Bariatric Surgery is Associated With Decreased Progression of Nonalcoholic Fatty Liver Disease to Cirrhosis: A Retrospective Cohort Analysis
| Autor: | Adam C. Sheka, Scott Kizy, Daniel B. Leslie, Schelomo Marmor, Constantin F. Aliferis, Gyorgy Simon, Ryan L Irey, Ashley Benner, Keith Wirth, Sayeed Ikramuddin, John R. Lake, Gretchen Sieger, Sisi Ma |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Liver Cirrhosis Male Risk medicine.medical_specialty Cirrhosis Adolescent Bariatric Surgery 03 medical and health sciences 0302 clinical medicine Non-alcoholic Fatty Liver Disease Nonalcoholic fatty liver disease medicine Humans Aged Retrospective Studies Proportional hazards model business.industry Hazard ratio nutritional and metabolic diseases Retrospective cohort study Middle Aged medicine.disease Obesity digestive system diseases Confidence interval Surgery Obesity Morbid Increased risk 030220 oncology & carcinogenesis Disease Progression 030211 gastroenterology & hepatology Female business |
| Zdroj: | Annals of surgery. 272(1) |
| ISSN: | 1528-1140 |
| Popis: | Objective This study sought to compare trends in the development of cirrhosis between patients with NAFLD who underwent bariatric surgery and a well-matched group of nonsurgical controls. Summary of background data Patients with NAFLD who undergo bariatric surgery generally have improvements in liver histology. However, the long-term effect of bariatric surgery on clinically relevant liver outcomes has not been investigated. Methods From a large insurance database, patients with a new NAFLD diagnosis and at least 2 years of continuous enrollment before and after diagnosis were identified. Patients with traditional contraindications to bariatric surgery were excluded. Patients who underwent bariatric surgery were identified and matched 1:2 with patients who did not undergo bariatric surgery based on age, sex, and comorbid conditions. Kaplan-Meier analysis and Cox proportional hazards modeling were used to evaluate differences in progression from NAFLD to cirrhosis. Results A total of 2942 NAFLD patients who underwent bariatric surgery were identified and matched with 5884 NAFLD patients who did not undergo surgery. Cox proportional hazards modeling found that bariatric surgery was independently associated with a decreased risk of developing cirrhosis (hazard ratio 0.31, 95% confidence interval 0.19-0.52). Male gender was associated with an increased risk of cirrhosis (hazard ratio 2.07, 95% confidence interval 1.31-3.27). Conclusions Patients with NAFLD who undergo bariatric surgery are at a decreased risk for progression to cirrhosis compared to well-matched controls. Bariatric surgery should be considered as a treatment strategy for otherwise eligible patients with NAFLD. Future bariatric surgery guidelines should include NAFLD as a comorbid indication when determining eligibility. |
| Databáze: | OpenAIRE |
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