CAN NAFLD BE IMPROVED BY THE THERAPY WITH INTRAGASTRIC BALLOON FOR SEVERE OBESITY?

Background and aim: Hepatic lipid accumulation (Fatty Liver, FL) is often associated with obesity, especially when a cluster of metabolic disturbances (metabolic syndrome, MS), does occur. A "bright liver'' at abdominal ultrasonography (US) and, in most cases, increased levels of hepatic enzymes, alanine aminotransferases (ALT) and gamma-glutamyltranspeptidases (GGT), are considered the hallmarks of the obesity-associated NAFLD. Insulin resistance (IR) is reported to be the main link among obesity, FL and MS. Bioenterics Intragastric Balloon (BIB; Bioenterics, Santa Barbara, Ca., USA) is considered a safe procedure to reduce the weight in severe obesity. The aim was to evaluate if the weight-loss induced by the BIB might improve NAFLD and metabolic alterations in such patients. Material and methods: Since 2004 in our digestive endoscopy service, 68 patients (M22, F46; age 21-63) with obesity and morbid obesity (BMI 32-62) underwent BIB insertion. The BIB was placed under endoscopic control and it was removed after 6 months. Before and after the BIB placement, routine biochemical evaluation, and US were performed. ALT elevation was defined as >1.5 × the upper normal values, and GGT>50 U/l. IR was calculated by the Homeostasis Model Assessment (HOMA-IR), as fasting serum insulin (μU/ml) × fasting plasma glucose (mmol/l)/22.5; values >2.5 indicate a state of IR. Patients HBV(+), HCV(+), with alcohol consumption >20g/day, or known drugs in the history were excluded. Results: Fifty-eight patients showed at US a ``bright liver'', consistent with NAFLD. ALT was elevated in 30% of the patients; GGT increased in 26%; HOMA-IR was >2.5 in 93%; 27% showed an arterial hypertension. Till now 30 patients (M 13) have completed the BIB treatment. The BMI values decreased significantly after BIB (from 35-50 to 28-49; p<0.05). Before BIB, elevated ALT values were recorded in 37%; after removal in 20% of the patients. Elevated GGT were recorded in 27% before BIB and after removal in 13%. HOMA-IR was >2.5 in all the patients before BIB and after removal in 30%. In 16 patients the BMI decrease was >10% and only one patient showed after BIB a persistent elevation of ALT and GGT. Conclusions: Our results confirmed that NAFLD is frequently observed in severe obesity. BIB induces a significant weight loss and reduce IR which is closely linked to liver damage. In the majority of the patients after BIB treatment, ALT and GGT levels fell into normal range.