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The use of serum transaminases to monitor response to treatment is questionable, on the basis of published
work. Although most studies have reported decreases in liver enzymes (e.g. γ-glutamyl transpeptidase,
aspartate aminotransferase and alanine transaminase) it has not been consistently shown which of
these is the most reliable to monitor. Furthermore, the correlation of these enzyme measurements
with histological improvements is either poor or highly variable. In the Swedish Obese Subjects
study, the largest and longest case-control study of obesity interventions, the plasma concentrations
of alanine transaminase decreased in the bariatric surgery group and, although concentrations of
aspartate aminotransferase increased, they were still lower than those of the control group 10 years after
intervention.
No data exist to prove that one bariatric procedure is superior to any of the others, although a recent
study suggested RYGB is marginally better than adjustable gastric banding [1]. In the absence of
conclusive mechanistic studies, correlations suggest that the lower insulin resistance and concentrations
of liver pro-inflammatory and inflammatory markers could be the most likely mediators underlying
the clinical improvements. The conclusion from these findings is that early intervention during the
course of NAFLD, and before the development of fibrosis, could be more likely to lead to favourable
outcomes, and that these might be even more pronounced in patients with T2DM or insulin resistance.
Although these findings are promising, randomized controlled trials are needed that compare the effects
of bariatric surgery with those of non-surgical therapies on hepatic histological appearances in patients
with T2DM, obesity, or both, before NAFLD and NASH can be considered as a specific indication for
bariatric surgery.
References
[1] Caiazzo R, Lassailly G, Leteurtre E, et al. Roux-en-Y gastric bypass versus adjustable gastric
banding to reduce nonalcoholic fatty liver disease: a 5-year controlled longitudinal study. Ann
Surg 2014;260:893-898; discussion 898-899.
[2] Miras AD, le Roux CW. Mechanisms underlying weight loss after bariatric surgery. Nat Rev
Gastroenterol Hepatol 2013;10:575-584.
[3] Miras AD, le Roux CW. Metabolic surgery: shifting the focus from glycaemia and weight to end-
organ health. Lancet Diabetes Endocrinol 2014;2:141-151.
The International Liver Congress™ 2015 • Vienna, Austria • April 22–23, 2015 55
work. Although most studies have reported decreases in liver enzymes (e.g. γ-glutamyl transpeptidase,
aspartate aminotransferase and alanine transaminase) it has not been consistently shown which of
these is the most reliable to monitor. Furthermore, the correlation of these enzyme measurements
with histological improvements is either poor or highly variable. In the Swedish Obese Subjects
study, the largest and longest case-control study of obesity interventions, the plasma concentrations
of alanine transaminase decreased in the bariatric surgery group and, although concentrations of
aspartate aminotransferase increased, they were still lower than those of the control group 10 years after
intervention.
No data exist to prove that one bariatric procedure is superior to any of the others, although a recent
study suggested RYGB is marginally better than adjustable gastric banding [1]. In the absence of
conclusive mechanistic studies, correlations suggest that the lower insulin resistance and concentrations
of liver pro-inflammatory and inflammatory markers could be the most likely mediators underlying
the clinical improvements. The conclusion from these findings is that early intervention during the
course of NAFLD, and before the development of fibrosis, could be more likely to lead to favourable
outcomes, and that these might be even more pronounced in patients with T2DM or insulin resistance.
Although these findings are promising, randomized controlled trials are needed that compare the effects
of bariatric surgery with those of non-surgical therapies on hepatic histological appearances in patients
with T2DM, obesity, or both, before NAFLD and NASH can be considered as a specific indication for
bariatric surgery.
References
[1] Caiazzo R, Lassailly G, Leteurtre E, et al. Roux-en-Y gastric bypass versus adjustable gastric
banding to reduce nonalcoholic fatty liver disease: a 5-year controlled longitudinal study. Ann
Surg 2014;260:893-898; discussion 898-899.
[2] Miras AD, le Roux CW. Mechanisms underlying weight loss after bariatric surgery. Nat Rev
Gastroenterol Hepatol 2013;10:575-584.
[3] Miras AD, le Roux CW. Metabolic surgery: shifting the focus from glycaemia and weight to end-
organ health. Lancet Diabetes Endocrinol 2014;2:141-151.
The International Liver Congress™ 2015 • Vienna, Austria • April 22–23, 2015 55
