In the United States, 5% of adults suffer from a condition known as nonalcoholic steatohepatitis (NASH). NASH is a more severe form of nonalcoholic fatty liver disease (NAFLD) and is becoming the leading cause of chronic liver disease. NAFLD usually develops in obese patients and occurs when liver cells begin to store too much fat. This extra fat may disrupt regular liver function when it becomes severe enough. While liver disease can develop in patients who drink too much alcohol, NAFLD occurs without alcohol intake. Most patients are asymptomatic during early phases of NASH and NAFLD. Patients are most commonly diagnosed when they undergo routine bloodwork and/or abdominal imaging.
When NAFLD turns to NASH, patients may develop progressive liver inflammation that can progress into fibrosis or, in other words, scar tissue. Fibrosis is graded from F0 to F4 with F0 being no fibrosis and F4 being end-stage liver disease, also known as cirrhosis. Currently, there are no FDA-approved drugs to treat NASH. Doctors usually recommend eating a healthier diet and exercising regularly. Patients who are overweight or obese, the consensus is that weight loss is the treatment of choice.
Enter bariatric surgery
What if you’ve tried dieting and exercise but can’t lose weight? No situation is too hopeless. For patients who fit certain medical requirements, there is an option to undergo different forms of weight loss surgeries, also known as bariatric surgeries. A few forms of bariatric surgery are:
- Roux-en-Y gastric bypass. This procedure is called “bypass” because the resulting configuration causes the food you eat to bypass your stomach and part of the small intestine. During the surgery, the surgeon reconstructs your stomach and intestines so the food won’t be fully absorbed thereby leading to a decrease in net calories.
- Sleeve gastrectomy. This is a procedure where the surgeon removes a portion of the stomach. The remaining part of the stomach is narrower and smaller. At this size, the stomach can’t hold as much food leading the patient’s appetite to go down as well.
- Biliopancreatic diversion with duodenal switch. In this surgery, the surgeon also removes a portion of the stomach. However, it also includes a second part in which the surgeon attaches the end of the intestine known as the ileum to a part near the stomach called the pylorus. Just like in the other procedures, food passing through skips the majority of the intestine.
- Laparoscopic Adjustable Gastric Band Care. Through this procedure, a band is inserted in the top part of the stomach. This forms a pouch that slows the food from passing through, leaving the patient fuller for longer. The band can be adjusted using a port placed under the skin. The port is attached to a tube that goes around the band. The surgeon will insert a needle through the skin into the tube and add or remove water as needed. Adding water will tighten the band and removing water will loosen it.
Before deciding which bariatric surgery to undergo, it is important to consult with a bariatric doctor to determine which procedure is best for you.
But does bariatric surgery help with NASH?
While wait loss surgery has been known to help with several medical conditions, one team of researchers wanted to see if it could benefit NASH patients. They looked at the records of 1,158 patients who had biopsies confirming a diagnosis of NASH without cirrhosis. Six hundred fifty underwent bariatric surgery and 508 used other means to treat their condition. Only 5 patients that chose to have surgery suffered from serious liver problems, while 40 patients in the nonsurgical control group experienced liver problems. Thirty-nine patients in the bariatric surgery group and 60 patients in the nonsurgical group suffered major adverse cardiovascular events. Overall, patients who had the surgery suffered less liver problems post treatment.
For patients suffering from NASH, losing weight is non-negotiable. Keeping all this extra fat will continue to cause these patients tremendous pain and liver trouble. However, patients who have unsuccessfully tried the standard prescription of eating healthy and exercising may find themselves despondent. The whispered promises from broccoli and brussel sprouts have failed them. Yet many of these patients can lose weight by undergoing bariatric surgery. After surgery, patients can live a healthier and pain-free life. If you think bariatric surgery can help you, speak with your doctor about the different treatment options available.
Written by Chani Bonner
- NASH Definition & Prevalence
- Nonalcoholic Fatty Liver Disease – Doctorpedia Gut Health Article
- Laparoscopic Adjustable Gastric Banding | Johns Hopkins Medicine
- Association of Bariatric Surgery With Major Adverse Liver and Cardiovascular Outcomes in Patients With Biopsy-Proven Nonalcoholic Steatohepatitis