Non-alcoholic steatohepatitis (NASH) and metabolic surgery in Asia

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease worldwide, as well as, in Asia. The incidence of NAFLD has been reported to range from 65% to 95% in patients undergoing bariatric surgery. Spectrum of NAFLD ranges from simple steatosis to non-alcoholic steatohepatitis (NASH) to fibrosis and cirrhosis. Liver biopsy is the gold standard for diagnosis of NAFLD. Other investigations including imaging of abdomen and liver function tests (LFTs) are not diagnostic per se but play a role in management. Treatment strategies include lifestyle modifications, pharmacotherapy and bariatric surgery. Bariatric surgery has shown promising results worldwide as well as in Asian patients. Asian literature shows that there is significant improvement in NAFLD after both restrictive and mal-absorptive procedures. Reversal of all features of NAFLD, NASH and fibrosis are reported after bariatric surgery. In conclusion, improvement of obesity associated NAFLD after bariatric surgery is well documented. Both restrictive as well as malabsorptive procedures are effective but NAFLD per se is not an indication for surgery.