Background and aim: NAFLD (Non Alcoholic Fatty Liver Disease) remains stable for many years in most obese patients or it may worsen progressively to NASH (Non Alcoholic SteatoHepatitis) and liver cirrhosis in a subset of them. As alternative to the invasiveness of liver biopsy, the NAFLD Fibrosis Score (NFS), a combination of serum and clinical markers developed by Angulo e al., is reported to accurately predict the severity of fibrosis in NAFLD. On the other hand previous reports have shown an improvement of fatty liver markers after weight loss. Aim of the study is to investigate NFS changes in a group of obese patients before and after bariatric treatment with intragastric balloon. Material and methods: Forty-five obese patients (32F/13M, age 24-68 yrs, BMI 43.3±5 kg/m2) were consecutively admitted to our Endoscopy Service for the treatment of obesity with Bioenterics Intragastric Balloon (BIB®). Exclusion criteria: alcohol intake >20g/die, HBV(+), HCV(+). BMI and NFS were recorded before BIB placement (T0) and after 6 months at removal (T6). Data are expressed as mean±SD, median and ranges or %, where appropriate. Both parametric (T-Student) and non parametric (Wilcoxon) tests were used to compare continuous variables. Results: At T0 NFS values >+0.676, consistent with advanced fibrosis, were observed in 11/45 patients (25%), whereas 15/45 (33%) had NFS values <-1.455 (without fibrosis). In 19/45 (42%) the NFS values averaged from -1.455 to +0.676 (indeterminate). After the treatment the patients, with both suspected and advanced liver fibrosis (score >-1.455), improved significantly their BMI from 43.3±5.0 to 39.0±4.6 kg/m2 (p=0.0009) and NFS from 0.08 (-1.45/3.81) to -0.77 (-3.46/2.92;p=0.002). Moreover those patients, with a BMI decrease < or =3.4% (median value of Delta-BMI% in our sample), did not change their NFS significantly (p=0.46) after BIB:-1.29(-3.60/3.81) at T0 vs -0.94 (-5.37/2.92) at T6. Conclusions: Bariatric treatment may improve liver injury in obesity. The NFS can be useful for monitoring the obese patients during weight loss.
THE NAFLD FIBROSIS SCORE IMPROVES AFTER BARIATRIC THERAPY WITH INTRAGASTRIC BALLOON
RICCI, Giorgio;ALVISI, Vittorio
2010
Abstract
Background and aim: NAFLD (Non Alcoholic Fatty Liver Disease) remains stable for many years in most obese patients or it may worsen progressively to NASH (Non Alcoholic SteatoHepatitis) and liver cirrhosis in a subset of them. As alternative to the invasiveness of liver biopsy, the NAFLD Fibrosis Score (NFS), a combination of serum and clinical markers developed by Angulo e al., is reported to accurately predict the severity of fibrosis in NAFLD. On the other hand previous reports have shown an improvement of fatty liver markers after weight loss. Aim of the study is to investigate NFS changes in a group of obese patients before and after bariatric treatment with intragastric balloon. Material and methods: Forty-five obese patients (32F/13M, age 24-68 yrs, BMI 43.3±5 kg/m2) were consecutively admitted to our Endoscopy Service for the treatment of obesity with Bioenterics Intragastric Balloon (BIB®). Exclusion criteria: alcohol intake >20g/die, HBV(+), HCV(+). BMI and NFS were recorded before BIB placement (T0) and after 6 months at removal (T6). Data are expressed as mean±SD, median and ranges or %, where appropriate. Both parametric (T-Student) and non parametric (Wilcoxon) tests were used to compare continuous variables. Results: At T0 NFS values >+0.676, consistent with advanced fibrosis, were observed in 11/45 patients (25%), whereas 15/45 (33%) had NFS values <-1.455 (without fibrosis). In 19/45 (42%) the NFS values averaged from -1.455 to +0.676 (indeterminate). After the treatment the patients, with both suspected and advanced liver fibrosis (score >-1.455), improved significantly their BMI from 43.3±5.0 to 39.0±4.6 kg/m2 (p=0.0009) and NFS from 0.08 (-1.45/3.81) to -0.77 (-3.46/2.92;p=0.002). Moreover those patients, with a BMI decrease < or =3.4% (median value of Delta-BMI% in our sample), did not change their NFS significantly (p=0.46) after BIB:-1.29(-3.60/3.81) at T0 vs -0.94 (-5.37/2.92) at T6. Conclusions: Bariatric treatment may improve liver injury in obesity. The NFS can be useful for monitoring the obese patients during weight loss.I documenti in SFERA sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
