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Are elevated systemic bile acids involved in the pathophysiology of sarcopenia and liver injury following gastric bypass?

Journal Volume 86 - 2023
Issue Fasc.2 - Case reports
Author(s) S. Bourseau 1, N. Bozadjieva-Kramer 2 3, A. Goffaux 1 4, P. Baldin 5, F. Etogo-Asse 6, P. Trefois 7, N. Lanthier 1 4
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Full Article
PAGES 377-381
(1) Service d’Hépato-Gastroentérologie, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium
(2) Department of Surgery, University of Michigan, Ann Arbor, MI, USA
(3) Veterans Affairs Ann Arbor Healthcare System, Research Service, Ann Arbor, Michigan, USA
(4) Laboratory of Hepatology and Gastroenterology, Institut de Recherche Expérimentale et Clinique, UCLouvain, Université catholique de Louvain, Brussels, Belgium
(5) Service d’Anatomie Pathologique, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium
(6) Service de Gastroentérologie, Clinique Saint-Jean, Brussels, Belgium
(7) Service de Radiologie, Cliniques universitaires Saint-Luc, UCLouvain, Brussels, Belgium

Bariatric surgery is currently the most effective treatment for sustained weight loss in severe obesity. However, recent data describe the development of liver damage and in particular massive steatosis and cholangitis in some patients, for which certain pathophysiological mechanisms are suggested such as bacterial overgrowth, malabsorption or sarcopenia. We describe the case of a patient presenting with a new liver dysfunction 6 years after a gastric bypass. The work-up revealed sarcopenic obesity characterised by low muscle mass and low muscle function as well as elevated fasting bile acids, severe liver steatosis and cholangitis. The pathophysiology of this disease is complex and multifactorial but could include bile acid toxicity. Bile acids are increased in cases of liver steatosis, but also in cases of gastric bypass and malnutrition. In our opinion, they may contribute to the loss of muscle mass and the vicious circle observed in this situation. Treatment with enteral feeding, intravenous albumin supplementation and diuretics reversed the liver dysfunction and the patient was discharged from hospital

Keywords: cholestasis, biopsy, gastric bypass, malnutrition, liver failure, sarcopenia.

The authors declare that they have no conflict of interest.
© Acta Gastro-Enterologica Belgica.
PMID 37428176