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Tuesday, Nov 19, 2019

Bariatric surgery helps reverse liver disease, sleep apnoea: AIIMS studies

A large majority of patients who underwent bariatric surgery showed improvement in liver-related conditions a year later, doctors found.

delhi Updated: Mar 27, 2018 19:37 IST
Anonna Dutt
Anonna Dutt
Hindustan Times
Around 25% to 30% people are estimated to have non-alcoholic fatty liver, but the condition is prevalent in around 70% to 90% of morbidly obese people.
Around 25% to 30% people are estimated to have non-alcoholic fatty liver, but the condition is prevalent in around 70% to 90% of morbidly obese people.(Shutterstock)

Weight-loss bariatric surgery can help reverse liver diseases and sleep apnoea in people who are obese, according to two studies conducted by the All India Institute of Medical Sciences (AIIMS) published in international journals in January and March.

Apart from alcohol consumption, non-alcoholic fatty liver disease (NAFLD) — liver inflammation caused by fat deposits around the abdomen — is one of the most common cause of chronic liver disease that can lead to liver cirrhosis (scarring) and liver failure.

Around 25% to 30% people are estimated to have non-alcoholic fatty liver, but the condition is prevalent in around 70% to 90% of morbidly obese people.

“Bariatric surgery is known to help obese people with diabetes to control their blood sugar levels, so we thought of looking at the impact of surgical weight-loss on other obesity-related diseases like NAFLD and sleep apnoea,” said Dr Sandeep Aggarwal, professor of surgery at AIIMS, and one of the authors of the study published in the international journal, Surgery for Obesity and Related Diseases.

Among the patients included in the study, 32 agreed for a follow-up biopsy after a year. Of these 32 patients, 27 (84.4%) had fat around the liver before the bariatric surgery, 28 patients (87.5%) had inflammation of the liver lobes, 31 (96.9%) had ballooning (a type of cell death in the liver by increasing in size), and 27 patients (84.4%) had fibrosis (scarring of the liver that eventually leads to cirrhosis).

In the biopsy done a year later, only five people had fat around the liver as compared to the 27 before the surgery. Of the 28 who had inflammation, it resolved in 12 people and in the remaining patients, it reduced 12 months after the surgery. Even ballooning was resolved in 12 and reduced in the rest.

Before the surgery, of four people that had NASH (non-alcoholic steatohepatitis, a significant chronic liver disease), it resolved in three after the surgery. The team will continue the study to get more cases to support their findings.

Sleep Apnoea

The doctors at AIIMS enrolled 27 morbidly obese people for the study published in March 2018 in Journal of Minimal Access Surgery; 96.3% had obstructive sleep apnoea, a sleep disorder associated with obesity in which breathing stops and starts repeatedly.

Three to six months after the surgery, on follow-up, the doctors saw that the average Epworth Sleepiness Scale (ESS) score, used to check for daytime sleepiness caused by improper sleep at night caused by sleep apnoea, had gone down from 8.9 to 4.03.

A sleep study – polysomnography – also showed that of the 14 patients with severe sleep apnoea, one was cured, four downgraded to mild sleep apnoea and four to moderate sleep apnoea.

The number of people needing CPAP (continuous positive airway pressure) therapy that helps people with sleep apnoea to breathe more regularly at night decreased from 15 to three.

“Around 5% of our population is overweight and obese and that can lead to these lifestyle diseases. We have seen that surgical intervention is more effective than lifestyle changes like dietary changes and exercise as compliance is an issue. Apart from that bariatric surgery also leads to hormonal changes and changes in the palette of the patient eg, not craving sweets etc which has a long-term impact on lifestyle changes too,” said Dr Aggarwal.

Meanwhile, of the 124 patients screened, 76 were included in the study that proved the efficacy of the fibroscan test, a type of ultrasound-based test, to detect liver damage in obese patients and set standards for doing it.

“In this study, we also checked whether the fibroscan test is accurate in obese people because the readings are impacted by the fat around the abdomen. The study also established that when just a fibroscan is enough and when doctors must conduct a biopsy, which is the gold standard when it comes to detecting liver damage,” said Dr Aggarwal.