[Medscape] Weight loss surgery is the “best treatment” for fatty liver disease

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New research shows that bariatric surgery significantly reduces the risk of liver complications as well as serious cardiovascular effects in patients with proven non-alcoholic steatohepatitis (NASH). demonstrated by biopsy, compared with similar patients who did not undergo surgery.

“This is the first study in the medical field to report a treatment modality,” said lead author Steven Nissen, MD, of the Cardiovascular and Thoracic Institute, Cleveland Clinic, Ohio, in a statement from the hospital. associated with a reduced risk of major adverse events in NASH patients.”

“The SLENDOR studies show that in patients with obesity and NASH, the significant and sustainable weight loss achieved by bariatric surgery can both protect the heart and reduce the risk of heart failure,” he said. progression to end-stage liver disease”

The study was published online November 11 in JAMA

Research SPLENDOR

The Surgical Procedure and Long-term Efficacy in NASH and Obesity Risk Study (SPLENDOR) included 1158 patients with NASH whose biopsies were non-cirrhotic; 650 people underwent weight loss surgery and the remaining 508 served as controls.

The participants had an average age of 49.8 years, had a mean body mass index (BMI) of 44.1kg/m^2, and nearly 64% were women.

The surgical procedure for weight loss consisted of Roux-en-Y gastrectomy, performed in 83% of patients, and gastric bypass, performed in the remaining 17%.

Lead author Ali Sminian, M.D., Director, Institute of Metabolism and Weight Loss, Cleveland Clinic, Ohio notes: “The primary pre-defined endpoints were the incidence of major liver complications and MACE.” Major hepatic adverse events included progression to clinical or histological cirrhosis, development of cancer, need for liver transplantation, or liver-related death.

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MACE is a composite of coronary events, cerebrovascular events, heart failure, or cardiovascular death.

At a median follow-up of 7 years, 5 patients in the bariatric surgery group compared with 40 patients in the nonoperative control group experienced a serious liver event.

The investigators reported that at 10 years, the cumulative rate of major liver complications was 88% lower in those in the bariatric surgery group, which occurred in 2.3% in the surgery group, compared with 9.6% in the no-surgery group (hazard ratio [HR], 0.12; P=.01)

At the end of the study, 39 patients in the surgical group underwent MACE compared with 60 patients in the control group. After 10 years, the cumulative rate of MACE was 70% lower in the bariatric surgery group, at 8.5%, compared with 15.7% in the control group (HR, 0.30; P=.007).

Again after 10 years, bariatric surgery also reduced body weight by an average of 22.4% in those who had undergone one surgery compared with weight loss, an average of 4.6% among non-surgical controls. surgery (P<0.001), while in patients with diabetes, bariatric surgery also significantly reduced A1c.

However, the authors note that the risk of major adverse events occurring within 30 days of bariatric surgery is relatively high.

But in the first years after the procedure, only four patients (0.6%) died from surgical complications, including two patients with gastrointestinal fistula.

The main treatment for NASH is weight loss

As the author points out, obesity is a major pathophysiological driver of NASH, and weight loss is now thought to be the primary treatment for NASH.

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“However, bariatric surgery is the most effective therapy for obesity,” they stress.

Shanu Kothari, MD, President of the Society for Metabolic and Weight Loss Surgery agreed, and said in a statement: “No treatment other than bariatric surgery has been shown to work. such a significant effect in reducing the risk of serious consequences or death in NASH patients”.

“Weight loss surgery should be considered the first-line treatment for these patients,” he stressed.

And as Aminian pointed out, there are currently no drugs approved by the PDA to treat fatty liver.

“The striking findings of this study provide strong evidence that bariatric surgery should be considered an effective treatment option for patients with fatty liver and advanced obesity,” he added in the statement. last”

Source: https://www.medscape.com/viewarticle/963529?fbclid=IwAR3IF2vmpgWnfRDAyt_OloSNXqChDf18kJv28eJiVB0tmbYPCxURaML8X5I

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Translated by: Thuy Linh

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