Besserung der NAFLD nach bariatrischen/metabolischen Eingriffen

Zusammenfassung

Die nicht-alkoholische Fettlebererkrankung (NAFLD) ist die häufigste chronische Leberfunktionsstörung der westlichen Welt und wird auch als hepatische Manifestation des metabolischen Syndroms bezeichnet. Zu den wichtigsten Risikofaktoren zählt unter anderem die morbide Adipositas. Eine effektive medikamentöse Therapie gibt es aktuell nicht. Wirkungsvolle Behandlungsstrategien setzen sich aus einer Lebensstielmodifikation mit Bewegungssteigerung zusammen, welche mit einer deutlichen Gewichtsreduktion einhergehen sollte. Bezüglich des Tempos des empfohlenen Gewichtsverlustes existieren keine ausreichenden Empfehlungen. Durch bariatrische Eingriffe kann effizient ein lange andauernder Gewichtsverlust erzielt werden, und es kommt auch zur Behandlung von Adipositas-assozierten Kormobiditäten, insbesondere des metabolischen Syndroms. In retrospektiven Studien konnte als Nebeneffekt von bariatrischen Eingriffen eine Verbesserung von histologischen und biochemischen Parametern der NAFLD nachgewiesen werden. Dennoch stellt die bariatrische Operation derzeit keine etablierte Behandlungsoption für NAFLD dar. Fortgeschrittene Stadien der NAFLD bewirken häufig eine maligne Transformation in der Leber. Weltweit zählen hepatozelluläre Karzinome, welche unter anderem in NASH-Zirrhose entstehen können, zu den häufigsten Indikationen für eine Lebertransplantation. Ziel der Arbeit ist es, die Auswirkungen bariatrischer Eingriffe (chirurgisch/endoskopisch) auf NAFLD zusammenzufassen.

Summary

Nonalcoholic fatty liver disease (NALFD) is the most common chronic liver disorder in the western world and is strongly associated with obesity and metabolic syndrome. Obesity increases significantly the risk of NALFD. Currently there is no effective drug therapy and the management of NALFD is mainly focused on achieving weight loss through diet, physical activity and lifestyle modification. Bariatric surgery is the most effective treatment for morbid obesity and its associated metabolic comorbidities. Retrospective studies have reported positive effects on liver tests and histological abnormalities of NALFD following bariatric operation. Yet, bariatric surgery is still not an established treatment of NAFLD. Patients with nonalcoholic steatohepatitis (NASH), the advanced stage of NAFLD, have an increased risk of developing cirrhosis and consequent risk of liver failure or hepatocellular carcinoma, due to which they could be subjected for liver transplantation. The aim of this review is to analyze the evidence for the effects of bariatric interventions (surgery/endoscopy) on NAFLD.

Schlüsselwörter

Nicht-alkoholische Fettlebererkrankung (NAFLD) - nicht-alkoholische Steatohepatitis (NASH) - Adipositas - bariatrische/metabolische Chirurgie

Keywords

Non-alcoholic fatty liver disease (NAFLD) - non-alcoholic steatohepatitis (NASH) - obesity - bariatric/metabolic surgery

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