Industry Ties in Medicine: Insight from the Open Payments Program.

and the evidence supporting them are discussed in our article. Patients with NASH who have other indications for bariatric surgery can be referred for sur gical evaluation, but we cannot support recommending it as primary treatment for NASH at this time. The studies on this topic are predominantly retrospec tive, uncontrolled, or not randomized. The largest prospective trial to date was recently reported in Gastroenterology and revealed nearly 85% histologic res olution of NASH at 1 year after bariatric surgery. Despite these excellent re sults, the study authors pointed out that the trial was not randomized and that additional studies are indicated. Koch et al argue that it is “unlikely that a human studies subcommittee would permit randomization to sur gery vs no surgery [in this setting]” because of the obvious mortality benefit of bariatric surgery. We disagree and believe that the safety and benefit of this procedure in patients with NASHwho have no other indications for bariatric surgery has not been vigorously researched and de serves further investigation. Through additional studies, we may be able to improve patient selection and more clearly define the risks, benefits, and complications of these bariatric proce dures in the setting of liver disease, cirrhosis, and portal hypertension.