Nonalcoholic fatty liver disease and bariatric surgery

Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease worldwide. Treatment recommendations for NAFLD are aimed towards weight reduction, thereby reducing insulin resistance. Unfortunately, lifestyle modifications have not yielded long-term success, while durable weight loss is routinely achieved with bariatric surgery. This article reviews the effects of bariatric surgery on patients with NAFLD. In these patients, postsurgical evaluations of liver histology by repeat liver biopsy are hindered by the risk of the procedure and the inherent sample variability, which makes the impact of bariatric surgery on NAFLD difficult to quantify. In longitudinal studies of NAFLD, the biopsy-based evaluations should be augmented by repeated measurements of the noninvasive biomarkers that may provide an insight into the changes in the physiological state of the liver after bariatric or other types of interventions. Nevertheless, currently available tests are not able to provide this type of in-depth outcome measures for these patients.