Late effects of jejunoileal bypass operations on hepatic inflammation, fibrosis and lipid content

Patients more than six years following jejunoileal bypass operations for morbid obesity underwent liver biopsy for evaluation of hepatic histology and determination of hepatic lipid content. The amount of hepatic inflammation and fibrosis present was quantitated and compared to that present in liver biopsy specimens obtained at the time of performance of the jejunoileal bypass operation. Hepatic lipid content was compared to that present in the livers of six normal-weight patients with no liver disease, and with liver specimens from twenty morbidly obese patients undergoing gastroplasty operations. Since their jejunoileal bypass operations, hepatic fibrosis has increased in 87% of the patients and hepatic inflammation in 52%. Fibrotic liver disease is currently present in 50% of the patients compared to 10% at the time of performance of the jejunoileal bypass operations. Patients with jejunoileal bypass operations were found to have nine times more hepatic triglyceride than was found in patients with normal livers, and twice as much as identified in obese patients. These results suggest that some patients with jejunoileal bypass operations have severe liver histologic disease associated with increased hepatic triglyceride content. Patients with jejunoileal bypass operations should have periodic histologic evaluation of their livers.