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NASH found to decrease after bariatric surgery

Researchers in France found that the rate of nonalcoholic steatohepatitis decreased 1 year after bariatric surgery among patients with the disease, according to study data published in Gastroenterology.

In a prospective study, 109 obese patients with NASH underwent bariatric surgery at the University Hospital of Lille in France. Researchers collected and evaluated clinical, biological and histologic data before surgery and 1 year after surgery.

“The primary outcome was the disappearance of NASH. The secondary outcomes were the changes between baseline and 1 year in the NAFLD activity score and in individual scores for hepatocellular ballooning, lobular and portal inflammation, steatosis, and fibrosis,” the researchers wrote. “Other outcomes were the changes between baseline and 1 year in clinical and biological parameters [such as] BMI, alanine aminotransferase, [gamma]-glutamyltransferase, serum triglycerides, total cholesterol, fasting blood glucose and fasting insulin, and insulin resistance.”

Overall, NASH had disappeared from 85.4% of the patients 1 year after surgery (n = 70; 95% CI, 75.8%-92.2%). After surgery, patients had lower mean BMI compared with before surgery (49.3 ± 8.2 vs. 37.4 ± 7) and lower alanine aminotransferase levels (52.1 ± 25.7 IU/L vs. 25.1 ± 20 IU/L).

In addition, mean levels of gamma-glutamyltransferases were lower after surgery compared with before surgery (51 IU/L vs. 23 IU/L) and mean insulin resistance index values were also lower (3.6 ± 0.5 to 2.9 ± 0.5; P < .01 for both).

Analysis of the Brunt score showed that NASH disappeared from more patients with mild NASH at baseline compared with patients with severe NASH at baseline (94.2% vs. 70%; P = .007). In histologic analysis, steatosis was found to be in only 10% of tissue 1 year after surgery, compared with 60% of the tissue before surgery.

The mean NAFLD Activity Score was 5 at baseline, but then reduced to 1 after surgery (P < .0001).

The researchers observed improvement in fibrosis according to the Metavir score (P < .003) and Kleiner score (P < .0001). From these scores, fibrosis was observed to improve among 33.8% of the patients (95% CI, 23.6%-45.2%).

Twelve patients had persistent NASH 1 year after surgery, but still experienced significant weight loss compared with patients without NASH (9.1 ± 1.5 vs. 12.3 ± 0.6; P = .005).

“The encouraging results of the current study suggest that bariatric surgery should be tested in multicenter randomized controlled trials in morbidly or severely obese patients with NASH who did not respond to lifestyle therapy to determine the recommendations for this therapeutic option,” the researchers concluded. – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.