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Obesity Surgery

, Volume 25, Issue 12, pp 2280–2289 | Cite as

Bariatric Surgery and Non-Alcoholic Fatty Liver Disease: a Systematic Review of Liver Biochemistry and Histology

  • Guy Bower
  • Tania Toma
  • Leanne Harling
  • Long R Jiao
  • Evangelos Efthimiou
  • Ara Darzi
  • Thanos Athanasiou
  • Hutan AshrafianEmail author
Original Contributions

Abstract

Background

Non-alcoholic fatty liver disease (NAFLD) is becoming a leading cause of global liver disease that is associated with the rising prevalence of obesity worldwide. There is now increasing clinical and mechanistic evidence reporting on the metabolic and weight loss effects of bariatric surgery on improving NAFLD in obese patients.

Objectives

The aim of this paper was to quantify the effects of bariatric surgery on NAFLD by appraising the modulation between pre- and post-operative liver enzyme levels (as markers of liver injury) and liver histology.

Methods

A systematic review of studies reporting pre-operative and post-operative liver enzymes or liver histology was done in obese patients with NAFLD undergoing bariatric surgery. Data were meta-analysed using random-effects modelling. Subgroup analysis, quality scoring and risk of bias were assessed.

Results

Bariatric surgery is associated with a significant reduction in the weighted incidence of a number of histological features of NAFLD including steatosis (50.2 and 95 %CI of 35.5–65.0), fibrosis (11.9 and 95 %CI of 7.4–16.3 %), hepatocyte ballooning (67.7 and 95 %CI 56.9–78.5) and lobular inflammation (50.7 and 95 %CI 26.6–74.8 %). Surgery is also associated with a reduction in liver enzyme levels, with statistically significant reductions in ALT (11.36 u/l, 95 %CI 8.36–14.39), AST (3.91 u/l, 95 %CI 2.23–5.59), ALP (10.55 u/l, 95 %CI 4.40–16.70) and gamma-GT (18.39 u/l, 95 %CI 12.62–24.16). Heterogeneity in results was high.

Conclusions

Bariatric surgery is associated with a significant improvement in both histological and biochemical markers of NAFLD. Future studies must focus on higher levels of evidence to better identify the benefits of bariatric surgery on liver disease in order to enhance future treatment strategies in the management of NAFLD.

Keywords

Non-alcoholic fatty liver disease NAFLD Bariatric surgery Metabolic surgery Body mass index Intervention Surgery Weight loss 

Notes

Ethical Approval

For this type of study, formal consent is not required.

Conflict of Interest

The authors declare that they have no conflict of interest.

Financial Disclosure

None

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Guy Bower
    • 1
  • Tania Toma
    • 1
  • Leanne Harling
    • 1
  • Long R Jiao
    • 1
    • 3
  • Evangelos Efthimiou
    • 1
    • 2
  • Ara Darzi
    • 1
  • Thanos Athanasiou
    • 1
  • Hutan Ashrafian
    • 1
    • 2
    • 3
    Email author
  1. 1.Department of Surgery and CancerImperial College LondonLondonUK
  2. 2.Department of Bariatric SurgeryChelsea and Westminster HospitalLondonUK
  3. 3.Department of Hepatobiliary and Pancreatic SurgeryImperial College Healthcare NHS TrustLondonUK

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