Metabolic liver disease best treated with surgery

Newswise – Metabolic (bariatric) surgery is more effective than medications and lifestyle interventions for treating advanced non-alcoholic fatty liver disease.

A new paper, published today in The Lancet by King’s College London and the Catholic University of Rome, is the first to compare three active treatments for non-alcoholic steatohepatitis (NASH) and specifically investigate the effectiveness of metabolic surgery (weight loss surgery) in a randomized clinical trial.

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease, affecting 55% of people with type 2 diabetes and 75% of those with obesity globally. Non-alcoholic steatohepatitis (NASH) is the progressive form of the disease and is characterized by damage and inflammation of liver cells, which induces liver fibrosis (tissue scarring). Untreated, it can lead to liver failure and liver cancer, and is one of the leading causes of liver transplantation in the Western world. NASH also increases the risk of cardiovascular disease and overall mortality in patients with obesity or type 2 diabetes. NAFLD/NASH currently affects 12% of adults in the UK; in the United States, the disease is estimated to affect 27 million people by 2030.

The multicenter randomized trial was conducted in Italy. The trial compared the effectiveness of bariatric and metabolic surgery against lifestyle changes and the best current medical care in 288 patients.

Pre- and post-operative liver biopsies showed that surgery was more effective in inducing complete reversal of inflammation and cell damage in the liver – the hallmarks of NASH – without worsening liver fibrosis after 1 year after surgery. The likelihood of achieving NASH reversal was 3-5 times higher with metabolic surgery than with medical care. Surgery was also more effective in improving at least one stage of liver fibrosis, another pre-specified endpoint of the trial. Both surgeries also seemed to improve NASH.

The researchers say that the ability of surgery to control and even improve NASH-associated fibrosis is of particular clinical importance, as fibrosis is the primary predictor of liver complications and poor cardiovascular outcomes and death in patients. patients with NASH.

Professor Geltrude Mingrone, first author of the report, Professor of Medicine at the Catholic University of Rome and Professor of Diabetes and Nutrition at King’s College London, said: “The results of our study support the use of metabolic surgery as a treatment for NASH, a condition long considered an orphan of effective therapies”.

Professor Francesco Rubino, Co-Principal Investigator and Chair of Bariatric and Metabolic Surgery at King’s College London and Consultant Surgeon at King’s College Hospital, said: “The presence of NASH predicts significant risk of complications and mortality in people with severe obesity and type 2 diabetes. The results of this study provide a compelling argument for prioritizing metabolic surgery in this patient population.”

Compared to conventional medical treatment, surgery also resulted in better overall health benefits. While both surgical procedures also appeared to improve NASH, the gastric bypass group was more effective than sleeve gastrectomy in improving type 2 diabetes and reducing other cardiovascular risk factors associated with NAFLD/NASH.

ENDS