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Bariatric Surgery in NAFLD

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Abstract

Currently, there are no approved medications to treat patients with nonalcoholic steatohepatitis (NASH) with fibrosis or cirrhosis. Although the management goal in these patients is weight reduction by 7–10% with lifestyle modifications, only less than 10% of patients achieve this target at 1-year, and fewer maintain the weight loss at 5 years. Bariatric surgery is an option that may be considered in those who fail to lose weight by lifestyle changes. Bariatric surgery has been shown to improve liver histology including fibrosis secondary to NASH, in addition to other benefits including an improvement or resolution of type 2 diabetes mellitus, dyslipidemia, and hypertension, and a reduction of cardiovascular morbidity or mortality. There are no guidelines of bariatric surgery indications for the management of NASH. The purpose of this review is to critically appraise the current knowledge of the role of bariatric surgery and the potential mechanisms for its perceived benefits in the management of patients with NASH-related liver disease.

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Abbreviations

ACLF:

Acute-on-chronic liver failure

BS:

Bariatric surgery

BA:

Bile acids

BPD:

Biliopancreatic diversion with duodenal switch

BMI:

Body mass index

FXR:

Farnesoid-x receptor

FMT:

Fecal microbiota transfer

FGF:

Fibroblast growth factor

Fmri:

Functional MRI

GET:

Gastric emptying time

GLP-1:

Glucagon-like polypeptide-1

HCC:

Hepatocellular carcinoma

HE:

Hepatic encephalopathy

HGP:

Hepatic glucose production

LABG:

Laparoscopic adjustable gastric banding

LSG:

Laparoscopic sleeve gastrectomy

LT:

Liver transplant

NAS:

NAFLD activity scores;

NHANES II:

National Health and Nutrition Examination Survey

NIS:

Nationwide Inpatient Sample

NAFLD:

Nonalcoholic fatty liver disease

NASH:

Nonalcoholic steatohepatitis

PYY:

Peptide YY

RYGB:

Roux-en-Y gastric bypass (RYGB)

SBTT:

Small bowel transit time

TGR5:

G protein-coupled receptor

T2DM:

Type 2 diabetes mellitus

VSG:

Vertical sleeve gastrectomy

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Authors and Affiliations

  1. Institute of Digestive Health and Liver Diseases, Mercy Medical Center, Baltimore, MD, USA

    Mahak Chauhan, Kuldeep Singh & Paul J. Thuluvath

  2. Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA

    Paul J. Thuluvath

Authors
  1. Mahak Chauhan
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  2. Kuldeep Singh
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  3. Paul J. Thuluvath
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MC and PJT drafted the article, and PJT revised it for important intellectual content; KS reviewed the article for intellectual content; MC created the figures. All authors approved the final version and agreed to be accountable for all aspects of the work.

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Correspondence to Paul J. Thuluvath.

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Chauhan, M., Singh, K. & Thuluvath, P.J. Bariatric Surgery in NAFLD. Dig Dis Sci 67, 408–422 (2022). https://doi.org/10.1007/s10620-021-07317-3

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