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Abstract Details
Is Bariatric Surgery Resolving NAFLD via Microbiota-Mediated Bile Acid Ratio Reversal? A Comprehensive Review
Surg Obes Relat Dis. 2020 Mar 20;S1550-7289(20)30131-3. doi: 10.1016/j.soard.2020.03.013.Online ahead of print.
Eider Talavera-Urquijo1, Marc Beisani2, José M Balibrea3, John C Alverdy4
Author information
1Department of General & Digestive Surgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
2Department of Surgery, Hospital del Mar, Barcelona, Spain.
3Department of Gastrointestinal Surgery, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain. Electronic address: balibrea@gmail.com.
4Department of Surgery University of Chicago, Pritzker School of Medicine, Chicago, Illinois.
Abstract
Despite the fact that there is still insufficient evidence to consider non-alcoholic fatty liver disease (NAFLD) as an stand-alone indication for bariatric surgery, many clinical and histopathological beneficial effects on both NAFLD and non-alcoholic steatohepatitis (NASH) have been shown. Although weight loss seems to be the obvious mechanism, weight-loss independent factors are also believed to be involved. Among them, changes in gut microbiota and bile acids (BA) composition may be playing an unappreciated role in the improvement of NAFLD. In this review we examine the mechanisms and interdependence of the gut microbiota and BA, and their influence on NAFLD pathogenesis and its reversal following bariatric surgery. According to the currently available evidence, gut microbiota has a major influence on BA composition. In fact, both BA and microbiome disturbances (dysbiosis) play a role in the etiopathogenesis of NAFLD and might be potential therapeutic targets. In addition, bariatric surgery can modify the intraluminal ileal environment in a way that causes significant repopulation of the gut microbiota and a reversal of the plasma primary/secondary BA ratio, which, in turn, induces weigh-independent metabolic improvements.