BARIATRIC THERAPY WITH INTRAGASTRIC BALLOON IMPROVES NAFLD FIBROSIS SCORE. PRELIMINARY DATA ON 27 OBESE PATIENTS

INTRODUCTION: NAFLD (Non Alcoholic Fatty Liver Disease) remains stable for many years in most obese patients. However it may worsen progressively to NASH (Non Alcoholic SteatoHepatitis) and liver cirrhosis in a subset of them. Therefore to identify the presence and severity of liver fibrosis in patients with NAFLD is important for the management of them. Liver biopsy is widely recognized as the only reliable mean to determine the severity of fibrosis, even though it is an invasive procedure associated with a number of complications. The NAFLD Fibrosis Score (FS) suggested by Angulo et al (2007) could be considered the most reliable method among noninvasive approaches for the assessment of the severity of fibrosis in NAFLD.On the other hand, the weight loss induced by bariatric therapy was reported to improve liver damage in obese patients. AIMS & METHODS: To investigate FS changes in a group of obese patients before and after bariatric treatment with intragastric balloon. Twenty-seven obese consecutive patients (mean age 43.1, range 25-68;F/M 20/7, BMI 42.6±4.9) were admitted to our Endoscopy Service for the treatment of obesity with Bioenterics Intragastric Balloon (BIB®, Inamed & Co. Santa Barbara, USA). Exclusion criteria were alcohol intake >20 g/die, HBV +ve, and HCV +ve. BMI and NAFLD FS was recorded before BIB placement (t-0) and after 6 months at removal (t-6). Data are expressed as mean± SD, median and ranges or%, where appropriate. Both parametric (TStudent) and non parametric (Wilcoxon's rank test) were used to compare continuous variables. RESULTS: Before BIB (t-0) the high cutoff FS (>0.676), indicative for advanced fibrosis was present in 7/27 patients (26%), whereas 8/27 (30%) had the low cutoff score (<-1.455);in 12/27 (44%) it was indeterminate (suspected) for fibrosis (-1.455-+0.676). After BIB (t-6), BMI significantly decreased (42.6±4.9 vs 37.8±3.9, p = 0.0001). The FS median value and range (min/max) in the patients with both suspected and advanced liver fibrosis (cutoff score >-1.455) significantly (p = 0.013) decreased: -0.17 (-1.37/+1.26) vs -1.06 (-3.47/+1.98) after BIB. CONCLUSION: We suggest that NAFLD fibrosis score, constructed from routine clinical and laboratory variables, may be considered an useful assessment in the follow-up of obese patients undergoing bariatric treatment. Further investigations in larger series of patients are necessary to demonstrate if weight loss may improve liver damage due to fibrosis.