Non-alcoholic Fatty Liver Disease (NAFLD) and Bariatric Surgery
Morbid obesity is associated with debilitating conditions that adversely affect quality of life and increase the risk of premature death including the metabolic syndrome (hypertension, hypercholesterolemia, type 2 diabetes mellitus (T2DM)) and non-alcoholic fatty liver disease (NAFLD). Insulin resistance is almost a universal finding in patients with NAFLD with majority suffering from T2DM. NAFLD was found to be present in more than 67 % of overweight patients (body mass index (BMI) more than 25 kg/m2) and nearly in 94 % of obese patients (BMI more than 30 kg/m2). NAFLD is a common cause of chronic liver disease worldwide. Simple fatty liver disease (steatosis) is a benign condition, reversible by weight loss. Inflammatory cell infiltration leading to non-alcoholic steatohepatitis (NASH) is a more aggressive condition, which is present in up to 10 % of cases and may lead to varying degree of fibrosis and cirrhosis or hepatocellular cancer (HCC) in up to 2 % of this at risk population. However, NASH and hepatic fibrosis short of cirrhosis cannot be reliably diagnosed clinically, radiographically, biochemically or even on gross examination intraoperatively, making liver biopsies the only reliable way to evaluate the liver status. Bariatric surgeons encounter NAFLD in 85–95 % of morbidly obese patients and thus have the unique opportunity to diagnose and assess severity of NAFLD by conducting an intraoperative liver biopsy in morbidly obese patients.
KeywordsNon alcoholic fatty liver disease NAFLD NASH Bariatric surgery Liver biopsy Steatosis Steatohepatitis Liver fibrosis, cirrhosis
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