Bariatric surgery for curing NASH in the morbidly obese? Guillaume Lassailly, Robert Caïazzo, François Pattou, Philippe Mathurin  Journal of Hepatology  Volume 58, Issue 6, Pages 1249-1251 (June 2013) DOI: 10.1016/j.jhep.2012.12.026 Copyright © 2013 European Association for the Study of the Liver Terms and Conditions

Fig. 1 Effect of RYGB on NASH. RYGB achieves its physiological benefits through “BRAVE” effects, i.e., bile flow alteration, a reduction in gastric size, anatomical rearrangement, vagal manipulation and subsequent enteric gut hormone modulation. Moreover, recent studies emphasized the effect of bacterial flora, which streamlines management of metabolic energy. RYGB decreases Firmicutes and increases Gammaproteobacteria. The different pathophysiologic effects of bariatric surgery are synergistic so as to counterbalance the negative effects of NASH on the liver. The beneficial effects of bariatric surgery include increases in gut hormones (i.e. GLP-1), gene expression of PPARα and PPARγ and a reduction in the endoplasmic reticulum stress that induces apoptosis. Journal of Hepatology 2013 58, 1249-1251DOI: (10.1016/j.jhep.2012.12.026) Copyright © 2013 European Association for the Study of the Liver Terms and Conditions