Health
Surgery is best for metabolic liver disease
Newswise — Metabolic (bariatric) surgery is more effective than pharmacotherapy and lifestyle interventions in 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 compares three aggressive treatments for non-alcoholic steatohepatitis (NASH) and the efficacy of metabolic surgery (debulking surgery). This is the first paper to specifically investigate the In a randomized clinical trial.
nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease, affecting 55% of people with type 2 diabetes and 75% of obese people globally. non-alcoholic steatohepatitis (NASH) is a progressive form of this disease characterized by hepatocyte damage and inflammation that induces liver fibrosis (tissue scarring). Left 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 obese or type 2 diabetic patients. NAFLD/NASH now affects 12% of UK adults. By 2030, it is estimated that 27 million people in the United States will have this condition.
A multicenter randomized trial was conducted in Italy. The trial compared the effectiveness of bariatric surgery and metabolic surgery with lifestyle changes and current best practice in 288 patients.
Preoperative and postoperative liver biopsies showed that surgery was effective in inducing complete reversal of hepatic inflammation and cellular damage, a core feature of NASH, without exacerbating liver fibrosis 1 year after surgery. shown to be more effective. The odds of achieving NASH reversal were 3- to 5-fold higher with metabolic surgery than with medical care. The two surgical procedures appeared to improve NASH equally.
The investigators believe that the ability of surgery to control and even ameliorate NASH-associated fibrosis is a major predictor of hepatic complications, poor cardiovascular outcome and mortality in patients with NASH and is therefore particularly clinically relevant. said to be important.
Lead author of the report, Professor Geltrude Mingrone, Professor of Medicine at the Roman Catholic University and Professor of Diabetes and Nutrition at King’s College London, said: A condition that has long been considered an orphan of effective treatment.”
Professor Francesco Rubino, Senior Collaborator, King’s College London, Chair of Bariatric and Metabolic Surgery, and Consultant Surgeon, King’s College Hospital, said: Diabetes mellitus. The results of this study provide a compelling case for prioritization of metabolic surgery in this patient population. ”
Surgery also improved overall health benefits compared to conventional medical treatment. Both surgical procedures appeared to improve his NASH comparably, but the gastric bypass group was superior in terms of improving type 2 diabetes and reducing other cardiovascular risk factors associated with NAFLD/NASH. It was more effective than sleeve gastrectomy.
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