To the Editor.—
In regard to the letter from Carl M. Sutherland et al (1982; 248:171) entitled "Hepatic Toxicity From Adjuvant Chemotherapy After Small-Bowel Bypass," it has been known for some time1 that morbid obesity is associated with an increase in collagen found in the liver, especially in the central areas pericellularly and in the space of Disse by electron microscopy.After jejunoileal bypass, this fibrosis is severely increased and develops into micronodular cirrhosis in some persons. Most of the time, this micro-nodular cirrhosis is asymptomatic and is found primarily on biopsy. Most patients who have had liver failure secondary to the jejunoileal bypass do so within the first year after surgery, which is unrelated to development of cirrhosis. Thereafter, the patients seem to do well. It is not surprising that if this "silent" micro-nodular cirrhosis is an established event, treatment with hepatotoxic agents several years after the jejunoileal
Marubbio AT. Hepatic Changes After Jejunoileal Bypass. JAMA. 1982;248(22):2969. doi:10.1001/jama.1982.03330220015009
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