Management of Non-alcoholic Fatty Liver Disease and the Role of Bariatric Surgery – A Brief Review for Surgeons

Abstract Nonalcoholic fatty liver disease (NAFLD) is closely linked to the metabolic syndrome and is highly prevalent in bariatric patients. The gold standard to diagnose NAFLD is a liver biopsy specifically to detect inflammatory changes characteristic of nonalcoholic steatohepatitis (NASH); technological advancements will improve the accuracy of current non-invasive modalities. Modification of risk factors via food management is important to prevent the progression of NAFLD to NASH and cirrhosis. Several clinical trials are underway for pharmacological treatment of NAFLD; currently the mainstay of treatment is insulin sensitizers and vitamin E. There is strong evidence that bariatric surgery improves biochemical and histological features of NAFLD and therefore, bariatric surgery should be considered as a treatment of NAFLD in patients with obesity. Gastric bypass exhibits anti-lipogenic, anti-inflammatory, anti-oxidant and anti-diabetic properties in the livers of laboratory animals thereby providing a unique window to study regulation of body adiposity and insulin resistance.