SAT-104 Reversal of Nonalcoholic Fatty Liver Disease with Bariatric Surgery in South Asians: Has the Cure Been Finally Found? Real World Data From a Sri Lankan Tertiary Care Setting

Nonalcoholic fatty liver disease (NAFLD) ranges from non-progressive simple steatosis to progressive nonalcoholic steatohepatitis and can eventually progress to cirrhosis and even be complicated with hepatocellular carcinoma. The prevalence of NAFLD is alarming and is approximately 65-85% among obese individuals. In the United States, NAFLD is the commonest cause of chronic liver cell disease and it is predicted to become the most common indication for liver transplantation within the next 5 years. Unfortunately NAFLD has limited treatment options with generally suboptimal results. Although bariatric surgery has been found to have impressive rates of reversal of NAFLD in Caucasians, there is limited data on its effects among South Asians. In this study we aimed to find the effect of bariatric surgery on reversal of NAFLD among obese Sri Lankan patients. We did a retrospective analysis of medical records of 170 obese patients who underwent bariatric surgery at the Colombo South Teaching Hospital, Sri Lanka. Out of the patients 74.1% (n = 126) were females. The mean age was 38.1 ± 10.4 years. The mean pre-operative body weight and body mass index were 115.0 ± 23.0 kg and 45.1 ± 6.8 kg/m(2) respectively. Laparoscopic sleeve gastrectomy was the commonest type of bariatric surgery (69.5%) performed, followed by laparoscopic mini gastric bypass (24.1%) and laparoscopic Roux-en-Y gastric bypass (4.9%). One patient underwent open sleeve gastrectomy. NAFLD was detected in 88.7% pre-operatively, according to ultrasound scan (USS) imaging (grade 1 fatty liver 29.8%, grade 2 fatty liver 58.9%). On USS imaging at 6 months after the procedure, the prevalence of fatty liver reduced to 29.4% (grade 1 fatty liver 19.6%, grade 2 fatty liver 9.8%). The pre-operative mean AST and ALT values showed a significant reduction at 6 months after the procedure (30.4 ±18.6 U/L vs 22.1 ±8.9 U/L, p<0.005 and 39.1 ±28.3 U/L vs 19.8 ±9.6 U/L, p< 0.001) as compared to baseline. The percentage of patients who had AST or ALT elevation, showed significant reduction at 6 months postoperatively as compared to baseline (35.2% vs 6.9%, p<0.01). In conclusion, bariatric surgery fully reversed NAFLD in 68.1% (p<0.001) and reduced the grade of NAFLD in 87.2% (p<0.001) of patients according to USS imaging. It significantly reduced baseline AST and ALT values by 27.3% and 49.3% respectively at 6 months post procedure. Thus bariatric surgery shows impressive levels of complete reversal and downgrading of NAFLD biochemically as well as ultrasonically in Sri Lankan patients with comparable efficacy to studies done in Caucasian populations. Bariatric surgery should be considered as a potential therapeutic option in obese South Asian patients with NAFLD, especially when it is of a higher grade.