Original communicationEffects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis
Section snippets
Patients
A total of 689 (651 women, 138 men) consecutive patients underwent biliopancreatic diversion (BPD) for severe obesity from 1984 to 1994 at Laval Hospital, Quebec, Canada.37 Wedge liver biopsies were performed in 95% of the patients. Baseline characterization of the population,18 operative morbidity, pattern of weight loss, and effects on comorbidity during a mean follow-up period of 112±32 (±SD) months (range 74 to 204) have been published.37., 38. No patients with hepatotoxic medication or
Patient characteristics
Before reoperation in the 104 patients (BMI = 31±8 kg·m−2), mean weight loss was 38±18 kg. Changes in blood chemistry are shown in Table III, demonstrating improvements in some serum liver function test results, in serum lipids, and through lowering of fasting blood glucose from 117±356 to 90±13 mg/dL (P<.0001). Blood pressure decreased from 137±17/83±12 mm Hg to 123±17/74±11 mm Hg (P<.0001). In aggregate these results entail significant improvement of the metabolic syndrome. There were no
Discussion
This study of 104 patients with repeat wedge liver biopsies after substantial sustained weight loss and correction of the metabolic syndrome by biliopancreatic diversion, demonstrates the role of obesity and the metabolic syndrome in the pathogenesis and prediction of liver fibrosis and cirrhosis. This association had been suggested by us18., 42. and others,21., 43., 44. but this is the first demonstration of proof-of-concept by reversing severe fibrosis and cirrhosis through elimination of the
Acknowledgements
The exceptional secretarial services of Diane E. Zarb are greatly appreciated.
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