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Figure 1. Mechanisms of bariatric surgery.
Effect of bariatric surgery on NAFLD and NASH
Lifestyle interventions and thiazolidinedione pharmacotherapy improve steatosis, but a weight loss of
greater than 10% is usually necessary for inflammation to regress. Many retrospective and prospective
clinical studies have investigated the effect bariatric surgery has on NAFLD, but no randomized controlled
trial has been done. Most studies have been done in mixed populations, i.e. with and without T2DM,
and investigators have reported improvements in histological examinations from liver biopsies, non-
invasive ultrasonography, and plasma transaminases. The histological improvements include consistent
reductions in steatosis and, in some cases, in Mallory’s hyaline bodies and inflammation. However, thus
far fibrosis seems more resistant to weight loss after bariatric surgery; results of the longest, largest,
and best executed study so far have shown that fibrosis scores can worsen during a 5 year period after
biliointestinal bypass (which as a procedure is now obsolete), Roux en-Y gastric bypass (RYGB) and
laparoscopic adjustable gastric banding.
54 Postgraduate Course Syllabus • Metabolic Liver Disease
Effect of bariatric surgery on NAFLD and NASH
Lifestyle interventions and thiazolidinedione pharmacotherapy improve steatosis, but a weight loss of
greater than 10% is usually necessary for inflammation to regress. Many retrospective and prospective
clinical studies have investigated the effect bariatric surgery has on NAFLD, but no randomized controlled
trial has been done. Most studies have been done in mixed populations, i.e. with and without T2DM,
and investigators have reported improvements in histological examinations from liver biopsies, non-
invasive ultrasonography, and plasma transaminases. The histological improvements include consistent
reductions in steatosis and, in some cases, in Mallory’s hyaline bodies and inflammation. However, thus
far fibrosis seems more resistant to weight loss after bariatric surgery; results of the longest, largest,
and best executed study so far have shown that fibrosis scores can worsen during a 5 year period after
biliointestinal bypass (which as a procedure is now obsolete), Roux en-Y gastric bypass (RYGB) and
laparoscopic adjustable gastric banding.
54 Postgraduate Course Syllabus • Metabolic Liver Disease
