
Weight Loss
Bariatric Surgery
Liver pathology
Liver Cirrhosis pathology
Non-alcoholic Fatty Liver Disease pathology
Obesity, Morbid surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1528-0012
- Volume :
- 159
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 32553765
- Full Text :
- https://doi.org/10.1053/j.gastro.2020.06.006