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The Role of Metabolic Surgery in Non-alcoholic Steatohepatitis Improvement

  • Lipid and Metabolic Effects of Gastrointestinal Surgery (R. Cohen, Section Editor)
  • Published:
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Abstract

Purpose of review

Non-alcoholic fatty liver disease (NAFLD) is frequently associated with obesity and overweight. It has a broad spectrum of clinical and histological presentations, such as steatosis, inflammation (known as non-alcoholic steatohepatitis or NASH), fibrosis, and cirrhosis. There is increasing evidence that marked weight loss following bariatric surgery is associated with NASH resolution; however, little is known about the mechanisms that may lead to this beneficial condition and if it is due to weight loss alone. In this review, the authors present the latest data regarding NASH resolution following metabolic surgery and try to answer the following questions: is NASH resolution due to weight loss alone or is it related to weight-independent effects similarly to T2D? In such case, can NASH be considered as a sole criterion for metabolic surgery?

Recent findings

Most data evaluating NAFLD and bariatric and metabolic surgery are derived from cohort studies. Available data are extremely variable, but in general show a dramatic regression of steatosis, inflammatory changes, and in some cases even fibrosis that is probably linked to major weight loss following surgery.

Summary

There are no randomized controlled trials evaluating the effects of metabolic surgery over NASH vs. lifestyle modifications. To consider NASH a sole indication for metabolic surgery regardless of BMI, such studies are desperately needed and should be the primary focus of future research in metabolic surgery.

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Authors and Affiliations

  1. The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, Rua Cincinato Braga, 37 5° andar, São Paulo, SP, Brazil

    Pedro Paulo Caravatto & Ricardo Cohen

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  1. Pedro Paulo Caravatto
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  2. Ricardo Cohen
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Correspondence to Pedro Paulo Caravatto.

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Pedro Paulo Caravatto and Ricardo Cohen declare that they have no conflict of interest.

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This article is part of the Topical Collection on Lipid and Metabolic Effects of Gastrointestinal Surgery

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Caravatto, P.P., Cohen, R. The Role of Metabolic Surgery in Non-alcoholic Steatohepatitis Improvement. Curr Atheroscler Rep 19, 45 (2017). https://doi.org/10.1007/s11883-017-0681-y

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