Patrick H Alizai1, Janica Wendl2, Anjali A Roeth3, Christian D Klink4, Tom Luedde5, Inga Steinhoff6, Ulf P Neumann7, Maximilian Schmeding8, Florian Ulmer9. 1. Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany. palizai@ukaachen.de. 2. Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany. janica.wendl@rwth-aachen.de. 3. Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany. aroeth@ukaachen.de. 4. Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany. cklink@ukaachen.de. 5. Department of Gastroenterology, Digestive Diseases and Intensive Care Medicine, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany. tluedde@ukaachen.de. 6. Institute of Pathology, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany. isteinhoff@ukaachen.de. 7. Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany. uneumann@ukaachen.de. 8. Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany. mschmeding@ukaachen.de. 9. Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany. fulmer@ukaachen.de.
Abstract
BACKGROUND: Bariatric surgery provides long-term weight loss and improvement of obesity-associated diseases such as nonalcoholic steatohepatitis (NASH). Histologic improvement of NASH has been reported in some studies after bariatric surgery. This study was designed to assess the liver function in obese patients as well as its recovery after bariatric surgery with a noninvasive test method. METHODS: In a prospective cohort study from October 2011 to May 2014, morbidly obese individuals receiving bariatric surgery were investigated for functional liver recovery (n = 34). Liver function was determined by the LiMAx test (enzymatic capacity of cytochrome P450 1A2) preoperatively, 6 and 12 months postoperatively. Liver biopsy specimens were obtained from 18 participants and classified according to the nonalcoholic fatty liver disease (NAFLD) activity score (NAS). RESULTS: The mean age of participants was 44 years, and the mean body mass index (BMI) was 52 kg/m(2). The mean percent excess BMI loss (%EBMIL) was 53 % after 6 months and 68 % after 1 year. Mean liver function capacity increased significantly from 255 μg/kg/h preoperative to 324 μg/kg/h after 6 months and 342 μg/kg/h after 12 months. A negative correlation was observed between %EBMIL and alteration of liver function capacity in the first 6 months. Finally, the median NAS showed a negative correlation with liver function capacity. CONCLUSIONS: Bariatric surgery leads to a significant functional recovery of the liver. An initial marked weight loss may negatively influence functional liver recovery.
BACKGROUND: Bariatric surgery provides long-term weight loss and improvement of obesity-associated diseases such as nonalcoholic steatohepatitis (NASH). Histologic improvement of NASH has been reported in some studies after bariatric surgery. This study was designed to assess the liver function in obesepatients as well as its recovery after bariatric surgery with a noninvasive test method. METHODS: In a prospective cohort study from October 2011 to May 2014, morbidly obese individuals receiving bariatric surgery were investigated for functional liver recovery (n = 34). Liver function was determined by the LiMAx test (enzymatic capacity of cytochrome P450 1A2) preoperatively, 6 and 12 months postoperatively. Liver biopsy specimens were obtained from 18 participants and classified according to the nonalcoholic fatty liver disease (NAFLD) activity score (NAS). RESULTS: The mean age of participants was 44 years, and the mean body mass index (BMI) was 52 kg/m(2). The mean percent excess BMI loss (%EBMIL) was 53 % after 6 months and 68 % after 1 year. Mean liver function capacity increased significantly from 255 μg/kg/h preoperative to 324 μg/kg/h after 6 months and 342 μg/kg/h after 12 months. A negative correlation was observed between %EBMIL and alteration of liver function capacity in the first 6 months. Finally, the median NAS showed a negative correlation with liver function capacity. CONCLUSIONS: Bariatric surgery leads to a significant functional recovery of the liver. An initial marked weight loss may negatively influence functional liver recovery.
Authors: Philip R Schauer; Deepak L Bhatt; John P Kirwan; Kathy Wolski; Stacy A Brethauer; Sankar D Navaneethan; Ali Aminian; Claire E Pothier; Esther S H Kim; Steven E Nissen; Sangeeta R Kashyap Journal: N Engl J Med Date: 2014-03-31 Impact factor: 91.245
Authors: Kevin B Barker; Nicole A Palekar; Steven P Bowers; Joel E Goldberg; Joseph P Pulcini; Stephen A Harrison Journal: Am J Gastroenterol Date: 2006-02 Impact factor: 10.864
Authors: Pouneh Mofrad; Melissa J Contos; Mahmadul Haque; Carol Sargeant; Robert A Fisher; Velimir A Luketic; Richard K Sterling; Mitchell L Shiffman; Richard T Stravitz; Arun J Sanyal Journal: Hepatology Date: 2003-06 Impact factor: 17.425
Authors: Lisette T Hoekstra; Wilmar de Graaf; Geert A A Nibourg; Michal Heger; Roelof J Bennink; Bruno Stieger; Thomas M van Gulik Journal: Ann Surg Date: 2013-01 Impact factor: 12.969
Authors: John G Kral; Swan N Thung; Simon Biron; Frederic-Simon Hould; Stefane Lebel; Simon Marceau; Serge Simard; Picard Marceau Journal: Surgery Date: 2004-01 Impact factor: 3.982
Authors: Edoardo G Giannini; Claudia Coppo; Chiara Romana; Giovanni B Camerini; Franco De Cian; Nicola Scopinaro; Francesco S Papadia Journal: Dig Dis Sci Date: 2018-04-09 Impact factor: 3.199
Authors: Maximilian Jara; Tomasz Dziodzio; Maciej Malinowski; Katja Lüttgert; Radoslav Nikolov; Paul Viktor Ritschl; Robert Öllinger; Johann Pratschke; Martin Stockmann Journal: Dig Dis Sci Date: 2018-11-07 Impact factor: 3.199
Authors: Pierre Eric Danin; Rodolphe Anty; Stephanie Patouraux; Marc Raucoules-Aimé; Jean Gugenheim; Albert Tran; Philippe Gual; Antonio Iannelli Journal: Obes Surg Date: 2018-03 Impact factor: 4.129
Authors: Xin Chu; Kelsey Karasinski; Sean Donellan; Scott Kaniper; G Craig Wood; Weixing Shi; Michael A Edwards; Rohit Soans; Christopher D Still; Glenn S Gerhard Journal: Langenbecks Arch Surg Date: 2019-12-11 Impact factor: 3.445
Authors: Sophia M-T Schmitz; Andreas Kroh; Alexander Koch; Jonathan F Brozat; Christine Stier; Ulf P Neumann; Tom F Ulmer; Patrick H Alizai Journal: Obes Surg Date: 2021-04-04 Impact factor: 4.129
Authors: Jordan J Nostedt; Noah J Switzer; Richdeep S Gill; Jerry Dang; Daniel W Birch; Christopher de Gara; Robert J Bailey; Shahzeer Karmali Journal: Can J Gastroenterol Hepatol Date: 2016-09-29
Authors: Patrick H Alizai; Annabel Haelsig; Philipp Bruners; Florian Ulmer; Christian D Klink; Cornelis H C Dejong; Ulf P Neumann; Maximilian Schmeding Journal: Ann Med Surg (Lond) Date: 2017-12-07
Authors: Sophia Marie-Therese Schmitz; Andreas Kroh; Tom Florian Ulmer; Julia Andruszkow; Tom Luedde; Jonathan Frederik Brozat; Ulf Peter Neumann; Patrick Hamid Alizai Journal: BMC Gastroenterol Date: 2020-08-05 Impact factor: 3.067