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MASLD AI 04:08 AM
September 2025
Elizabeth Goacher, PA-C from Duke Medical Center in Durham, NC, delivers an in-depth discussion on pharmacotherapy for MASLD/MASH, highlighting both current treatment options and emerging therapies. She reviews the role of GLP-1 receptor agonists in managing obesity and type 2 diabetes while offering secondary benefits for liver health, and addresses key considerations for procedural planning due to delayed gastric emptying. Elizabeth also explores the ongoing debate around vitamin E and pioglitazone, summarizing data from pivotal trials and guideline recommendations. The session emphasizes the groundbreaking approval of resmetirom, the first FDA-approved medication for MASH with F2–F3 fibrosis, detailing its mechanism as a thyroid hormone receptor beta agonist, trial outcomes, safety profile, and practical prescribing considerations, including payer coverage and drug interactions. This presentation provides hepatology and GI providers with practical insights on staging, non-invasive testing strategies (FIB-4, FibroScan, ELF, MRE), treatment sequencing, and how to integrate pharmacotherapy with lifestyle and multidisciplinary care to optimize outcomes in metabolic liver disease.
Related Podcast
MASLD Pharmacotherapy With Elizabeth Alqueza
August 2025
In this presentation, Elizabeth Alqueza, PA at Beth Israel Deaconess Medical Center, provides a comprehensive overview of pharmacotherapy for Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD) and MASH. She highlights the latest treatment strategies, including lifestyle modifications, cardiovascular risk reduction, and targeted liver-directed therapies. Elizabeth reviews the role of GLP-1 receptor agonists in weight loss and liver health, the evidence for Vitamin E and Pioglitazone in select patients, and the landmark approval of Resmetirom (Rezdiffra)—the first FDA-approved therapy for MASH with moderate to advanced fibrosis. Drawing from clinical trial data, including the MAESTRO-NASH trial, she explains mechanisms of action, efficacy outcomes, safety considerations, and practical prescribing guidance. This session underscores the importance of combining non-invasive testing, lifestyle interventions, and emerging pharmacologic therapies to improve patient outcomes and prevent progression to cirrhosis and liver-related complications.
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Comparing F3 and F4 Fibrosis With Scott Springer
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.
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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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Lifestyle Management With Sarah Dawkins
August 2025
Join Sarah Dawkins, NP, for an in-depth and inspiring conversation on lifestyle management for MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) and MASH (Metabolic Dysfunction-Associated Steatohepatitis), presented through the GHAPP MASLD Community Network and sponsored by Madrigal Pharmaceuticals. In this engaging session, Sarah uses the real-world case of "Albert" to explore how to assess fibrosis risk using non-invasive testing like FIB-4 and FibroScan, and why lifestyle interventions remain the cornerstone of care for patients without advanced fibrosis. Through a patient-centered lens, she outlines practical strategies for addressing dietary counseling, exercise goals, and culturally sensitive approaches to nutrition—highlighting how individualized care, family involvement, and positive reinforcement can create meaningful behavior change. The session dives into the science behind genetic risk factors like PNPLA3, the role of central obesity in inflammation, and the impact of Western diets on liver health. Sarah also reviews the Mediterranean diet, exercise recommendations, and evidence-based interventions, including the benefits of aerobic + resistance training over HIIT for MASLD improvement. With clinical pearls on motivational interviewing, overcoming barriers to access, and the use of tools like the Exercise and Diet Adherence Scale (EDAS), this session empowers providers to make lifestyle conversations impactful—even when time is short.
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LFTs Demystified: A practical guide for APPs
July 2025
In this GHAPP MASLD Community Network podcast, Jessica Crimaldi, NP, from the Cleveland Clinic, provides practical, real-world insights into interpreting liver function tests (LFTs) in the context of MASLD (metabolic dysfunction-associated steatotic liver disease) and MASH (steatohepatitis). Drawing on over a decade of experience in GI and hepatology, Jessica explains common ALT and AST elevation patterns that should prompt a diagnostic workup, even in asymptomatic patients. She reviews the hepatocellular vs. cholestatic patterns of injury, the value of the R-factor calculator in identifying the likely etiology of liver enzyme abnormalities, and how to differentiate MASH from other liver diseases such as PBC, viral hepatitis, or bile duct obstruction. The episode also addresses key non-liver labs like triglycerides, A1C, and cholesterol, and how they contribute to assessing metabolic risk. Finally, Jessica discusses the role of serial LFT monitoring in evaluating treatment response—highlighting what it means when liver enzyme levels fall and why "normal" LFTs don’t always indicate disease resolution. Whether you're a primary care provider or hepatology specialist, this podcast offers valuable guidance for early detection, risk stratification, and longitudinal monitoring of patients with MASH.
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Podcast: LFTs Demystified: A Practical Guide for APPs
June 2025
In this podcast episode, Michelle Barnett, PA-C, a liver disease specialist based in Colorado Springs, provides a clear and practical overview on demystifying liver enzyme abnormalities—particularly in the context of MASH (Metabolic Dysfunction–Associated Steatohepatitis) and MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease). With MASLD affecting nearly 1 in 4 American adults, understanding liver enzyme patterns is critical for early detection and effective management. Michelle breaks down commonly reported values from hepatic function panels—ALT, ALP (alkaline phosphatase), and total bilirubin—explaining what constitutes normal, acute, subacute, and chronic elevations. She walks through hepatocellular, cholestatic, mixed, and isolated hyperbilirubinemia patterns and what they reveal about underlying liver conditions such as MASH, alcohol-associated liver disease, viral hepatitis, biliary obstruction, and drug-induced liver injury. Whether you're a provider or a patient looking to better understand lab results, this episode delivers expert guidance on interpreting liver enzyme elevations to support more informed clinical decisions.
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APP Insight: Common Questions from Community GI About MASH
June 2025
In this informative video, Janet Gripshover, DNP, FNP-BC, and nurse manager for the liver transplant program at Cedars-Sinai, answers key questions about managing MASH (Metabolic Dysfunction–Associated Steatohepatitis) and navigating non-invasive testing. She addresses a common clinical challenge—what to do when FIB-4 and FibroScan results are discordant. Janet explains that while non-invasive tests are useful, they're not foolproof, and when results are unclear—especially in patients with significant metabolic risk factors—liver biopsy remains the gold standard for accurate diagnosis. She also shares expert recommendations on dietary changes for patients with fatty liver disease, emphasizing alcohol avoidance, high-protein, low-fat, and lower-carb diets, as well as achievable weight loss goals (around 5% of body weight). Janet highlights when to escalate care beyond lifestyle interventions—typically after 3 to 6 months if there’s no improvement—and discusses options such as pharmacologic therapy or bariatric surgery. This video provides practical, evidence-based guidance for healthcare providers managing the complexities of MASLD and MASH.
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Non-Invasive Testing With Kelly Smeester
August 2025
Join Kelly Smeester, MMS, RD, PA-C, from South Denver Gastroenterology, for an in-depth discussion on the latest tools and strategies in non-invasive liver disease assessment, presented through the GHAPP MASLD Community Network. This evidence-based session walks viewers through a case study of a patient with Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and explores the full range of non-invasive testing modalities used to evaluate liver fat, stiffness, and fibrosis risk. Kelly breaks down the utility of key tests including FIB-4, ELF Score, FibroScan (VCTE), and MR Elastography, and compares their accuracy, accessibility, limitations, and clinical value. Learn how to interpret biomarkers such as CAP (Controlled Attenuation Parameter) and kPa (Kilopascals), how to navigate indeterminate FIB-4 results, and when to escalate to more advanced imaging like MRE. The session also provides insights into combined scoring models (FAST, MAST, MEFIB), real-world use cases, and how comorbidities and patient-specific factors (BMI, ALT, bilirubin, ascites) can impact test reliability. Whether you're managing early-stage fatty liver disease or advanced fibrosis, this session provides essential knowledge to guide accurate diagnosis, risk stratification, and long-term monitoring without a liver biopsy.
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Liver Model Overview
July 2025
Join Alison Moe, PA-C with United Digestive, as she walks through a hands-on demonstration using a life-sized liver model to help patients better understand fibrosis and liver disease progression. In this engaging and practical overview, Allison explains how different stages of liver fibrosis—from normal liver to cirrhosis and hepatocellular carcinoma—can be felt and visualized using a segmented anatomical model. She shares how this tool enhances patient education during discussions about non-invasive liver testing, such as FibroScan, CAP scores, FIB-4, ELF testing, and more. Designed to support visual learners and improve comprehension of disease state, this video is a valuable resource for clinicians and patients navigating the complexities of metabolic-associated fatty liver disease (MASLD) and its progression to MASH. Learn how tactile and visual teaching aids can bridge the gap between diagnostics and patient understanding in hepatology care.
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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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