A randomized trial from Italy found that two types of bariatric-metabolic surgery were significantly more effective than lifestyle modification plus best medical care in treating non-alcoholic steatohepatitis (NASH). The study included over 200 patients with obesity and biopsy-confirmed NASH who completed the trial, and showed that 56% of patients assigned to Roux-en-Y and 57% of those randomized to sleeve gastrectomy achieved the primary endpoint of histological resolution of NASH, compared with only 16% of participants who underwent lifestyle modification. The study, called BRAVES, was conducted at three hospitals in Italy and was a 52-week open-label multicenter trial comparing lifestyle modification plus best medical care to the two types of bariatric-metabolic surgery. In addition to improved NASH resolution, the secondary endpoint of the trial was improvement of fibrosis of at least one stage without worsening of NASH which was also observed in the surgery groups. These findings further support the use of bariatric-metabolic surgery in people with metabolic diseases, and may provide a viable option for NASH patients who require significant weight loss.
