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August 2025
Join Scott Springer, PA-C, from Erie County Medical Center in Buffalo, NY, for a case-based clinical discussion on how to evaluate and manage F3 vs. F4 fibrosis in patients with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and MASH, presented through the GHAPP MASLD/MASH Community Network and sponsored by Madrigal Pharmaceuticals. Using a detailed side-by-side comparison of a fictional patient "Sam," Scott demonstrates how to interpret key non-invasive testing modalities—including FIB-4, ELF, and FibroScan—to stage liver fibrosis, determine candidacy for emerging therapies like resmetirom (Rezdiffra), and identify when liver biopsy may still be necessary. Learn how changes in platelet count, ELF score, and liver stiffness (kPa) help distinguish advanced fibrosis (F3) from cirrhosis (F4) and how this affects treatment decisions, HCC surveillance, and portal hypertension management. Scott also emphasizes the role of GLP-1 therapy, aggressive cardiometabolic risk reduction, and lifestyle counseling as core strategies in MASLD care. This session is a practical guide for GI and hepatology providers navigating MASLD staging, treatment eligibility, and long-term monitoring in 2025 and beyond.
Related Podcast
MASLD vs MetALD With Allysa Saggese
September 2025
In this MASLD Community Network session, Allysa Saggese, NP, from Weill Cornell Medicine, New York, walks through a real-world case to demystify the overlap between MASLD, MASH, and metabolic-alcohol related liver disease (MetALD). You’ll learn how to take a precise alcohol history, translate “standard drink” equivalents (≈14 g ethanol), and use objective biomarkers like PEth alongside FIB-4, FibroScan (kPa), ELF, CAP, and MRI elastography to stage disease accurately and catch discordant results. Allysa covers how alcohol can skew labs (ALT/AST, triglycerides, BP), why reducing/abstaining may change non-invasive testing thresholds, when to consider liver biopsy, and who qualifies for HCC surveillance. She also outlines treatment pillars—lifestyle optimization, cardiometabolic risk control, and appropriate pharmacotherapy (including where resmetirom fits and when to avoid it)—so clinicians can tailor care for patients spanning pure MASLD to MetALD. Watch to sharpen your staging, counseling, and monitoring strategy—and help patients make data-driven changes that improve outcomes.
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MASLD Pharmacotherapy With April Morris
August 2025
Join April Morris, FNP, a hepatology and endocrinology nurse practitioner, for a comprehensive review of MASLD pharmacotherapy as part of the GHAPP MASLD Community Network. This expert-led session outlines a three-pronged strategy for managing Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and MASH, focusing on obesity reduction, cardiometabolic risk control, and liver-directed treatment. April walks through first-line lifestyle approaches, highlights key pharmacologic agents like GLP-1 receptor agonists, and explains their mechanisms and clinical relevance—including the groundbreaking data from the semaglutide trials showing resolution of MASH and improvement in liver fibrosis. The session also reviews the role and limitations of vitamin E and pioglitazone, emphasizing their risks in patients with diabetes or cardiovascular disease. The spotlight then shifts to resmetirom (Rezdiffra), a thyroid hormone receptor beta agonist FDA-approved for adults with non-cirrhotic NASH and moderate-to-advanced fibrosis (F2–F3). April explains the MAESTRO-NASH trial endpoints, clinical efficacy, common side effects, and appropriate patient selection. Learn how resmetirom improves fatty acid oxidation, reduces hepatic fat and fibrosis, and the key drug–drug interactions and statin dose considerations to manage during treatment. The discussion concludes with practical tips for monitoring, non-invasive staging (FibroScan, ELF, MRI-PDFF), and the evolving guidance on treatment duration, safety labs, and insurance barriers. This session is essential for clinicians navigating the growing landscape of therapeutic options in MASLD/MASH care.
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MASLD Basics With Jill Olmstead
August 2025
Join Jill Olmstead, NP, a seasoned gastroenterology nurse practitioner from Providence St. Joseph Health, for an in-depth overview of MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) and MASH (Metabolic Steatohepatitis) in this GHAPP MASLD Community Network presentation, proudly sponsored by Madrigal Pharmaceuticals. With over 20 years of clinical experience, Jill explains the evolving nomenclature from NAFLD/NASH to MASLD/MASH and how this impacts diagnostic criteria, patient communication, and multidisciplinary management. Learn how to identify steatotic liver disease, assess cardiometabolic risk factors, and use tools like FIB-4 and FibroScan to evaluate fibrosis and stratify risk. Jill walks through real-world case scenarios, highlighting when to order a liver biopsy, when to refer to hepatology, and how to apply AASLD guidelines in clinical practice. From evaluating elevated liver enzymes to addressing the global burden of MASLD and its progression to cirrhosis and HCC, this session is essential for providers navigating the complexities of modern liver disease management in both primary care and specialty settings.
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Podcast: Pharmacotherapy for MASH/MASLD: An Overview
June 2025
In this comprehensive episode, Christina Hanson, FNP-C at South Denver GI, provides an in-depth overview of pharmacotherapy for MASLD and MASH, with a focus on the FDA-approved therapy resmetirom (brand name Rezdiffra). Drawing on over 18 years of experience in hepatology and GI care, Christina explains the histologic endpoints used in clinical trials—MASH resolution and fibrosis improvement without worsening disease—and how they guided the approval of resmetirom. She breaks down the drug’s mechanism of action as a selective thyroid hormone receptor beta (THR-β) agonist, which promotes lipid metabolism and reduces liver inflammation without systemic toxicity. Christina reviews key Phase 3 data from the MAESTRO-NASH trial, showing resmetirom’s significant impact on both MASH resolution and fibrosis regression across diverse patient populations. She also outlines criteria for appropriate patient selection (those with stage F2-F3 fibrosis), clinical monitoring strategies, and management of side effects like transient GI discomfort. Christina emphasizes the importance of baseline screening for liver disease, autoimmune conditions, thyroid function, and lipid levels before initiating therapy. She highlights best practices from the 2024 AASLD guidelines for ongoing monitoring and treatment response assessment, including ALT and liver stiffness thresholds that help determine whether to continue or discontinue therapy. This episode is a must-watch for hepatology clinicians looking to implement evidence-based, patient-centered strategies in the management of MASH.
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Alcohol and MASLD/MASH: Navigating the Complex Relationship
July 2025
In this insightful episode, Oyin Penny, NP with Premier Gastroenterology of Kansas City, addresses the complex clinical challenge of managing patients with MASLD (metabolic dysfunction-associated steatotic liver disease) who also consume alcohol. Oyin shares practical, evidence-based strategies for screening alcohol use in MASLD and MASH, emphasizing the importance of creating a nonjudgmental, patient-centered environment. She outlines how to use tools like PEth (phosphatidylethanol) testing to objectively quantify alcohol intake and explains the synergistic hepatotoxicity that occurs when alcohol use coexists with metabolic liver disease. Oyin also explores when to initiate non-invasive tests (NITs), why alcohol can distort fibrosis staging, and how to time assessments and treatment appropriately. From setting SMART goals to recommending behavioral support, medications like naltrexone, and exploring mental health and social work interventions, this episode offers a full-spectrum approach to managing high-risk patients. Whether you're a GI, hepatology provider, or in primary care, this episode provides tools for personalized care, alcohol harm reduction, and effective long-term MASLD management.
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Common Questions From Patients About MASH
August 2025
In this engaging episode from the GHAPP MASLD Community Network, Alison Moe shares practical insights into the most common questions patients ask about advanced fibrosis and fatty liver disease. Using a liver model, she explains the stages from normal liver to steatosis, fibrosis, and cirrhosis, emphasizing that with lifestyle modifications—such as weight loss, glycemic control, and now FDA-approved pharmacotherapy—fatty liver disease, including F3 fibrosis, can be reversible. Alison also addresses a critical concern: alcohol consumption. She breaks down how her guidance differs depending on the presence and stage of fibrosis, adhering to strict AASLD guidelines to protect liver health. Whether you're a healthcare provider or a patient looking for clarity, this video offers evidence-based guidance and compassionate answers.
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Comparing F3 and F4 Fibrosis With Erin Tanner
July 2025
Join Erin Tanner, NP from Gastro Health in Birmingham, Alabama, for a practical and in-depth exploration of how to differentiate and manage patients with F3 versus F4 fibrosis in the setting of MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) and MASH. This session, part of the MASLD & MASH Community Network, features two detailed case studies—Sam A and Sam B—who share identical comorbidities but diverge in fibrosis stage, illustrating how non-invasive testing (NITs) can guide diagnosis and treatment. Erin walks through the clinical application of tools like FIB-4, FibroScan (VCTE), ELF test, and CAP score, emphasizing the importance of interpreting lab and imaging results in context. The discussion covers key decision points, including when to initiate pharmacologic therapy like resmetirom (Rezdiffra), how to determine eligibility for HCC surveillance, and when to consider liver biopsy. She also addresses common challenges in community GI settings, such as incidental fatty liver findings, elevated ferritin levels, and the limitations of FIB-4 in older or diabetic patients. Whether you're in hepatology, gastroenterology, or primary care, this talk offers actionable insights on fibrosis staging, lifestyle counseling, and long-term monitoring in patients with MASLD and MASH.
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Comparing F3 and F4 Fibrosis With Robin Soto
July 2025
In this in-depth case-based session from the GHAPP MASLD/MASH Community Network, Robin Soto, NP from UC San Diego Health, explores the clinical nuances of diagnosing and managing fibrosis stage 3 versus stage 4 in patients with MASH (Metabolic Dysfunction–Associated Steatohepatitis). Using a real-world case study of a patient named Sam, Robin demonstrates how to interpret and reconcile non-invasive tests (NITs) like FIB-4, FibroScan, CAP score, and ELF test to guide accurate staging. She offers practical insights into treatment decisions, including when to use resmetirom, the importance of lifestyle modification, and how to assess comorbidities like diabetes, obesity, and cardiovascular risk. The session also outlines when and how to monitor for hepatocellular carcinoma (HCC), implement liver cancer surveillance strategies, and approach multidisciplinary care for advanced fibrosis or cirrhosis. Whether you’re a hepatology specialist or a primary care provider, this video equips you with evidence-based tools for managing MASLD and optimizing outcomes in complex liver disease.
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Common Questions from Primary Care Providers About MASH
July 2025
In this FAQ session, Brian Lam, PA-C, breaks down a common question he receives from primary care providers, endocrinologists, and even other GI specialists: Which patients with fatty liver should be referred to hepatology or GI for further evaluation? Using a clear and practical approach, Brian explains how to apply FIB-4, a simple lab-based non-invasive test, to guide referrals. He emphasizes that patients with metabolic syndrome—especially those with diabetes—are at significantly higher risk for MASH (Metabolic dysfunction-associated steatohepatitis), with roughly 1 in 3 diabetic patients affected. If the FIB-4 is greater than 1.3, or greater than 2.0 in adults over 65, it's time to refer. Brian also highlights the utility of FIB-4 with reflex to ELF, now available through major labs like LabCorp and Quest, as an efficient two-step method to detect advanced fibrosis and at-risk MASH. This video is perfect for busy clinicians looking for a referral-friendly workflow to catch MASH early and improve liver health outcomes in high-risk populations.
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Motivational Interviewing: Practical Techniques for Lifestyle Adherence
August 2025
Discover how motivational interviewing can transform the management of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) by empowering patients to make sustainable lifestyle changes. In this session, we explore why lifestyle modification—particularly achieving 5–10% weight loss—is the most effective intervention for MASLD, yet often fails when approached through traditional “diet and exercise” advice alone. Learn the four core principles of motivational interviewing—expressing empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy—and how to apply them in real-world clinical encounters to improve patient engagement and outcomes. Through practical strategies, sample dialogue, and a compelling patient case study, this discussion highlights how small, achievable changes in diet and physical activity can reduce hepatic inflammation, improve insulin resistance, and even reverse fibrosis. Whether you’re a hepatology provider, primary care clinician, or allied health professional, you’ll gain actionable tools to activate patient motivation, overcome barriers, and support lasting behavioral change in MASLD care.
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