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Bariatric surgery achieved long-term resolution of NASH without worsening fibrosis

Key clinical point: Bariatric surgery led to long-term resolution of nonalcoholic steatohepatitis without worsening fibrosis.

Major finding: In all, 84% of patients evaluated at 5 years met this primary endpoint.

Study details: A single-center, prospective study of 180 patients with severe or morbid obesity, biopsy-confirmed nonalcoholic steatohepatitis, and at least one other comorbidity.

Disclosures: The study was funded by the French Ministry of Health, Conseil Régional Nord-Pas de Calais, National de la Recherche, and the European commission (FEDER). The researchers reported having no conflicts of interest.

Citation:

Lassailly G et al. Gastroenterology. 2020 Jun 15. doi: 10.1053/j.gastro.2020.06.006.

Commentary:

As obesity prevalence increases at an alarming pace, nonalcoholic steatohepatitis (NASH) has become the most common indication for liver transplantation in women and the second most common in men in the United States. Impeding the inflammation and reversing the resultant fibrosis prior to the development of end-stage liver disease and needing liver transplantation are essential goals in NASH management. The lack of Food and Drug Administration–approved pharmacotherapy triggered interest in the effect of weight loss on NASH and short-term benefits were noted. In this article, Lassailly et al. demonstrated long-term benefits of bariatric surgery in patients with NASH. They prospectively enrolled 180 patients and histologically followed 64 patients at 1 year and 5 years postoperatively. NASH resolved in 84% of patients and fibrosis regressed in >70%. Importantly, advanced fibrosis (F3) regressed in 15/19 patients. Cirrhosis regressed to F3 in two-thirds of patients. No liver-related mortality or decompensation was observed. These favorable outcomes embolden the practice of referring NASH patients with morbid obesity to bariatric surgery before liver disease severity becomes prohibitive of this approach. NASH pharmacotherapy may become available in the future. However, we must not forget that cardiovascular disease remains a common cause of morbidity and mortality in NASH patients. With these study findings and previously established benefits of bariatric surgery on mitigating cardiovascular risk and treating relevant metabolic derangements (e.g., diabetes mellitus), pursuing bariatric surgery in NASH patients may be the seed that, if planted early on, can later flourish with resolution of NASH, prevention of cardiovascular disease, metabolic optimization, and potentially longer and healthier life.

Manhal J. Izzy, MD, is assistant professor of medicine, Vanderbilt Digestive Disease Center, Vanderbilt University, Nashville, Tenn.