Prevention and Reversal of Liver Damage following Biliopancreatic Diversion for Obesity.

Liver damage following biliopancreatic diversion (BPD) for obesity is an infrequent, dangerous and, when left untreated, even potentially fatal complication. The laboratory expression of developing liver damage is the progressive deterioration of the liver enzymes over 70 i.u., persisting and progressing beyond 6 months after surgery. Until recently, the treatment for this complication consisted of hospitalization for total parenteral nutrition and then, if this proved unsatisfactory, surgical reversal. In this report, a new therapeutic approach to this condition is presented. Four patients who, following a BPD for obesity, developed deterioration of the liver enzymes (AST, ALT over 70 i.u.) which persisted and progressed beyond the first 6 months after surgery, were given a treatment consisting of the ambulatory administration of 'Viokase' tablets, an uncoated pancreas extract with a high protease content (30,000 i.u.) taken with protein-rich meals. After 2-4 months of Viokase treatment, in all four patients the liver enzymes returned to normal levels: AST from 160, 86, 120 and 89 i.u. to 26, 20, 24 and 27 i.u. Two patients who complained of diarrheic stools (ten per day) received metronidazole for several days, dramatically improving their condition and returning their daily stool count to normal.