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October 2025
In this APP Insight, Tina Gregg, NP-C, from GI Associates, addresses two of the most common questions about MASLD and MASH that clinicians encounter in practice. First, she clarifies that normal liver enzymes do not rule out MASH or advanced fibrosis—up to half of biopsy-proven cases can present with normal ALT and AST levels. Tina explains why liver enzymes fluctuate, why traditional reference ranges may be misleading, and how clinicians can better interpret lab results in context. She also answers another frequent question: Are statins safe in patients with MASLD or MASH? Drawing on evidence from multiple large studies, Tina emphasizes that statins are both safe and beneficial for most patients with fatty liver disease and play a key role in managing cardiovascular risk. This session, part of the GHAPP MASLD & MASH Community Network, helps APPs dispel common misconceptions and make evidence-based decisions in liver and metabolic care.
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Common Questions From Patients About MASH
June 2025
In this video, Jonathan Yeh, PA, answers three of the most frequently asked questions about MASH—Metabolic Dysfunction–Associated Steatohepatitis—and offers practical advice for understanding and managing this progressive form of fatty liver disease. He begins by explaining what MASH is: an inflammatory, more advanced stage of MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease), driven by abnormal fat accumulation in the liver due to impaired fat transport. Jonathan then breaks down the treatment approach, emphasizing the importance of lifestyle modification—particularly diet and exercise. He highlights the benefits of a green Mediterranean diet, regular physical activity, and sustainable weight loss, which can improve or even reverse MASH in many patients. For individuals with more advanced fibrosis, pharmacologic treatment with resmetirom (Rezdiffra) may be indicated. This concise FAQ offers helpful guidance for patients and providers alike on tackling MASH with evidence-based strategies.
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Misconceptions About Liver Health
October 2025
In this educational video, Punam Punja, MMS, PA-C, from Emory Healthcare in Atlanta, debunks some of the most common misconceptions about liver health that often lead to confusion among patients. Drawing from over 15 years of experience in general hepatology, Punam clarifies that cirrhosis can be stable—and even partially reversible—if detected early, and that normal liver enzymes do not necessarily indicate a healthy liver. She emphasizes that acetaminophen can be used safely in moderation, even in patients with advanced fibrosis, and that symptom-free patients may still have significant liver disease. Punam also addresses myths around liver cleanses, viral versus autoimmune hepatitis, and the misconception that only alcohol or viruses cause fibrosis, highlighting MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease) as one of the most prevalent modern causes. She encourages providers and patients alike to stay informed and proactive in managing liver health.
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Common Questions From Community GI About MASH
August 2025
In this educational video, HoChong Gilles, NP—Clinical Program Director at the Central Virginia VA Healthcare System—breaks down practical, non-invasive strategies for evaluating liver fibrosis in community GI and primary care settings. With over 25 years of hepatology experience, she walks through the importance of calculating the FIB-4 score using just four parameters: age, ALT, AST, and platelet count. Learn how to interpret FIB-4 score cutoffs to determine low, indeterminate, or high risk of advanced fibrosis and explore alternative tools like the ELF (Enhanced Liver Fibrosis) test when imaging options are limited. Whether you're a hepatology specialist or a frontline provider, this video offers actionable insights to help bridge the gap in liver care access using guideline-supported lab-based methods.
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APP Insight: Common Questions from Patients About MASH
July 2025
In this impactful episode, Sherona Bau, NP from UCLA, addresses the most frequent and pressing questions patients ask after being diagnosed with MASLD (Metabolic dysfunction-associated steatotic liver disease) or MASH (Metabolic-associated steatohepatitis)—including concerns about life expectancy, risk of liver failure, liver cancer, and genetic impact on family members. She emphasizes the importance of risk stratification using non-invasive testing, particularly FibroScan®, to determine the extent of fat accumulation and liver fibrosis. Sherona explains that early identification of stage 2 or 3 fibrosis is critical, as treatment options are now available for these stages, offering hope for patients. She also stresses that MASLD is not just a liver disease—it's a systemic, metabolic condition—and encourages coordinated care with endocrinologists, cardiologists, and dietitians. Additionally, she discusses the hereditary nature of fatty liver and the importance of family screening, especially for children of affected individuals. This video offers clear, compassionate guidance for patients and providers navigating the complexities of fatty liver disease.
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Common Questions from Community GI About MASH
July 2025
In this insightful video, Christie Morrison, a local advanced practice provider with the GHAPP MASLD/MASH Community Network, answers two of the most frequently asked questions from community GI providers: when to refer patients with MASH to a transplant center and how to evaluate liver fibrosis when FibroScan® isn’t accessible. Christy emphasizes the importance of using non-invasive testing (NITs)—including FIB-4 and ELF (Enhanced Liver Fibrosis) scores—to help identify patients with F3 fibrosis, who are at higher risk for rapid progression to cirrhosis and hepatocellular carcinoma (HCC). She encourages early referral to transplant hepatology to avoid delays in care, especially given long wait times and the value of multidisciplinary support teams at transplant centers. For clinicians without access to FibroScan, Christy shares practical alternatives such as ordering reflex testing to ELF via major labs and leveraging easy-to-use digital tools like MDCalc for FIB-4 calculation. This episode is a valuable resource for GI providers looking to optimize liver care pathways and prevent late-stage complications in MASLD and MASH patients.
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Common Questions From Primary Care Providers About MASH
July 2025
In this concise and practical discussion, Lindsay Pratt, PA-C from the University of Colorado’s Department of Hepatology and Liver Transplant, shares expert guidance on screening and managing patients with MASLD (Metabolic dysfunction-associated steatotic liver disease) and MASH (Metabolic-associated steatohepatitis). Speaking directly to the common questions she receives from primary care providers, Lindsay outlines when to screen for MASLD/MASH—emphasizing the importance of evaluating patients with elevated liver enzymes, hepatic steatosis on imaging, and cardiometabolic risk factors like diabetes, hypertension, hyperlipidemia, and sleep apnea. She breaks down the utility of FIB-4 as a first-line non-invasive test, when to use FibroScan®, and clears up a common misconception about statin use in liver disease—encouraging providers to continue or initiate statins when indicated. This session is ideal for clinicians managing metabolic syndrome and its liver manifestations and offers simple, evidence-based tools to identify at-risk patients early.
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Misconceptions About Liver Health
October 2025
In this educational discussion, Marcella Pomeranz, NP, lead nurse practitioner at Digestive Associates in Las Vegas, addresses one of the most common misconceptions she encounters in clinical practice—patients believing that only heavy alcohol use causes liver disease. Drawing on NHANES data, Marcella explains that nearly 38% of Americans have hepatic steatosis, and the vast majority of cases stem from MASLD (Metabolic Associated Steatotic Liver Disease), not alcohol. She highlights how factors such as metabolic dysfunction, high blood pressure, high cholesterol, diabetes, viral hepatitis, autoimmune liver diseases, genetic disorders like Wilson’s disease and hemochromatosis, and even medications like NSAIDs and methotrexate contribute to liver injury and fibrosis. Marcella also discusses the impact of ethnicity, noting that Hispanic patients face a higher risk of progression to cirrhosis. By helping patients understand that liver disease is often metabolic—not self-inflicted, clinicians can reduce stigma, encourage earlier detection, and promote lifestyle optimization to prevent fibrosis and cirrhosis. This session offers valuable insights for APPs, GI specialists, and hepatology providers dedicated to improving patient education and liver health outcomes.
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Common Questions From Community GI About MASH
August 2025
In this MASLD Community Network episode, Valerie Shin, NP with UCLA Health Hepatology, addresses frequently asked questions from community GI providers about noninvasive tests (NITs) for assessing steatosis and fibrosis in MASLD and MASH. She reviews the benefits and key limitations of the FIB-4 score—highlighting the risk of false negatives in patients with normal AST/ALT levels, false positives in older patients, and inaccuracy when thrombocytopenia is unrelated to liver disease. Valerie explains when to consider second-line NITs, including transient elastography (FibroScan®), ELF score, and MR elastography, detailing their strengths, availability challenges, and technical limitations such as operator dependence, BMI restrictions, and insurance coverage issues. She also clarifies the rare but important role of liver biopsy when NITs produce conflicting or inconclusive results. Whether you’re a healthcare provider seeking practical diagnostic guidance or a patient wanting to understand your testing options, this video offers expert insights into selecting and interpreting noninvasive liver tests for MASLD and MASH.
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Misconceptions About Liver Health
June 2025
In this video, Scott Springer, PA-C, from Erie County Medical Center in Buffalo, NY, addresses one of the most common misconceptions in liver health—trusting over-the-counter supplements and detox products to improve liver function. Drawing from his experience in both hepatology and addiction medicine, Scott emphasizes that many non-prescribed products marketed for liver support are not only ineffective but can actually cause liver harm. He cautions against relying on unregulated supplements and urges patients to consult medical professionals before taking anything for liver health. One surprising and evidence-based recommendation he makes: drink coffee. Filtered coffee, in particular, has been shown to support liver health and may reduce the risk of liver disease progression. Scott recommends two to three cups per day, without added sugar or excess dairy—especially for patients with MASLD or MASH. This video offers practical, research-backed advice for patients and providers alike, highlighting what truly helps (and what may harm) the liver.
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Common Questions From Primary Care Providers About MASH
October 2025
In this educational video, Cheryl Walsh, ACNP-C, from GI Alliance in Northwest Arkansas, shares practical guidance for primary care providers on how to effectively support patients with elevated liver enzymes. With nearly 15 years of experience in gastroenterology and hepatology, Cheryl explains how simple first steps—such as ordering imaging studies and incorporating the FIB-4 index into lab work—can provide valuable insight into whether a patient may have MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease) or even early fibrosis. She highlights how these preliminary evaluations streamline care, allowing hepatology specialists to move forward quickly with advanced imaging or elastography when needed. Cheryl underscores the importance of collaboration between primary care and GI teams to ensure early detection and better patient outcomes in metabolic liver disease.
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