Can High Liver Enzymes Result From Gastric Bypass?

Studies have shown that liver enzymes can be abnormally increased one year after bariatric surgery (BS), with the Omega-Loop Gastric Bypass (OLGB) being a risk factor for liver enzyme elevation. However, not all bariatric surgeries have beneficial effects on the liver, as those leading to malabsorption can cause liver failure or worsen fibrosis and the development of cirrhosis.

A retrospective study by Elan R. Witkowski, MD, MS, found that dyslipidemia and elevated ALT levels were common after bariatric surgery. Over a third of patients undergoing bariatric surgery had raised ALT levels preoperatively, with over a tenth having levels greater than twice the normal range. Severe liver dysfunction may also occur after bariatric procedures such as OAGB and RYGB.

New research shows that bariatric surgery patients should be evaluated for liver disease. Elevated liver enzymes and an AST to ALT ratio <0.8 are common after surgery. Bariatric surgery is associated with lower serum ALT and AST levels at 2- and 10-year follow-up. Liver retraction in open Roux-en-Y gastric bypass (RYGBP) for morbid obesity may cause an elevation in liver transaminase levels postoperatively.

Despite the positive effects of RNYGB, reports of liver injury are rare. Three mechanisms can explain liver injury induced by bariatric surgery: Omega-Loop Gastric Bypass (OLGB), a method of BS, is a risk factor predicting liver enzyme elevation. Liver retraction in open Roux-en-Y gastric bypass (RYGBP) for morbid obesity may cause an elevation in liver transaminase levels postoperatively.

In conclusion, although rare, hepatic decompensation following bariatric surgeries can occur.

Can being overweight raise ALT levels?

The people with obesity had higher levels of ALT (17. 17 ± 7. 54 vs. 19. 55 ± 9. 79 IU/L, p = . 02), ALP (217. 0 ± 68. 34 vs.

Background. Obesity‐induced inflammation may independently disturb the function of critical organs such as liver. This study aimed to investigate the association of obesity with serum levels of biomarkers of liver function including alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and gamma‐glutamyl transferase (GGT) in adult women.

Methods. This cross‐sectional study was carried out on 360 adult women in the summer of 2020 in Tehran, Iran. The participants were categorized into two groups based on their body mass index (BMI≤29. 9 and BMI 30). The serum levels of ALT, AST, ALP and GGT were measured. Logistic regression method was used to assess the association between BMI and liver enzymes after adjusting for the confounders.

Results. The mean BMI in non‐obese and obese groups was 26. 32 ± 2. 61 and 33. 40 ± 2. 80 kg/m 2, respectively ( p =. 01). A significant association was found between BMI with ALT ( β =. 16, p =. 002) and GGT ( β =. 19, p =. 01) enzymes after adjustment for age. The association between BMI and GGT remained significant after further adjustments for smoking, alcohol use, physical activity and educational status. There was no significant association between BMI and liver enzymes after adjustment for dietary intake.

What can falsely elevate liver enzymes?

Common causes of elevated liver enzymes include: Nonprescription pain medicines, particularly acetaminophen (Tylenol, others). Certain prescription medicines, including statins, which are used to control cholesterol. Drinking alcohol.

Can high ALT be caused by diet?

After 8 weeks, those in the diet group had lower liver enzymes and a greater reduction in liver fat.

Reducing the amount of saturated fats, trans fats, and carbohydrates can also help treat and prevent NAFLD, a common cause of high ALT.

To improve liver health and help lower ALT, you don’t necessarily need to make drastic changes to your diet. Start by trying to eat at least five servings of fresh fruits and vegetables per day.

You can also try incorporating these tips into your weekly meal planning:

What is the most likely cause of elevated liver enzymes?

There are many causes of mildly elevated ALT and AST levels. The most common causes are nonalcoholic fatty liver disease (NAFLD) and alcoholic liver disease. In NAFLD, the liver has more fatty tissue in it than normal. Regular or heavy alcohol use can also hurt the liver and increase liver enzymes. Other medical conditions can increase liver enzymes, like hepatitis B or C and a condition that runs in families called hemochromatosis. Using certain medicines and over-the-counter supplements can also increase liver enzymes.

People with mild elevations in liver enzymes usually do not have symptoms.

Your doctor will ask you questions and examine you to try and find out why your liver enzymes are elevated. He or she may also do blood tests. A scan of your liver, called an ultrasound, might help your doctor find a cause.

What organs are affected by gastric bypass surgery?

Bariatric surgery is a crucial treatment for severe obesity, which affects overall health and survival. It targets various organ systems, including the brain, stomach, small intestine, large intestine, liver, pancreas, adipose, and muscle tissue. The most effective treatment for severe obesity is bariatric surgery, which not only maintains long-term weight loss but also improves or remission of several comorbidities, including type 2 diabetes mellitus. Some weight loss surgeries modify gastrointestinal anatomy and physiology, including the secretions and actions of gut peptides. This review discusses how bariatric surgery alters patterns of gastrointestinal motility, nutrient digestion and absorption, gut peptide release, bile acids, and gut microflora, and how these changes alter energy homeostasis and glucose metabolism. Obesity is associated with various comorbidities, such as diabetes, heart disease, hypertension, cancer, sleep apnea, and osteoarthritis. Lifestyle interventions can be successful short-term, but there is a high rate of recidivism. Bariatric surgery has been shown to successfully maintain weight loss, and there is evidence that changes in gut physiology may play an important role. This review examines the changes in different aspects of gut physiology after bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB), including taste, meal pattern and duration, gastric emptying, intestinal transit time, gut hormone release, bile acid metabolism, and microbiota.

Can weight loss cause elevated liver enzymes?

Weight loss was shown to be associated with improvements in liver enzymes and improvements of nonalcoholic fatty liver disease. However, some evidence also shows that liver enzymes may transiently increase immediately after a dietary-induced weight loss.

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Can gastric bypass surgery cause liver problems?

Conclusions. Severe liver dysfunction may also occur after bariatric procedures such as OAGB and RYGB. A comprehensive, meticulous follow-up for early identification of postoperative liver impairment should be aspired. Bypass length reduction led to a fast improvement in all patients.

Keywords: NAFLD, Weight loss, Liver dysfunction, Bypass reversal.

Introduction. Obesity and the concomitant metabolic syndrome represent a global health care issue. In up to 80%, obesity is associated with nonalcoholic fatty liver disease (NAFLD) including nonalcoholic steatohepatitis (NASH), which may progress to significant liver fibrosis, cirrhosis, and hepatocellular carcinoma . Although lifestyle modification and weight loss is known to be the most effective treatment of NAFLD, long-term reduction of excessive overweight needs discipline and endurance, and is often unsuccessful.

What is one of the top 3 causes of death after bariatric surgery?

The study focuses on the mortality rates of patients undergoing bariatric metabolic surgery (BMS) in the UK. The largest cause of death was pneumonia and respiratory causes, with 12 deaths, including 5 COVID-19 pneumonia cases. The next largest categories were infection/sepsis and liver failure, both with 6 deaths, followed by cardiac causes, malignancy, and multiple organ failure with 5 deaths. The smallest category was cerebrovascular accidents with 2 deaths.

A history of asthma or COPD is not independent of the cause of death, but a history of cerebrovascular accident was close to significance. A total of 7 comorbidities had significantly higher mean ranks when a history of the disease is present, including asthma/COPD, malignancy, cerebrovascular accident, diabetes, hypertension, IHD, and OSA.

The whole cohort consisted of 74. 7 female patients, 25. 3 male patients, and RYGB was the most common at 52. 5 years. The mean age at operation was 45. 51 years (95 CI: 44. 80 to 46. 22). The overall analysis had a significant p-value of 0. 002, meaning the variables included (sex, operation type, and age at operation) do affect survival. The only variable to significantly affect survival was age at operation with a hazard ratio of 1. 063.

The total all-cause cumulative mortality rate for those undergoing BMS in the UK was 4. 38, with a 30-day mortality rate of 0. 11. This result is comparable with the results of the review performed by Chang et al. which gave 30-day mortality of 0. 08–0. 22, although the mortality reported after day 30 was comparatively lower at 0. 31–0. 35. The average death rate for the whole UK population is 10. 4/1000 population annually with an average 10-year total mortality at 10. 4. According to BOMSS figures (April 2023–March 2024), 30-day mortality post-bariatric surgery is 0. 04, which is lower than the 30-day mortality found by this study.

There is no single study of long-term post-bariatric metabolic surgery mortality in the UK. Two studies on BMS mortality from the USA both reported higher 30-day mortality rates, with a 30-day mortality rate of 1. 9 and 0. 9, and longer-term mortality rates of 11. 8 (at 15 years) and 2. 6 (8, 9, 10). These studies were published in 2004 and 2007 respectively, whereas the first bariatric operation in our unit was in 2010; both these studies were performed in USA with much larger sample sizes, which may explain the differences between the mortality rates. Additionally, the development of skills, infrastructure, medical equipments, pre-operative screening methods, and governance systems possibly impacted the improvement in mortality over the last 15 years.

The mean age at operation for the whole cohort was similar to previous research at 45. 51 years old, with the mean age at operation for deceased patients being higher at 50. 87. Bariatric metabolic surgery tends to have a higher proportion of female patients than male, as reflected by the whole cohort being 74. 7 female (amongst deceased patients this was 66. 7).

One-third of the pneumonia and respiratory deaths were caused by COVID-19 pneumonia, potentially inflating the number of deaths you may otherwise see in this category. Just 5. 3 of deaths (2. 6 including missing cases) were caused by cerebrovascular accident, which is more comparable to the results found by the Omalu et al. paper, which found that stroke accounted for 3. 0 of deaths.

Since pneumonia and respiratory causes are the largest causes of long-term mortality after bariatric metabolic surgery, it is important to implement other strategies to manage this condition, such as more precise pre-operative lung function tests, post-operative and long-term chest care education, or even precise investigation of the cause of pneumonia and respiratory deterioration. Patients with pre-existing respiratory disease need more attention and the risk of death should be discussed during the pre-operative consultation.

What is the most common late complication of gastric bypass?

Late-stage complications of bariatric surgery include, but are not limited to:

‍ Dumping syndrome: This is extremely common for those who’ve undergone gastric bypass or gastric sleeve. Dumping syndrome occurs when food, particularly sugar, moves too quickly from the stomach to the small intestine. You may experience dizziness, nausea, vomiting, abdominal pain, bloating, or irregular heartbeat as a result.;

Hernias: A hernia occurs when a gap in the muscular wall allows the abdomen to protrude outward. They form when there’s a combination of pressure and weak muscle. These can be painful and will worsen over time. Remember to incorporate regular exercise and movement into your post-op recovery plan to avoid hernias from forming.;

Bowel Obstruction: If you’re not having a bowel movement or passing gas, you likely have a bowel obstruction. This happens when something blocks either your large or small intestine, and your digestive system stops functioning. This requires immediate medical attention.;

Why is my ALT high but everything else normal?

High levels of ALT in your blood may be a sign of a liver injury or disease. Some types of liver disease cause high ALT levels before you have symptoms of the disease. So, an ALT blood test may help diagnose certain liver diseases early.

What is an ALT Blood Test?. An ALT test measures the amount of ALT in your blood. This test is commonly used to help diagnose liver damage or disease.

ALT (alanine transaminase) is an enzyme, a protein that speeds up certain chemical reactions in your body. It is found mainly in your liver. Usually, you will have low levels of ALT in your blood. But when liver cells are damaged, they release ALT into the bloodstream. High levels of ALT in your blood may be a sign of a liver injury or disease. Some types of liver disease cause high ALT levels even before you have symptoms of the disease. So, an ALT blood test may help diagnose certain liver diseases early, when they may be easier to treat.

An ALT test is usually ordered as part of a group of liver function tests.

Can you have high liver enzymes and nothing be wrong?

Elevated liver enzymes might be found during routine blood testing. In most cases, liver enzymes are only mildly raised for a short time. This usually doesn’t signal a chronic, serious liver problem.