{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T13:00:27Z","timestamp":1792155627539,"version":"4.4.0"},"reference-count":72,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Eur J Clin Investigation"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background\/Aims<\/jats:title>\n                    <jats:p>Metabolic bariatric surgery remains the most potent weapon we have against severe obesity and its metabolic consequences. Yet, its effects on the liver are far from uniform. Although restrictive and mixed procedures like sleeve gastrectomy and Roux\u2010en\u2010Y gastric bypass consistently improve metabolic dysfunction\u2010associated steatotic liver disease (MASLD), hypoabsorptive operations carry a distinct and troubling risk of progressive liver injury. The available evidence, drawn predominantly from case series, registry data and retrospective analyses, suggests that this risk is not an all\u2010or\u2010nothing phenomenon but instead follows a conceptual gradient, one that correlates with the degree of intestinal malabsorption and, more specifically, with the extent of bile acid malabsorption. This review traces the evidence for this dose\u2010dependent relationship from the historical disaster of the jejunoileal bypass to contemporary procedures like the biliopancreatic diversion and the single\u2010anastomosis duodenal\u2010ileal bypass.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials &amp; Methods<\/jats:title>\n                    <jats:p>We explore the pathophysiological triad that drives this process\u2014protein\u2010energy malnutrition, bacterial overgrowth, and bile acid hepatotoxicity\u2014supported by recent experimental evidence directly linking biliary limb length to liver injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The review then contextualizes the discussion within associated multisystemic consequences, including de novo inflammatory bowel disease, severe metabolic bone disease, and a distinct discussion of the accelerated alcohol\u2010associated liver disease that follows bariatric surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>A synthesis of the available evidence supports the abandonment of a one\u2010size\u2010fits\u2010all approach in favour of meticulous patient selection, precise and individualized surgical technique based on measured bowel length and a commitment to lifelong, intensive, multidisciplinary postoperative surveillance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Hypoabsorptive bariatric procedures carry a dose\u2010dependent risk of progressive liver injury mediated by malabsorption, bacterial overgrowth and bile acid hepatotoxicity, necessitating individualized surgical planning and lifelong follow\u2010up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/eci.70234","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T11:17:31Z","timestamp":1780312651000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Chronic Liver Disease, Liver Damage and Liver Failure After Hypoabsorptive Bariatric Surgery: A Dose\u2010Dependent Relationship and Multisystemic Consequences"],"prefix":"10.1111","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6610-4094","authenticated-orcid":false,"given":"Francesco Saverio","family":"Papadia","sequence":"first","affiliation":[{"name":"Department of Surgical Sciences and Integrated Diagnostics (DISC), School of Medical and Pharmaceutical Sciences University of Genoa  Genoa Italy"},{"name":"IRCCS Policlinico San Martino AOM Liguria  Genoa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konrad Wojcieck","family":"Karcz","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Plastische, Wiederherstellende und Handchirurgie, Schwerpunkt f\u00fcr Schwerbrandverletzte Klinikum N\u00fcrnberg  N\u00fcrnberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Pasta","sequence":"additional","affiliation":[{"name":"IRCCS Policlinico San Martino AOM Liguria  Genoa Italy"},{"name":"Department of Internal Medicine (DIMI), School of Medical and Pharmaceutical Sciences University of Genoa  Genoa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo","family":"Giannini","sequence":"additional","affiliation":[{"name":"IRCCS Policlinico San Martino AOM Liguria  Genoa Italy"},{"name":"Department of Internal Medicine (DIMI), School of Medical and Pharmaceutical Sciences University of Genoa  Genoa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"e_1_2_15_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa035622"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1600869"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2015.04.014"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.19569"},{"issue":"4","key":"e_1_2_15_6_1","first-page":"301","article-title":"The Decline and Fall of the Jejunoileal Bypass","volume":"157","author":"Griffen W. 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