Fatty Liver (cont.)
Bhupinder Anand, MD
In this Article
Bariatric surgery is surgery of the gastrointestinal tract that results in loss of weight, and there are several different types of bariatric surgery. Since obesity is believed to be an important factor in the causation of NAFLD and loss of weight has been shown to have beneficial effects on NAFLD, it is not surprising that bariatric surgery has been considered as a potential treatment for NAFLD. Only one study has reported the effects of bariatric surgery on NAFLD and has demonstrated that fat and inflammation decrease, and progression from mild fibrosis to more severe fibrosis is arrested. (Patients with more severe fibrosis were not studied and, therefore it is not known if the progression from more severe fibrosis also is arrested.) Nevertheless, because appropriate studies to determine both the benefits and risks of bariatric surgery have not been done, it is recommended that bariatric surgery should not be used as a treatment for NASH. Instead, patients should be selected for surgery irrespective of the presence or absence of NASH.
Once a liver has become cirrhotic and complications have developed, the options for treatment are either treating the complications as they arise or to replace the diseased liver with a transplanted liver. In fact, NASH has become the third most common cause of transplanting livers, only surpassed by alcoholic liver disease and hepatitis C, but it is expected to climb to the number one position due to the epidemic of obesity and diabetes that is occurring in the U.S.. Unfortunately, NASH recurs frequently in the transplanted liver and then progresses to cirrhosis, presumably because the underlying causes - obesity and diabetes--continue.
Reviewed by Bhupinder Anand, MD on 3/14/2013
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