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The progression of liver disease was halted by investigational bariatric surgery

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The progression of liver disease was halted by investigational bariatric surgery

Currently, patients with obesity and cirrhosis have few treatments for their progressive liver disease, but a new study offers one available option: bariatric surgery. Weight loss surgery significantly reduces the long-term risk of developing serious liver complications compared to standard non-surgical therapy.

The 62 obese and cirrhotic patients in the clinical trial who underwent bariatric surgery – either gastric bypass or gastric sleeve – had a 72% lower risk of later developing more severe liver disease compared to the 106 patients who did not undergo surgery. After 15 years, 20.9% in the surgical group, but 46.4% in the nonsurgical group, developed one of the major complications of liver disease, including liver cancer and death.

“We showed that regardless of the stage of the disease, we can improve their outcomes if we help people lose weight. That could offer hope for patients and medical providers,” said Ali Aminian, director of the Bariatric and Metabolic Institute at the Cleveland Clinic and co-author of the study. published Monday in Nature Medicine. “We can change the trajectory of the disease.”

About 3 million Americans are believed to have cirrhosis – scarring of the liver – caused by a condition called metabolic dysfunction-associated steatohepatitis, or MASH, formerly known as non-alcoholic fatty liver disease. Obesity and diabetes are the most common causes of MASH, which in turn is the most common chronic liver disease in the United States. When fat fills the liver cells, it causes inflammation. Liver scarring may follow, which in the late stages is called cirrhosis.

Many people don’t know they have cirrhosis. At first, it causes only vague symptoms such as weakness or fatigue that a patient might report to a primary care provider. Blood tests and liver biopsies can confirm the diagnosis and assign it to the first stage, also called compensated, when the liver works well enough to meet the body’s needs. Later, in the decompensated phase, the liver can no longer function, so a transplant is needed for survival.

The long-term nature of liver disease explains why it has been difficult until now to clearly demonstrate clinical results, for new obesity drugs or other treatments, Shehzad Merwat, associate professor of hepatology and gastroenterology at UTHealth Houston, told STAT. He was not involved in the investigation. GLP-1s are relatively new drugs and liver disease is a slowly progressive condition.

“It will likely take years of observation before we know the clinical outcomes of liver disease in patients taking anti-obesity medications,” he said. “Bariatric surgery may be considered in a select group of eligible patients. Others may choose a non-surgical approach even if current data are not available.”

In the new study, surgical patients in the compensated phase had an 80% lower risk of progressing to the next, more severely decompensated phase. These patients lost 26.6% of their weight compared to non-surgical patients, who lost 9.7%

“Weight loss is beneficial from several perspectives because it reduces the risks of diabetes, high blood pressure and cardiovascular side effects,” Merwat said. “The goal is to have multiple different treatment options, including lifestyle modifications, medical and surgical options tailored to individual patients within the spectrum of MASH-related liver disease.”

The main cause of cirrhosis is the build-up of fat in the liver cells, so new GLP-1 drugs that target obesity could potentially be helpful, but for now there is no medical treatment, Aminian said, that goes beyond lifestyle interventions such as diet and exercise, plus simply monitoring symptoms. .

“The main contributing factor is weight loss,” Aminian said. “If they lose weight through surgery, lifestyle or the medications, that will help.”

There are some medications in development specifically designed to treat MASH, but Aminian said they have a purpose other than weight loss. “That does nothing for fat accumulation, metabolism and obesity, but may address the fibrosis and scar tissue formation in the liver and potentially reverse the fibrosis,” he said. “The future is promising.”

Although the long time frame of liver disease can make studying treatments challenging, there may be an advantage to its prolonged pace, Aminian said.

From the moment when fat accumulates in the liver to cirrhosis, which is towards the end, it takes decades. “We have a long window of opportunity to intervene to help people lose weight,” he said. “The problem is that people don’t know they have liver disease.”

STAT’s coverage of chronic health conditions is supported by a grant from Bloomberg Philanthropies. Us financial supporters are not involved in decisions about our journalism.

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