On this episode, join experts Kris Kowdley, MD (Director, Liver Institute Northwest) and Mitchell Shiffman, MD, (Hepatologist, Bon Secours Health System in Richmond, Virginia), as they discuss the importance of identifying and referring patients at risk for MASH with clinically significant fibrosis (≥F2). Our experts will discuss the liver specialist perspective on the urgency for specialty referral of appropriate patients, including the increased morbidity and mortality associated with advancing liver f...
On this episode, join experts Kris Kowdley, MD (Director, Liver Institute Northwest) and Mitchell Shiffman, MD, (Hepatologist, Bon Secours Health System in Richmond, Virginia), as they discuss the importance of identifying and referring patients at risk for MASH with clinically significant fibrosis (≥F2). Our experts will discuss the liver specialist perspective on the urgency for specialty referral of appropriate patients, including the increased morbidity and mortality associated with advancing liver fibrosis. They will explain ways to identify patients at risk for clinically significant fibrosis and will discuss how lifestyle modification and management of cardiometabolic comorbidities when present, may reduce the risk of progression to clinically significant fibrosis. They will also provide an overview of the importance of multidisciplinary collaboration and highlight the key role of primary care providers and endocrinologists as the front line for identification of patients before MASH progresses to clinically significant fibrosis.
This program is intended for clinicians in the US only. The information presented is aligned with the views and opinions of the speakers and is sponsored by Novo Nordisk. This podcast is not to be used as medical advice and is intended for educational purposes only.
Faculty Presenters:
Kris Kowdley, MD, FACP, FACG, FASGE, AGAF, GAASLD
Director, Liver Institute Northwest
Professor, Elson S. Floyd College of Medicine, Washington State University
Seattle, WA
Mitchell Shiffman, MD
Hepatologist, Transplant Hepatology
Bon Secours Health System
Richmond, VA
Click here for full reference list
References
Charlton M, Tonnu-Mihara I, Teng CC, et al. The clinical and economic burdens of metabolic dysfunction-associated steatohepatitis. J Med Econ. 2024;2:1–41.
Cusi K, Budd J, Johnson E, Shubrook J. Making sense of the nonalcoholic fatty liver disease clinical practice guidelines: what clinicians need to know. Diabetes Spectr. 2024;37(1):29–38.
Cusi K, Isaacs S, Barb D, et al. American Association of Clinical Endocrinology clinical practice guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings. Endocr Pract. 2022;28(5):528–562.
Dezső K, Paku S, Kóbori L, Thorgeirsson SS, Nagy P. What makes cirrhosis irreversible?-consideration on structural changes. Front Med (Lausanne). 2022;9:876293.
Ekstedt M, Hagstrom H, Nasr P, et al. Fibrosis stage is the strongest predictor for disease-specific mortality in NAFLD after up to 33 years of follow-up. Hepatology. 2015;61(5):1547–1554.
Estes C, Razavi H, Loomba R, Younossi Z, Sanyal AJ. Modeling the epidemic of nonalcoholic fatty liver disease demonstrates an exponential increase in burden of disease. Hepatology. 2018;67(1):123–133.
Heyens LJM, Busschots D, Koek GH, Robaeys G, Francque S. Liver fibrosis in non-alcoholic liver disease: from liver biopsy to non-invasive biomarkers in diagnosis and treatment. Front Med (Lausanne). 2021;8:615978.
Hussain A, Patel PJ, Rhodes F, Srivastava A, Patch D, Rosenberg W. Decompensated cirrhosis is the commonest presentation for NAFLD patients undergoing liver transplant assessment. Clin Med (Lond). 2020;20(3):313–318.
Kanwal F, Shubrook JH, Adams LA, et al. Clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease. Gastroenterology. 2021;161(5):1657–1669.
Koh JH, Chee D, Ng CH, et al. Sex-based disparities in liver transplantation for hepatocellular carcinoma and the impact of the growing burden of NASH. Transplant Direct. 2024;10(7):e1642.
Lai M and Afdhal NH. Liver fibrosis determination. Gastroenterol Clin N Am. 2019;48(2):281–289.
Liver Foundation Website. Accessed July 15, 2024. https://liverfoundation.org/liver-diseases/fatty-liver-disease/nonalcoholic-steatohepatitis-nash/nash-symptoms/
Loomba R, Wong R, Fraysee J, et al. Nonalcoholic fatty liver disease progression rates to cirrhosis and progression of cirrhosis to decompensation and mortality: a real world analysis of Medicare data. Aliment Pharmacol Ther. 2020;51(11):1149–1159.
Muthiah MD, Cheng Han N, Sanyal AJ. A clinical overview of non-alcoholic fatty liver disease: a guide to diagnosis, the clinical features, and complications-what the non-specialist needs to know. Diabetes Obes Metab. 2022;24(Suppl 2):3–14.
Nagai S, Collins K, Chau LC, et al. Increased risk of death in first year after liver transplantation among patients with nonalcoholic steatohepatitis vs liver disease of other etiologies. Clin Gastroenterol Hepatol. 2019;17(13):2759–2768.e5.
Ng CH, Lim WH, Hui Lim GE, et al. Mortality outcomes by fibrosis stage in nonalcoholic fatty liver disease: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2023;21(4):931–939.
Noureddin M, Vipani A, Bresee C, et al. NASH leading cause of liver transplant in women: updated analysis of indications for liver transplant and ethnic and gender variances. Am J Gastroenterol. 2018;113(11):1649–1659.
Payne JY, Alkhouri N, Le P, et al. Prevalence of at-risk NASH and its association with metabolic syndrome in US adults with NAFLD, 2017-2018. Hepatol Commun. 2023;7(1):e0019.
Piazzolla VA, Mangia A. Noninvasive diagnosis of NAFLD and NASH. Cells. 2020;9(4):1005.
REZDIFFRA (resmetirom) [package insert]. West Conshohocken, PA: Madrigal Pharmaceuticals, Inc.; 2024.
Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023;77(5):1797–1835.
Sanyal AJ, Anstee QM, Trauner M, et al. Cirrhosis regression is associated with improved clinical outcomes in patients with nonalcoholic steatohepatitis. Hepatology. 2022;75(5):1235–1246.
Srivastava A, Gailer R, Tanwar S, et al. Prospective evaluation of a primary care referral pathway for patients with non-alcoholic fatty liver disease. J Hepatol. 2019;71(2):371–378.
Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149(2):367–378.
Wattacheril JJ, Abdelmalek MF, Lim JK, Sanyal AJ. AGA clinical practice update on the role of noninvasive biomarkers in the evaluation and management of nonalcoholic fatty liver disease: expert review. Gastroenterology. 2023;165(4):1080–1088.
Wong RJ, Tran T, Kaufman H, Niles J, Gish R. Increasing metabolic co-morbidities are associated with higher risk of advanced fibrosis in nonalcoholic steatohepatitis. PLoS One. 2019;14(8):e0220612.
Younossi Z, Stepanova M, Ong JP, et al. Nonalcoholic steatohepatitis is the fastest growing cause of hepatocellular carcinoma in liver transplant candidates. Clin Gastroenterol Hepatol. 2019;17(4):748–755.e3.
Younossi ZM, Stepanova M, Al Shabeeb R, et al. The changing epidemiology of adult liver transplantation in the United States in 2013-2022: The dominance of metabolic dysfunction-associated steatotic liver disease and alcohol-associated liver disease. Hepatol Commun. 2023;8(1):e0352.
