Bariatric therapy with intragastric balloon improves liver dysfunction and insulin resistance in obese patients

Obesity is often associated with fatty liver (FL). In most cases, bright liver at ultrasound (US) and increased alanine aminotransferase (ALT) and gamma-glutamyltranspeptidase (GGT) levels are considered the hallmarks of nonalcoholic fatty liver disease (NAFLD). Insulin resistance (IR) is the main link between obesity and NAFLD. The use of the Bioenterics intragastric balloon (BIB) is a safe procedure either for inducing a sustained weight loss with diet support or for preparing those patients who are candidates for bariatric surgery. The aim of the study was to investigate whether the weight loss induced by intragastric balloon might improve IR and liver enzymes. The presence or absence of FL at US and the influence of a body mass index (BMI) decrease > or = 10% after BIB (DeltaBMI > or = 10%) were also considered.

One hundred and three consecutive obese (BMI > 30 kg/m(2)) patients (38 males/65 females; mean age 41.3, range 20-63 years) underwent BIB insertion under endoscopic control. The BIB was removed 6 months later. US, clinical, and routine laboratory investigations were performed before and after BIB. IR was calculated by the homeostasis model assessment (HOMA-IR > 2.5). Exclusion criteria were hepatitis B virus positive, hepatitis C virus positive, alcohol consumption >30 g/day, history of hepato-steatogenic drugs, and type 1 diabetes.

Ninety-three patients were eligible for the study. The BMI significantly decreased in all investigated patients, and it was > or = 10% in 59% of the patients. FL was seen at US in 70%, impaired fasting blood glucose was present in 13%, ALT exceeded the normal limit in 30.1%, GGT exceeded the normal limit in 15%, and HOMA-IR was >2.5 in 85%. Median HOMA-IR decreased significantly in FL (4.71 vs 3.10; p < 0.05) and non-FL (3.72 vs 2.81; p < 0.01) groups. Median ALT decreased significantly in the FL group (31.5 vs 24; p < 0.001) and GGT significantly decreased in the FL group (31 vs 23.5; p < 0.05). In the FL group with DeltaBMI > or = 10%, the median values of HOMA-IR (4.95 vs 2.69; p < 0.05), ALT (30 vs 23; p < 0.01), and GGT (28 vs 20; p < 0.001) significantly decreased after BIB. In the non-FL group, HOMA-IR values significantly decreased (4.07 vs 2.36; p < 0.01) in patients with a DeltaBMI > or = 10%; ALT and GGT did not significantly decrease.

Weight loss induced by intragrastric balloon reduces IR. The ALT and GGT decrease suggests an improvement in hepatic damage. The benefit depends on the decrease of BMI higher than 10%.