What is The Emerging Role of Bariatric Surgery in the Management of Nonalcoholic Fatty Liver Disease (Surgery for Fatty Liver)?
Nonalcoholic fatty liver disease (NAFLD) is a condition where too much fat builds up in liver cells. This isn’t due to things like alcohol or medication, but more than 5% fat in liver cells is abnormal. NAFLD can vary from having fat in the liver cells (referred to as nonalcoholic fatty liver or NAFL), which isn’t harmful and can be reversed, to nonalcoholic steatohepatitis (NASH) where there’s inflammation and liver damage which can lead to more serious conditions.
Currently, there are no approved medicines for treating NAFLD. The most common way to manage it is through lifestyle changes aimed at losing weight. Patients who are overweight can consider bariatric surgery, a type of weight-loss procedure. This surgery has been shown to reduce conditions related to being overweight, including NAFL and NASH. But, there aren’t many studies that show how bariatric surgery affects people with NAFLD. Even though there’s more awareness about NAFLD and its complications, there’s no clear agreement about using bariatric surgery as a treatment for NAFLD. More discussions need to happen on this topic, especially since bariatric surgery might be the only effective treatment for some overweight patients with NAFLD.
What Causes The Emerging Role of Bariatric Surgery in the Management of Nonalcoholic Fatty Liver Disease (Surgery for Fatty Liver)?
We don’t entirely know what causes NAFLD, or Non-Alcoholic Fatty Liver Disease. However, it’s often found in people who have type 2 diabetes, are overweight, have high levels of fat in their blood, or have metabolic syndrome. These conditions put people at a higher risk of getting NAFLD. Being overweight, especially, seems to be strongly linked to NAFLD. Both your genes and what you eat might also factor into whether you get NAFLD.
Risk Factors and Frequency for The Emerging Role of Bariatric Surgery in the Management of Nonalcoholic Fatty Liver Disease (Surgery for Fatty Liver)
Non-alcoholic fatty liver disease, or NAFLD for short, is quite prevalent around the world, affecting approximately 30% of the global population. In the United States alone, about one in four adults have this condition. Out of these patients, around 20% specifically meet the criteria for a more severe form called non-alcoholic steatohepatitis (NASH), which translates to between 6.5 to 16.3 million Americans. It’s important to note that people who are overweight, obese, or suffering from metabolic disorders are more likely to develop NAFLD.
- The global prevalence of NAFLD is around 30%.
- About 25% of American adults have NAFLD, and 20% of these meet the criteria for the more severe NASH – this accounts for 6.5 to 16.3 million Americans.
- The number of people with NAFLD is expected to increase due to rising obesity and metabolic disorders since these conditions increase the risk of developing NAFLD.
- Up to 75% of overweight patients and over 90% of people with a body mass index (BMI) greater than 40 kg/m2 have NAFLD.
- NAFLD is predicted to become the leading cause of chronic liver disease worldwide and the most common reason for liver transplants in the United States by 2030.
Signs and Symptoms of The Emerging Role of Bariatric Surgery in the Management of Nonalcoholic Fatty Liver Disease (Surgery for Fatty Liver)
Nonalcoholic fatty liver disease (NAFLD) typically doesn’t show any symptoms. However, some people with a more severe form of this condition known as nonalcoholic steatohepatitis (NASH) might feel generally unwell, feel tired a lot, or have a discomfort or pain in the right upper part of their abdomen.
It’s crucial for doctors to gather detailed information about the patient’s medical and family history. They also need to look into the person’s lifestyle habits, such as alcohol and drug use, to eliminate other possible reasons for liver damage. Additionally, it is essential to know the full list of medications that the patient is taking, which includes any non-prescription drugs and supplements.
When examining patients with NAFLD, doctors might not see any signs of the disease unless the patient has progressed to chronic liver disease. In such cases, patients might show signs like yellowing of the skin and eyes (jaundice), fluid in the abdomen (ascites), red palms, spider-like blood vessels on the skin (spider angiomas), or enlarged organs.
Testing for The Emerging Role of Bariatric Surgery in the Management of Nonalcoholic Fatty Liver Disease (Surgery for Fatty Liver)
NAFLD, or nonalcoholic fatty liver disease, is often discovered unexpectedly during routine lab tests or during abdominal imaging done for other health concerns. It shows up as a mild increase in specific liver enzymes or as an enlarged liver. Patients with early-stage NAFLD might show normal lab tests results, with only an increase to abnormal levels as inflammation of the liver cells develops.
The most definitive way to confirm a diagnosis of NASH, or non-alcoholic steatohepatitis, and to measure the stage of liver scarring, is through a liver biopsy. Still, this procedure is invasive and carries risks, especially for people who are overweight due to the additional fatty tissue. As such, a liver biopsy is usually only carried out when diagnoses are uncertain or in patients with a higher risk of developing NASH.
There are various evaluation methods for NAFLD, with the NAFLD Activity Score (NAS) being one of the most frequently used. The NAS is a numerical ranking based on a liver biopsy that rates fat accumulation in the liver cells, inflammation in liver lobules, and abnormal swelling of liver cells. A score of 5 or higher is a strong indication of NASH. But this scoring system was designed to track progression or regression of NASH in clinical trials, not to sort out different types of NAFLD.
Given the risks linked to liver biopsies, there is growing interest in using non-invasive testing methods and imaging techniques to diagnose liver scarring accurately. These non-invasive methods combine patient details such as age and sex with lab results involving specific liver markers to calculate a score to stage NASH and liver scarring. The most common non-invasive tests are the FIB-4 score, NAFLD Fibrosis Score, and Fibrotest.
Non-invasive imaging methods, like liver elastography and magnetic resonance elastography, are used to assess liver inflammation and scarring. Liver elastography is a common tool in clinics that measures the stiffness of the liver by looking at the speed of shear waves inside it. However, its effectiveness for overweight patients who might need weight-loss surgery is unclear.
The effectiveness of non-invasive tests and imaging methods for overweight patients remains uncertain. Further studies are needed to tackle the clinical challenges of diagnosing NAFLD and staging liver scarring in overweight patients.
Treatment Options for The Emerging Role of Bariatric Surgery in the Management of Nonalcoholic Fatty Liver Disease (Surgery for Fatty Liver)
The best approach to managing Non-alcoholic Fatty Liver Disease (NAFLD) is through lifestyle changes, like eating a healthier diet and exercising regularly. Losing just 5 to 10% of your total body weight can lead to significant improvements in both the liver’s function and health. In this respect, diet and exercise are the most efficient ways to control NAFLD.
Currently, there are no medications approved by the US Food and Drug Administration (FDA) specifically for treating NAFLD. Though, there are several drugs in development and undergoing trials. Medications that are being studied include receptor agonists (substances that help boost the function of certain body proteins), and medications that imitate the function of a hormone called glucagon-like peptide-1. There are also several drugs like oltipraz and NGM282 in the second phase of clinical trials, along with others like lanifibranor and dapagliflozin which are in the third phase of trials. Although vitamin E and pioglitazone have passed the final stage of trials, they are still not FDA-approved for treating NAFLD.
For people battling obesity, bariatric surgery (which helps patients lose weight by making changes to the digestive system) can help reduce the risk of NAFLD and other obesity-related health problems. The current guidelines suggest that individuals with a BMI over 35, regardless of other health conditions, or those with type-2 diabetes and a BMI over 30, could consider bariatric surgery. This surgery can also be an option for people with a BMI of 30 to 34.9 who haven’t achieved significant or lasting weight loss through diet and exercise.
Interestingly, over 95% of individuals who undergo bariatric surgery have NAFLD at the time of their surgery. Besides helping with weight loss, this surgery can also directly improve NAFLD through enhancing control of blood glucose, modifying gut bacteria, and altering responses to food. While NAFLD is not a specific reason to have bariatric surgery, patients with NAFLD who meet the above weight criteria can consider this option as it often helps to manage or resolve associated health issues and reduces the risk of dying from heart disease or cancer.
However, it’s important to note that maintaining weight loss through diet and exercise can be tricky. Most people regain more than half of the weight they lost within two years, and by the fifth year, more than 80% of the lost weight is typically regained. Given no medications are formally approved for treating NAFLD and achieving persistent weight loss is a challenge, bariatric surgery could be a suitable option for patients with obesity and NAFLD when lifestyle modifications do not yield results. As NAFLD is a significant risk factor for liver cancer, further research is necessary to establish specific guidelines for recommending bariatric surgery safely to patients with obesity and NAFLD.
What else can The Emerging Role of Bariatric Surgery in the Management of Nonalcoholic Fatty Liver Disease (Surgery for Fatty Liver) be?
When trying to diagnose Non-alcoholic Fatty Liver Disease (NAFLD), doctors need to rule out several other conditions that can also harm the liver. These conditions include:
- Alcohol-related liver disease
- α1-Antitrypsin deficiency (a genetic disorder that can cause lung and liver disease)
- Autoimmune liver disease (when the body’s defense system attacks the liver)
- Damage due to medication side effects
- Hemochromatosis (a condition that causes the body to absorb too much iron from food)
- Various types of hepatitis (infections that cause inflammation of the liver, specifically hepatitis A, B, C, D, and E)
- Wilson’s disease (a rare inherited disorder that causes copper to accumulate in vital organs)
It’s crucial for the doctor to consider these possibilities before reaching a final diagnosis.
What to expect with The Emerging Role of Bariatric Surgery in the Management of Nonalcoholic Fatty Liver Disease (Surgery for Fatty Liver)
The outcomes for patients with NAFLD, or non-alcoholic fatty liver disease, can vary a lot. While some patients might never experience any issues from the disease, research shows that patients with NAFLD generally have a higher death rate and shorter life span compared to the average person. Specifically, people with NAFLD are more likely to die from heart diseases.
Furthermore, patients who have a higher degree of liver scarring, or ‘fibrosis’, face an increased risk of complications related to the liver and generally have worse outcomes.
Possible Complications When Diagnosed with The Emerging Role of Bariatric Surgery in the Management of Nonalcoholic Fatty Liver Disease (Surgery for Fatty Liver)
People with NAFLD, or non-alcoholic fatty liver disease, are more likely to have complications that may affect the liver and other parts of the body. Those with NASH, a more severe type of NAFLD, are at a higher risk of developing serious liver conditions such as cirrhosis, liver cancer, end-stage liver disease, and perhaps even death. However, the most common cause of death in people with NAFLD is heart disease. Other complications of NAFLD can include kidney disease, sleep apnea, polycystic ovarian syndrome, hormonal disorders, and colorectal cancer.
Bariatric surgery, a type of surgery that helps people lose weight, has its own set of immediate risks and long-term complications. These risks and complications can vary depending on what kind of bariatric surgery is performed. Some immediate risks after surgery can include leaks in the gastrointestinal tract, narrowing of the gastrointestinal tract, and bleeding. Other possible side effects are nausea and vomiting, worsening heartburn, infections, and a swelling of the esophagus. In the long run, bariatric surgery may also lead to malnutrition, ulcers in the gastrointestinal tract, bowel obstruction, strictures at the site of surgery, rupture of the esophagus, hernias, and a condition known as dumping syndrome.
After gastric bypass, a type of bariatric surgery, you can get what’s called dumping syndrome. This condition can be early or late onset. Early dumping syndrome happens when food moves too quickly into the small intestine, causing symptoms like dizziness, flushed face, nausea, belly pain, and heart palpitations. On the other hand, late dumping syndrome is linked to low blood sugar due to an increase in insulin, which can cause symptoms like confusion, shaking, fainting, and heart palpitations.
Another problem that can happen after bariatric surgery is poor absorption of essential nutrients, vitamins, and minerals. This could lead to conditions like anemia and nerve damage. Medications may also not be absorbed as well, which could mean changes in how much medication is needed.
- NAFLD Complications:
- Heart disease
- Kidney disease
- Sleep apnea
- Polycystic ovarian syndrome
- Endocrine disorders
- Colorectal cancer
- NASH Complications:
- Cirrhosis
- Liver cancer
- End-stage liver disease
- Potential death
- Bariatric Surgery Risks:
- Leaks in the gastrointestinal tract
- Narrowing of the gastrointestinal tract
- Bleeding
- Nausea and vomiting
- Worsening heartburn
- Infections
- Esophagus swelling
- Bariatric Surgery Long-term Complications:
- Malnutrition
- Ulcers in the gastrointestinal tract
- Bowel obstruction
- Narrowing at the site of surgery
- Rupture of the esophagus
- Hernias
- Dumping syndrome
Preventing The Emerging Role of Bariatric Surgery in the Management of Nonalcoholic Fatty Liver Disease (Surgery for Fatty Liver)
Educating patients plays a key role in controlling and preventing the consequences of NAFLD (Non-Alcoholic Fatty Liver Disease), a condition often ignored or underestimated. It’s essential to provide detailed information to patients about diet, nutritious eating, losing weight, and exercise as these changes in lifestyle have proven to suppress liver damage and may even reverse the disease. It’s equally important to teach patients how to manage related conditions, like high cholesterol and high blood sugar. Patients should also be counseled on limiting alcohol consumption and the use of supplements you can buy off the shelf.
