Summer Collier
MSN, FNP-BC
Location : San Diego, CA, USA
BIO
Summer Collier is a nurse practitioner with advanced expertise in hepatology and a strong commitment to evidence-based, multidisciplinary care. At UC San Diego Health, she provides comprehensive management for patients with chronic liver disease, including viral hepatitis, autoimmune hepatitis, alcohol-associated liver disease, and metabolic dysfunction–associated steatotic liver disease (MASLD).
Collier is actively engaged in clinical research and has participated in multidisciplinary studies on liver fibrosis, steatosis, and treatment protocols for hepatitis C and alcohol use disorder. Her scholarly work focuses on improving transitions of care for patients with cirrhosis and expanding access to pharmacologic treatments for patients with alcohol use disorder.
A recognized leader in the field, Collier has presented at national conferences including The Liver Meeting (AASLD), Digestive Disease Week (DDW), and GHAPP, speaking on topics such as cirrhosis care, hepatology red flags, and advanced practice provider leadership. She previously served as Chair of the Advanced Practice Council at UC San Diego Health, driving initiatives that elevated APP visibility and impact within the organization.
Before joining UC San Diego Health, she was a family nurse practitioner and HIV specialist with Family Health Centers of San Diego. She also has prior experience as a registered nurse.
Collier completed a Master of Science in Nursing degree from University of San Diego and will complete the Doctor of Nursing Practice degree from University of California, Los Angeles in June 2025. She is certified by the American Nurses Credentialing Center.
MASLD-MASH Content Featuring Summer
Clinical Deep Dive: Unlocking the Treatment Potential of Rezdiffra
March 2025
This educational discussion dives into Rezdiffra, the first and only FDA-approved therapy for non-cirrhotic metabolic-associated steatohepatitis (MASH) with moderate to advanced fibrosis. The talk provides a clinical deep dive into the progression of MASH and fibrosis, highlighting the risks of untreated disease and the importance of early intervention. A key focus is the thyroid hormone receptor beta mechanism, explaining how Rezdiffra directly targets liver-specific pathways to reduce hepatic fat accumulation and fibrosis. Additionally, the discussion covers the rigorous FDA approval process and dual efficacy endpoints, detailing how Rezdiffra achieved significant fibrosis improvement and steatohepatitis resolution in the MAESTRO-NASH trial. The session also provides practical insights into patient access, prescribing considerations, and managing common side effects. With over 2,000 patients studied, Rezdiffra has demonstrated a strong safety profile and offers a once-daily oral treatment option that represents a major advancement in MASH management. This discussion is essential for gastroenterologists, hepatologists, and endocrinologists managing patients with MASH, as well as primary care providers and cardiologists who play a role in identifying at-risk individuals. If you are a healthcare professional looking to stay updated on the latest MASH research and treatment strategies, this session provides the insights you need.
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MASLD Pharmacotherapy With Summer Collier
August 2025
Join Summer Collier, FNP, from UC San Diego Health, for a comprehensive discussion on pharmacotherapy for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and MASH, presented through the GHAPP MASLD/MASH Community Network and sponsored by Madrigal Pharmaceuticals. In this session, Summer outlines the foundational role of lifestyle modification in treating MASLD, including diet, exercise, and weight loss, while emphasizing the growing need for liver-directed therapies in patients with moderate to advanced fibrosis. She reviews the clinical use of GLP-1 receptor agonists such as semaglutide and tirzepatide, which aid in glycemic control and significant weight loss, and explores their application in hepatology—including key data showing MASH resolution and fibrosis improvement. The discussion also addresses older treatment options like vitamin E and pioglitazone, explaining their risks, limitations, and patient selection criteria. The highlight of the presentation is a detailed analysis of resmetirom (Rezdiffra)—the first FDA-approved therapy for non-cirrhotic NASH with F2–F3 fibrosis. Summer walks through the MAESTRO-NASH trial, covering the mechanism of THR-β activation, improvements in liver histology, safety data, and practical prescribing guidance, including non-invasive monitoring, statin dose considerations, and drug–drug interactions. The session concludes with expert insights on staging, treatment duration, insurance access, and the evolving future of MASLD therapy. A must-watch for hepatology, GI, and primary care providers seeking to implement the latest evidence-based approaches in managing fatty liver disease.
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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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MASLD Pharmacotherapy With Kelly Smeester
August 2025
Join Kelly Smeester, MMS, RD, PA-C, from South Denver Gastroenterology for an in-depth pharmacologic review of current and emerging treatment options for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and MASH (Metabolic Dysfunction-Associated Steatohepatitis), as part of the GHAPP MASLD Community Network. This session outlines a comprehensive treatment strategy focused on three key goals: promoting weight loss, reducing cardiovascular risk, and targeting liver-specific interventions. Kelly highlights lifestyle and pharmacologic interventions including GLP-1 receptor agonists, GIP/GLP-1 dual agonists, and bariatric surgery, while exploring evidence-based guidance for treating comorbidities like type 2 diabetes, hypertension, and dyslipidemia. She dives into the latest data on vitamin E, pioglitazone, and the newly FDA-approved Resmetirom (Rezdiffra)—a thyroid hormone receptor beta agonist indicated for adults with non-cirrhotic NASH and F2–F3 fibrosis. Learn about the results from pivotal clinical trials like ESSENCE, PIVENS, and MAESTRO-NASH, the importance of NAFLD activity scoring, as well as dosing strategies, adverse effects, and drug interactions to consider when using Resmetirom. The session also explores practical monitoring approaches including FibroScan, MRI-PDFF, and ELF scores, with an outlook on evolving treatment duration and insurance coverage considerations. Whether you're a hepatology provider or part of a multidisciplinary care team, this presentation offers critical insights to optimize MASH treatment pathways today and in the future.
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MASLD Pharmacotherapy
July 2025
In this dynamic and highly informative session, Sherona Bau, NP, presents a comprehensive overview of pharmacotherapy in MASLD and MASH, breaking down current treatment strategies and emerging therapies for patients with metabolic dysfunction-associated steatotic liver disease. This presentation, part of the MASLD/MASH Community Network, begins by contextualizing the recent nomenclature shift from NAFLD/NASH to MASLD/MASH and its clinical implications. Sherona explores lifestyle intervention targets, including Mediterranean diet, weight loss goals based on fibrosis stage, and the role of GLP-1 and GIP receptor agonists in improving liver health. She highlights the ESSENCE trial results for semaglutide, discusses the only FDA-approved therapy to date—resmetirom (Rezdiffra)—and explains its mechanism of action via thyroid hormone receptor beta activation. The session dives deep into efficacy data from the MAESTRO-NASH trial, side effect profiles, drug–drug interactions, and monitoring recommendations. She also previews a pipeline of promising agents in phase 2 and 3 trials—including tirzepatide (GLP-1/GIP), cotadutide (GLP-1/GR), pemvidutide (GLP-1/GIP), and retatrutide (GLP-1/GIP/GR)—offering insight into what’s next in the evolving treatment landscape. This is a must-watch for hepatology and endocrinology clinicians focused on the future of fatty liver management.
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Comparing F3 and F4 Fibrosis With Edith Johannes
July 2025
Join Edith Johannes, NP from UCLA Health, for a comprehensive and approachable introduction to MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease)—formerly known as NAFLD—and how to accurately diagnose it. Designed for primary care providers and early learners in hepatology, this session outlines the fundamental criteria for diagnosing MASLD and MASH, the importance of ruling out alternate causes of hepatic steatosis, and the key role of cardio-metabolic risk factors. Edith discusses how to apply non-invasive testing tools such as the FIB-4 score, ELF test, and elastography to determine fibrosis stage, along with guidance on when to consider liver biopsy and refer to hepatology. The presentation also explores the overlap between MASLD and alcohol-related liver disease, addresses the impact of genetic risk factors like PNPLA3 (particularly in Hispanic populations), and reinforces the urgent need for early detection to prevent cirrhosis and liver cancer. With clinical pearls and case-based examples, this session helps clinicians feel confident in evaluating patients for MASLD and navigating next steps for care.
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Non-Invasive Testing With Sherona Bau
July 2025
In this engaging and highly informative GHAPP MASLD Community Network session, Sherona Bau, PA-C, walks attendees through a practical overview of non-invasive testing (NIT) for evaluating liver health in patients with MASLD (Metabolic dysfunction-associated steatotic liver disease) and MASH (Metabolic dysfunction-associated steatohepatitis). Drawing on real-world clinical experience, Sherona explains why non-invasive testing is essential for identifying fibrosis risk in a population where liver steatosis is prevalent in up to 30% of U.S. adults. Through the case of a 65-year-old Hispanic male named Albert, Sherona demonstrates how to interpret and apply tools such as FIB-4, FibroScan (VCTE and CAP score), ELF (Enhanced Liver Fibrosis) test, and MR Elastography (MRE). She highlights their respective strengths, limitations, clinical cut-offs, and insurance-related considerations. The session also covers when to order tests, how to assess data quality (e.g., IQR/median ratio in VCTE), and when to escalate care to hepatology or cardiology. Whether you are a primary care provider, endocrinologist, or hepatology specialist, this talk delivers practical algorithms and decision-making pathways for managing MASLD, improving early detection of fibrosis and cirrhosis, and integrating cardiovascular risk assessment into liver care. Sherona also emphasizes the importance of alcohol use history, metabolic syndrome risk factors, and annual NIT follow-up in patients at risk for disease progression.
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Comparing F3 and F4 Fibrosis With Lindsay Pratt
July 2025
Join Lindsey Pratt, PA-C from the University of Colorado Liver Transplant Program, for an in-depth clinical comparison of F3 and F4 fibrosis in patients with MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease) and MASH (Metabolic Dysfunction–Associated Steatohepatitis). Using an identical patient profile with differing non-invasive testing results, Lindsey demonstrates how to accurately stage fibrosis using tools like FIB-4, FibroScan, CAP score, and ELF test—emphasizing when pharmacologic intervention is appropriate and when advanced monitoring becomes critical. This session explores the clinical implications of fibrosis staging, treatment pathways including resmetirom (Rezdiffra), the role of GLP-1 receptor agonists, and practical nutrition and lifestyle strategies. For F4 patients, Lindsey outlines key elements of surveillance for hepatocellular carcinoma (HCC), portal hypertension management, and transplant evaluation. Whether you're in hepatology or primary care, this case-based discussion offers evidence-backed guidance for managing patients across the MASLD/MASH spectrum and preventing liver disease progression.
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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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Comparing F3 and F4 Fibrosis With Michelle Barnett
July 2025
In this installment of the GHAPP MASLD Community Network, Michelle Barnett, PA-C from Peak Gastroenterology in Colorado Springs, presents a deep dive into the clinical management of MASH—formerly known as NASH or non-alcoholic steatohepatitis. Through two comparative case studies, Michelle explores the nuances of diagnosing and managing patients with F3 and F4 fibrosis. Learn how to effectively use non-invasive diagnostic tools like FIB-4, FibroScan, and ELF testing, and gain valuable insights into stratifying fibrosis risk, monitoring hepatocellular carcinoma (HCC), and determining when resmetirom is appropriate. This session also covers practical guidance on nutrition, exercise, medication safety, and multidisciplinary care for patients with advanced liver disease. Whether you're a hepatology specialist or a primary care provider navigating the MASLD/MASH landscape, this video offers actionable strategies to improve long-term patient outcomes and reinforces the critical role of lifestyle intervention and liver disease surveillance.
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Lifestyle Management With Lisa Richards
July 2025
Join Lisa Richards, FNP-BC, from UC San Diego Health, as she leads a powerful educational session on the lifestyle management of MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease) in this GHAPP MASLD/MASH Community Network event, sponsored by Madrigal Pharmaceuticals. Through a compelling clinical case study, Lisa walks viewers through a step-by-step approach to diagnosing MASLD, assessing fibrosis risk using noninvasive tools like FIB-4 and FibroScan, and implementing guideline-based interventions. Learn how to counsel patients on culturally sensitive dietary modifications, physical activity strategies, and behavior change techniques that improve outcomes. This session also explores the clinical relevance of weight loss thresholds, Mediterranean-style eating plans, and the importance of patient-centered goal setting. Whether you’re a provider managing metabolic liver disease or looking to integrate newer therapies like resmetirom, this video offers practical tools to empower sustainable change and improve liver health.
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MASLD Basics With Summer Collier
July 2025
Join Summer Collier, NP from UC San Diego Health, for an essential overview of MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) in this GHAPP MASLD Community Network session. Designed for clinicians and healthcare professionals, this case-based talk covers the evolving nomenclature shift from NAFLD/NASH to MASLD/MASH, including key definitions, diagnostic criteria, and practical tools for identifying and managing patients with steatotic liver disease. Summer walks through foundational concepts like the role of hepatic steatosis, cardio-metabolic risk factors, and the importance of excluding significant alcohol use to establish a MASLD diagnosis. She also provides clinical insights into non-invasive fibrosis staging using FIB-4, FibroScan, elastography, and blood-based tests, as well as how to differentiate patients who may require hepatology referral or biopsy. Emphasizing the importance of early detection and risk stratification in primary care, this session highlights how fibrosis stage impacts prognosis, treatment planning, and long-term liver-related outcomes. For more educational sessions and MASLD tools — visit the GHAPP MASLD Community Network.
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Management of Life Style Modification
January 2025
This video focuses on the comprehensive management of patients with metabolic-associated steatohepatitis (MASH), emphasizing lifestyle modifications, dietary adjustments, and exercise strategies. Key topics include the importance of addressing risk factors like diet, exercise habits, and alcohol intake, as well as referrals to medically supervised weight loss clinics or bariatric surgery for advanced cases. The speaker highlights the benefits of the Mediterranean diet, intermittent fasting, and avoiding ultra-processed foods while discussing the role of resistance training to combat sarcopenia and maintain muscle mass. Practical advice and tailored recommendations ensure a holistic approach to managing MASH and improving patient outcomes.
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Third Step of Life Style Management
January 2025
This video provides a comprehensive overview of emerging pharmacologic treatments for metabolic-associated steatohepatitis (MASH) and their tailored applications based on patient profiles. Topics include FDA-approved therapies, drugs in advanced clinical trials (such as semaglutide and lanifibranor), and the potential for combination treatments targeting both steatohepatitis and fibrosis. The speaker emphasizes the importance of patient-specific approaches considering metabolic profiles, obesity, and diabetes status, alongside lifestyle interventions. Additionally, the video discusses the evolving interdisciplinary care model and highlights the exciting progress in non-invasive testing and treatment advancements for F2-F3 fibrosis.
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Approved Medication for MASH/NASH
January 2025
This video provides detailed guidance on selecting and monitoring patients for emerging therapies targeting advanced fibrosis (F2-F3) in NASH. Key topics include contraindications for patients with cirrhosis, considerations for concomitant medications, and dose adjustments for statins. The video outlines ideal candidates based on specific thresholds for VCTE, MRE, ELF scores, and other non-invasive tests while emphasizing the importance of ruling out portal hypertension and other liver diseases. It also reviews a stepwise monitoring approach, focusing on tolerability at three months and efficacy assessments at six and twelve months, with an emphasis on histologic and non-invasive test improvements.
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Types of Diet for the Treatment of MASLD
January 2025
This video explores comprehensive strategies for managing metabolic-associated steatohepatitis (MASH), focusing on fibrosis risk stratification, lifestyle modifications, and pharmacologic interventions. Learn about dietary recommendations like the Mediterranean diet, exercise guidelines emphasizing resistance training, and the role of intermittent fasting and processed food avoidance. The video also highlights weight loss targets, diabetes management, and emerging therapies such as GLP-1 receptor agonists and bariatric surgery, all aimed at improving liver health and patient outcomes.
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NITs to Identify High Risk MASH Patients
January 2025
Explore advancements in non-invasive diagnostics and risk stratification for liver fibrosis and MASH. This video highlights tools like FIB-4, transient elastography, and innovative scoring systems (e.g., FAST and Agile) to identify and predict outcomes for high-risk patients. Learn about serum biomarkers, updated guidelines, and the role of lifestyle interventions alongside targeted therapies for managing metabolic risks and advancing care in hepatology.
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MASLD Basics With Valerie Shin
August 2025
Join Valerie Shin, NP, from the Fatty Liver Institute at UCLA, for a foundational discussion in the GHAPP MASLD Community Network, sponsored by Madrigal Pharmaceuticals. This educational session covers the basics of steatotic liver disease (SLD), with a special focus on the evolving terminology and diagnostic criteria surrounding MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) and MASH (Metabolic Steatohepatitis). Valerie explains why the shift away from the outdated “fatty liver” label is more than semantics—it removes stigma, increases diagnostic precision, and improves patient-provider communication. Through clear visuals and case-based discussion, this presentation outlines the global epidemiology of MASLD, how to classify disease etiology (MASLD, MetALD, ALD, or other rare causes), and how to risk-stratify patients using non-invasive tools like FIB-4, FibroScan, and ELF. Learn how to diagnose MASLD, when to refer to hepatology, how to use biomarkers for staging fibrosis, and when pharmacotherapy like resmetirom may be appropriate. With rising global prevalence and many patients progressing silently to cirrhosis or HCC, early detection and management are key. Don’t miss this practical, clinically grounded presentation designed for APPs and primary care providers managing patients with metabolic liver disease.
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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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Podcast: PCP Screening for MASH/MASLD: Identifying At-Risk Patients
July 2025
In this essential podcast episode from the GHAPP MASLD/MASH Community Network, Summer Collier, NP at UC San Diego Health, dives into the critical role that primary care providers and advanced practice providers play in recognizing and managing MASLD (Metabolic dysfunction-associated steatotic liver disease) and its progressive form, MASH (Metabolic-associated steatohepatitis). With MASLD affecting a growing number of patients—many undiagnosed—Summer walks through practical strategies for early identification, starting with high-risk individuals such as those with type 2 diabetes, obesity, or metabolic syndrome. She highlights the use of the FIB-4 index as a quick, validated, and guideline-recommended first-line screening tool, and explains how to interpret FIB-4 results to stratify risk and determine next steps, including ELF testing, FibroScan®, or referral to GI/hepatology. Summer also offers actionable workflow tips to integrate liver screening into routine primary care, like embedding FIB-4 calculators in EMRs or incorporating assessments into annual diabetes visits. This episode is a must-listen for clinicians seeking to prevent liver fibrosis progression and liver cancer through early, proactive care.
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Differentiating Between F3 and F4
July 2025
In this comprehensive discussion, HoChong Gilles, a nurse practitioner with 25 years of hepatology experience at the Richmond VA Medical Center, explores the critical importance of accurately distinguishing between F3 (advanced fibrosis) and F4 (cirrhosis) in patients with MASH (metabolic-associated steatohepatitis). While both stages carry increased risks of liver-specific and overall mortality, Gilles explains that F3 may still be reversible with lifestyle changes or pharmacotherapy, whereas F4 signals irreversible liver damage with heightened risk of complications like portal hypertension, hepatic encephalopathy, and liver cancer. Viewers will gain a deeper understanding of how non-invasive tests—like FIB-4, ELF, FibroScan, and MRE—perform in identifying fibrosis stage, including their limitations and overlaps. Gilles also outlines when to consider liver biopsy, especially in cases with discordant test results, atypical features, or clinical uncertainty. This video emphasizes how staging accuracy informs eligibility for therapies, surveillance strategies like HCC screening, and overall prognosis. Learn how to approach this nuanced distinction in clinical practice and why F3 vs. F4 isn't just semantics—it's a turning point in patient care.
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Addressing Health Disparities: Equity Considerations in MASH/MASLD Care
July 2025
In this episode, Patrick Horne, NP at the University of Florida (UF Health), explores the impact of health disparities and socioeconomic inequality on the diagnosis and management of MASH (metabolic-associated steatohepatitis) and MASLD (metabolic dysfunction-associated steatotic liver disease). With a focus on rural and underserved populations, Patrick discusses how limited access to quality healthcare, healthy food, exercise options, and non-invasive testing (NITs) like FibroScan or MRI elastography can delay diagnosis and worsen outcomes. He shares practical, empathetic strategies for individualizing care, such as using accessible tools like FIB-4 or APRI, promoting low-cost physical activity like walking or swimming, and providing culturally sensitive nutrition advice tailored to financial and geographic realities. Patrick emphasizes the provider’s role as a patient advocate and coach, helping patients navigate barriers and create sustainable lifestyle modifications. This episode offers key insights for clinicians working to close gaps in care and promote equity in liver disease management.
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Pharmacotherapy Review
July 2025
Join Christina Hanson, FNP-C, from South Denver Gastroenterology, as she provides an in-depth overview of the current pharmacologic treatment landscape for Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH). This expert-led session explores the three cornerstones of MASH management—lifestyle and weight loss interventions, cardiovascular risk reduction, and liver-directed therapy—while highlighting the evolving role of GLP-1 receptor agonists and the recent FDA approval of resmetirom, the first medication indicated for adults with MASH and moderate to advanced fibrosis. Christina also discusses clinical trial data from MAESTRO-NASH, reviews historical agents like vitamin E and pioglitazone, and offers practical guidance on patient selection, safety considerations, and monitoring strategies. Whether you’re a GI provider, hepatology specialist, or primary care clinician managing fatty liver disease, this video provides valuable insights into how emerging therapies are shaping the future of MASH treatment.
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Highlighted Events
GHAPP Eighth Annual Conference
September 04 @ 12:00 pm - September 06 @ 12:00 pm MDT
About the 2025 GHAPP Conference The GHAPP conference is the only conference specifically designed by advanced practice providers (APPs) for the pur..
MASLD vs MetALD - Virtual
September 24 @ 04:00 pm - 04:30 pm PST
Join Summer Collier, FNP, on September 24, 2025, for a live GHAPP Zoom session focused on the evolving understanding of MASLD (Metabolic Dysfunction-A..
Pacific Northwest GI & Liver Update
October 03 @ 12:00 pm - October 04 @ 12:00 pm PST
The 2025 Pacific Northwest GI and Liver Conference will deliver focused educational updates highlighting clinically relevant advances in the managemen..
Related Content
Lifestyle Management With Jonathan Yeh
August 2025
In this GHAPP MASLD Community Network session, Jonathan Yeh, PA-C from Columbia University Irving Medical Center, presents a case-based discussion on the lifestyle management of MASLD (Metabolic Associated Steatotic Liver Disease) and MASH (Metabolic Associated Steatohepatitis). Through the case of a 65-year-old patient with obesity, type 2 diabetes, hypertension, and hyperlipidemia, Jonathan highlights how dietary modification, weight loss, and physical activity remain the foundation of treatment, even with new pharmacotherapies available. The presentation emphasizes the benefits of the Mediterranean diet, the importance of avoiding refined carbohydrates, and the role of both aerobic and resistance exercise in improving liver health, reducing steatosis, and potentially reversing fibrosis. Cultural considerations, patient adherence challenges, and strategies to drive behavior change are also addressed, providing clinicians with practical insights to support patients in preventing progression to advanced fibrosis or cirrhosis.
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MASLD Pharmacotherapy With Jonathan Yeh
August 2025
In this GHAPP MASLD Community Network Education Series, Jonathan Yeh, PA from Columbia University Irving Medical Center, reviews the latest advances in pharmacotherapy for MASLD (Metabolic Associated Steatotic Liver Disease) and MASH (Metabolic Associated Steatohepatitis). This presentation explores the evolution from NAFLD to MASLD, highlighting why metabolic dysfunction is central to disease progression. Jonathan discusses the role of lifestyle modification, GLP-1 receptor agonists (such as semaglutide and tirzepatide), vitamin E, pioglitazone, and bariatric surgery, while focusing on resmetirom—the first FDA-approved therapy for adults with non-cirrhotic MASH and moderate to advanced fibrosis. The session explains how resmetirom works as a thyroid hormone receptor beta agonist, its clinical trial evidence from the MAESTRO-NASH study, patient eligibility, safety considerations, drug–drug interactions, and monitoring recommendations. With ongoing studies and expanding treatment options, this discussion provides clinicians with practical strategies for managing MASLD and MASH, improving liver outcomes, and addressing the challenges of insurance access and long-term therapy.
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Lifestyle Management With Jennifer Geremia
August 2025
In this GHAPP MASLD Community Network presentation, Jennifer Geremia, PA-C, from Brigham and Women’s Hospital in Boston, discusses the critical role of lifestyle modifications in managing MASLD (Metabolic Associated Steatotic Liver Disease) and MASH (Metabolic Associated Steatohepatitis). Using a case-based approach, she highlights how patients with obesity, type 2 diabetes, hypertension, and hyperlipidemia can benefit from evidence-based interventions including dietary changes, weight reduction, and physical activity. The session emphasizes the importance of achieving and maintaining 7–10% weight loss, the benefits of a Mediterranean diet, and combining aerobic and resistance exercise to improve liver health and reduce progression to advanced fibrosis or cirrhosis. Jennifer also explores the challenges of long-term adherence, the impact of genetic and metabolic risk factors, and strategies for engaging patients in realistic and sustainable lifestyle changes. This program underscores how early intervention and multidisciplinary care can prevent liver disease progression and improve outcomes for at-risk patients.
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Comparing F3 and F4 Fibrosis With Jennifer Geremia
August 2025
In this GHAPP MASLD Community Network session, Jennifer Geremia, PA-C from Boston, discusses the critical differences between F3 fibrosis and F4 cirrhosis in patients with MASLD (Metabolic Associated Steatotic Liver Disease) and MASH (Metabolic Associated Steatohepatitis). Using a detailed case study, she outlines how non-invasive tests (NITs) such as FIB-4, FibroScan, CAP score, and ELF testing can help differentiate fibrosis stages and guide patient management. The discussion highlights when to consider advanced testing, the role of resmetirom (Rezdiffra) in eligible F2–F3 patients, and why treatment strategies differ for those with F4 cirrhosis, including the need for HCC surveillance, portal hypertension evaluation, and variceal screening. Jennifer also emphasizes lifestyle modifications, metabolic risk factor control, and multidisciplinary care as essential components of managing advanced liver disease. This presentation provides valuable insights for GI, hepatology, and primary care providers navigating the nuances of fibrosis staging and treatment decisions in 2025.
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Non-Invasive Testing With Oyin Penny
August 2025
In this GHAPP MASLD Community Network presentation, Oyin Penny, FNP, from Premier Gastroenterology of Kansas City, explores the evolving role of non-invasive testing (NITs) in assessing MASLD (Metabolic Associated Steatotic Liver Disease) and MASH (Metabolic Associated Steatohepatitis). Through a detailed case study of a 65-year-old male with obesity, diabetes, hypertension, and hyperlipidemia, we review how imaging biomarkers such as FibroScan, MR Elastography, CAP score, and MRI-PDFF, as well as clinical prediction tools like FIB-4 and ELF score, are applied to evaluate fibrosis risk and guide management decisions. This session highlights the strengths and limitations of various NITs, emphasizes the importance of accurate fibrosis staging, and outlines when to repeat testing, escalate to hepatology referral, or initiate therapy. The discussion underscores the critical need for early detection, risk stratification, and proactive management of liver disease in patients with metabolic risk factors to prevent progression to cirrhosis and improve long-term outcomes.
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Comparing F3 and F4 Fibrosis With Oyin Penny
August 2025
Understanding the differences between F3 and F4 fibrosis is crucial in the management of MASH (Metabolic Associated Steatohepatitis) and other liver diseases. In this session with Oyin Penny, FNP, from the GHAPP MASLD Community Network, we explore a case-based comparison using non-invasive tests (NITs), including FibroScan, ELF score, and Fib-4, to highlight how staging impacts prognosis, treatment strategies, and long-term outcomes. Case 6A focuses on a patient with F3 fibrosis, discussing lifestyle modification, metabolic disease optimization, and the role of therapies like Resmetirom (Rezdiffra). Case 6B revisits the same patient profile but with F4 fibrosis, emphasizing advanced management including HCC surveillance, EGD screening for varices, and consideration of non-selective beta blockers. By contrasting these scenarios, this presentation underscores the importance of accurate fibrosis staging, risk stratification, and timely interventions to improve patient outcomes.
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Clinical Deep Dive: Unlocking the Treatment Potential of Rezdiffra
March 2025
This educational discussion dives into Rezdiffra, the first and only FDA-approved therapy for non-cirrhotic metabolic-associated steatohepatitis (MASH) with moderate to advanced fibrosis. The talk provides a clinical deep dive into the progression of MASH and fibrosis, highlighting the risks of untreated disease and the importance of early intervention. A key focus is the thyroid hormone receptor beta mechanism, explaining how Rezdiffra directly targets liver-specific pathways to reduce hepatic fat accumulation and fibrosis. Additionally, the discussion covers the rigorous FDA approval process and dual efficacy endpoints, detailing how Rezdiffra achieved significant fibrosis improvement and steatohepatitis resolution in the MAESTRO-NASH trial. The session also provides practical insights into patient access, prescribing considerations, and managing common side effects. With over 2,000 patients studied, Rezdiffra has demonstrated a strong safety profile and offers a once-daily oral treatment option that represents a major advancement in MASH management. This discussion is essential for gastroenterologists, hepatologists, and endocrinologists managing patients with MASH, as well as primary care providers and cardiologists who play a role in identifying at-risk individuals. If you are a healthcare professional looking to stay updated on the latest MASH research and treatment strategies, this session provides the insights you need.
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Misconceptions About Liver Health
July 2025
In this quick but powerful video, Jeremy Davis, NP from Shreveport, Louisiana, addresses some of the most common misconceptions about liver health that he encounters in clinical practice. Many patients believe that liver disease only occurs in people who drink alcohol, but Jeremy explains how conditions like MASLD (Metabolic dysfunction-associated steatotic liver disease) and MASH (Metabolic-associated steatohepatitis) can affect individuals regardless of alcohol use. He also clears up the myth that only overweight patients are at risk, pointing out that co-morbidities such as hypertension, high cholesterol, cardiovascular disease, and type 2 diabetes can contribute to liver disease—even in patients with a normal BMI. Finally, Jeremy explains why normal liver enzyme labs (ALT and AST) don’t always rule out liver disease, making it crucial to assess underlying risk factors and improve provider and patient awareness. This video is a valuable resource for both healthcare professionals and patients looking to better understand non-alcoholic liver disease and why early screening matters.
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Common Questions from Patients About MASH
July 2025
In this focused episode, Suzanne Robertazzi, NP at the Washington DC VA, shares expert insights on how to prevent recurrence of MASH (Metabolic-associated steatohepatitis) and MASLD (Metabolic dysfunction-associated steatotic liver disease) in liver transplant recipients. Drawing on her experience caring for post-transplant veterans, Suzanne explains that MASH can return even after liver transplantation, making ongoing metabolic management essential. She outlines key strategies including tight blood sugar and blood pressure control, especially since transplant medications can contribute to hypertension. Suzanne also emphasizes the importance of introducing regular physical activity post-recovery and adopting a Mediterranean-style diet—while tailoring nutrition guidance to meet the needs of patients in urban settings with limited access to fresh foods. This video is a must-watch for transplant teams, hepatology providers, and patients seeking to extend the life and health of their new liver through evidence-based lifestyle and clinical interventions.
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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 educational video, Robin Soto, RN, MSN, FNP-BC from UC San Diego Health, answers common questions from primary care providers about the progression and management of MASLD (Metabolic dysfunction-associated steatotic liver disease) and MASH (Metabolic-associated steatohepatitis). She addresses the often-misunderstood reality that fatty liver disease can progress to cirrhosis, even in patients with no history of alcohol use—challenging the stigma that surrounds liver disease. Robin explains how MASH is a progressive condition, and if left unmanaged, can lead to advanced fibrosis and liver failure. She also shares practical dietary advice for patients, highlighting the benefits of the Mediterranean diet—rich in healthy fats, fiber, and low in processed foods and sugars—as recommended by hepatology societies like AASLD. Importantly, she emphasizes that even modest weight loss (3–10%) can significantly improve steatosis, inflammation, and even reverse fibrosis. This video is a valuable resource for clinicians and patients alike, focused on prevention, early intervention, and empowering lifestyle changes.
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Common Questions From Primary Care Providers About MASH
July 2025
In this insightful episode, Jessica Crimaldi, NP from the Cleveland Clinic, addresses two of the most frequently asked questions from primary care providers about MASLD (Metabolic dysfunction-associated steatotic liver disease) and MASH (Metabolic-associated steatohepatitis). First, she clarifies a common concern regarding statin use in patients with liver disease, emphasizing that statins are not only safe in most cases—including compensated cirrhosis—but also beneficial in managing cardiometabolic risk factors and slowing disease progression. She explains when statins are contraindicated and encourages collaboration with hepatology if there are concerns. Second, Jessica outlines a practical pre-referral workup for suspected MASLD/MASH patients. She details the labs needed to calculate FIB-4, suggests ordering an INR, and highlights the importance of screening for viral hepatitis, autoimmune liver disease, and common genetic liver disorders. This episode offers clear, actionable guidance for providers managing fatty liver disease in primary care and is a valuable resource for improving early diagnosis and coordinated care.
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Common Questions From Community GI About MASH
July 2025
In this session, Lavinia Iordache, PA-C, from the University of Miami, draws on a decade of experience in inpatient and outpatient hepatology to address common management questions related to MASLD (Metabolic dysfunction-associated steatotic liver disease) and MASH (Metabolic-associated steatohepatitis). She provides practical guidance for gastroenterology providers navigating when to monitor versus refer patients with fibrosis, how to interpret and time non-invasive testing (NITs) such as FIB-4, and when liver biopsy may still play a role—particularly in cases with persistently elevated liver enzymes despite lifestyle improvement. Lavinia also dives into the referral criteria for hepatology, the evolving role of resmetirom in stage 2–3 fibrosis, and the critical topic of HCC screening. While current AASLD guidelines limit HCC surveillance to cirrhosis, Lavinia highlights emerging evidence and EASL recommendations supporting imaging in patients with F3 fibrosis based on individualized risk factors like diabetes, genetics, and obesity. She also explains why CT or MRI is often preferred over ultrasound in MASLD patients due to obesity-related imaging limitations. This is a must-watch for hepatology and GI teams managing liver fibrosis in metabolic disease.
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Misconceptions About Liver Health
July 2025
In this short and informative video, Miu Lai Ng, a nurse practitioner at Tufts Medical Center, debunks two of the most common myths about liver health. First, she sets the record straight on liver cleanses and detox teas—explaining that your liver already detoxifies your body daily and doesn’t need fad diets or trendy supplements. Instead, what your liver needs is support through sustainable habits like reducing alcohol intake, cutting back on processed sugars, and maintaining a healthy weight. She also highlights a critical point: liver disease is often silent, and many people with significant liver damage have no symptoms until it’s advanced. If you're at risk due to metabolic syndrome, alcohol use, or other factors, Miu Lai urges you to talk to your healthcare provider about screening options like FIB-4 or FibroScan®. Your liver works hard for you—this video is a reminder to return the favor with real, lasting care.
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Misconceptions About Liver Health
July 2025
In this quick myth-busting session, Elizabeth Alqueza, PA-C from Beth Israel Deaconess Medical Center in Boston, addresses two of the most common misconceptions in hepatology related to steatotic liver disease (MASLD/MASH). First, she explains that liver disease is not always fixed or irreversible—and with proper management and elimination of the underlying cause, liver fibrosis can improve over time, a trend often monitored through FibroScan®. Second, she clarifies that significant liver improvement does not require extreme weight loss. In fact, a modest 5–10% reduction in total body weight—sometimes as little as 10–20 pounds—can lead to measurable improvements in liver inflammation and fibrosis. This video is ideal for providers and patients seeking a clearer understanding of how lifestyle changes can reverse liver disease and why timely, targeted interventions matter.
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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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Non-Invasive Testing With Jordan Mayberry
July 2025
In this educational session, Jordan Mayberry, PA-C from UT Southwestern, presents a practical overview of non-invasive testing for diagnosing and staging metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic-associated steatohepatitis (MASH). Using a real-world patient case, Jordan discusses how clinicians can leverage key tools—such as FIB-4, ELF testing, FibroScan (VCTE), and MRI elastography—to assess fibrosis and stratify risk in patients with MASLD. She explains the benefits, limitations, and clinical applications of each modality, including guidance on when and how to use them in everyday practice. Whether you're a hepatology specialist or a provider managing patients with cardiometabolic risk factors, this talk delivers a clear, step-by-step approach to incorporating non-invasive liver assessment into your workflow. Viewers are also invited to explore the GHAPP MASLD/MASH Community Network for ongoing education, resources, and clinical insights.
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APP Insight: Misconceptions About Liver Health
June 2025
In this video, Gabriella McCarty, NP-C, of Northshore Gastroenterology in Cleveland, Ohio, tackles common misconceptions surrounding fatty liver disease, also known as MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease). Drawing from her clinical experience, Gabriella highlights how fatty liver is often an incidental finding during routine GI visits, even when patients present for unrelated concerns like GERD or colon screenings. She emphasizes that MASLD is not caused by alcohol, but instead driven by metabolic risk factors such as obesity, diabetes, high cholesterol, and hypertension. Gabriella dispels the myth that normal liver enzymes indicate a healthy liver, explaining that liver markers are often unreliable in detecting advanced fibrosis or cirrhosis. She also warns against unregulated liver detox products and the outdated belief that fatty liver is harmless. With MASLD now the most common liver disease worldwide and increasing rates among younger populations, Gabriella stresses the importance of early screening, lifestyle modification, and patient education. This is a must-watch for anyone looking to better understand the silent progression of fatty liver disease and the tools available for timely intervention.
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Common Questions From Patients About MASH
July 2025
In this practical and patient-focused discussion from the GHAPP MASLD/MASH Community Network, we address some of the most frequently asked questions by patients newly diagnosed with MASLD (Metabolic dysfunction-associated steatotic liver disease). Many patients wonder how they can have liver disease if they don’t drink alcohol. This video explains the evolution from NAFLD to MASLD, emphasizing that MASLD is rooted in metabolic risk factors—not alcohol use—and commonly affects individuals with diabetes, obesity, and hypertension. Viewers will also learn about evidence-based lifestyle interventions, including the benefits of a hypocaloric diet, the recommended Mediterranean-style eating pattern, and 150 minutes of weekly physical activity. Finally, we tackle the question “Is MASLD curable?” with empowering guidance on how weight loss and exercise can help reverse liver damage and reduce liver fat. This is a must-watch for clinicians, care teams, and patients seeking clarity and confidence in managing this increasingly common liver disease.
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Common Questions From Primary Care Providers About MASH
July 2025
In this informative session, Jennifer Geremia, PA-C, a seasoned gastroenterology physician assistant in tertiary care Boston, addresses some of the most common questions primary care providers have about identifying and managing patients with fatty liver disease, MASLD (Metabolic dysfunction-associated steatotic liver disease), and MASH (Metabolic-associated steatohepatitis). Jennifer highlights the importance of using FIB-4 as a first-line non-invasive test (NIT) in high-risk patients with diabetes, obesity, or other metabolic conditions—noting how easily this tool can be integrated into routine labs via the EMR. She underscores that the liver is often overlooked in chronic disease management and makes a strong case for routine fibrosis screening alongside cardiovascular and diabetes evaluations. The talk also dives into actionable next steps after FIB-4 testing, including elastography, ELF testing, and referrals to GI when needed. Jennifer closes by discussing realistic lifestyle intervention goals—especially the importance of 7–10% weight loss for meaningful reductions in steatosis and fibrosis risk. This session is a must-watch for PCPs, APPs, and clinicians managing metabolic comorbidities and seeking practical, evidence-based strategies for early MASH detection and management.
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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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APP Insight: Common Questions from Patients About MASH
June 2025
In this episode, Jordan Mayberry, MPAS, PA-C, a seasoned hepatology provider at UT Southwestern in Dallas, Texas, addresses some of the most frequently asked questions from patients diagnosed with MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease) and MASH (Metabolic Dysfunction–Associated Steatohepatitis). With over 12 years of clinical experience, Jordan explains the root causes of MASLD/MASH, including key cardiometabolic risk factors like obesity, diabetes, hypertension, and hyperlipidemia, as well as genetic predispositions—particularly in Hispanic populations. He emphasizes the importance of fibrosis assessment in guiding treatment decisions, explaining that patients with early-stage disease should focus on lifestyle changes, while those with more advanced fibrosis (stages F2–F3) may be candidates for pharmacologic therapy such as resmetirom (Rezdiffra). Jordan also explores how prognosis depends on fibrosis stage and long-term management of comorbidities, making early intervention and risk stratification essential. This episode offers practical insights for clinicians aiming to improve conversations and care strategies for patients living with MASLD or MASH.
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Non-Invasive Testing With Lindsay Pratt
July 2025
In this educational session from the GHAPP MASLD/MASH Community Network, Lindsay Pratt, PA-C from the University of Colorado, guides viewers through the practical application of non-invasive testing (NITs) for assessing fibrosis in patients with MASLD (Metabolic dysfunction-associated steatotic liver disease). Using a real-world case study, she highlights how to interpret FIB-4, ELF score, vibration-controlled transient elastography (VCTE/FibroScan®), and MR elastography (MRE) to stratify patients by risk and guide next steps in management. Lindsay explains the strengths and limitations of each NIT, how lifestyle modifications and cardiometabolic risk factors play a role in disease progression, and how tools like the AGA Clinical Care Pathway can be applied in day-to-day practice. This session is ideal for hepatologists, GI providers, APPs, and primary care professionals working to improve outcomes in patients with fatty liver disease—without relying on liver biopsy.
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NITs: A Practical Overview: Navigating the Basics
July 2025
In this practical and engaging overview, Janet Gripshover, nurse practitioner and nurse manager for the Cedars-Sinai Liver Transplant Program, breaks down the essentials of non-invasive testing (NITs) for assessing fibrosis in patients with metabolic-associated steatotic liver disease (MASLD). She explains the critical distinction between MASLD and MASH (metabolic-associated steatohepatitis), highlighting why early identification of aggressive liver disease is essential—even in patients without cirrhosis. Janet reviews key NIT tools, including FibroScan, MR elastography, and serum biomarkers like FIB-4 and ELF score, providing clinical insights on interpreting results, integrating them into risk stratification, and tailoring next steps for patient care. Viewers will learn when to act on elevated liver stiffness, how to interpret CAP scores, and why weight loss and comorbidity control remain foundational treatments. Whether you're new to hepatology or seeking a refresher on navigating fibrosis assessments, this video offers a clear, actionable framework to help prevent disease progression and optimize outcomes for patients with fatty liver disease.
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Non-Invasive Testing With Janet Gripshover
July 2025
In this in-depth and practical discussion, Janet Gripshover, NP from Cedars-Sinai in Los Angeles, explores the evolving role of non-invasive testing (NITs) in the diagnosis and risk stratification of MASLD (Metabolic dysfunction-associated steatotic liver disease) and MASH (Metabolic dysfunction-associated steatohepatitis). Drawing from real-world experience and a case study involving a 65-year-old patient with multiple cardiometabolic risk factors, she breaks down the latest 2025 approaches to fibrosis assessment—highlighting the use of FIB-4, ELF score, vibration-controlled transient elastography (FibroScan®), and MR elastography. Gryover also emphasizes how combining tests across modalities can improve accuracy and patient care while avoiding the risks of liver biopsy. Learn how liver stiffness, lab values, and clinical history all intersect to guide care and treatment decisions in patients with fatty liver disease. This session is part of the MASLD/MASH Community Network and is ideal for providers, specialists, and anyone interested in the forefront of liver disease management.
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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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GHAPPcast: Recognizing the Severity of MASH
January 2025
Thank you to Madrigal for sponsoring this episode of GHAPPcast. In this episode of GHAPPcast, nurse practitioners Patrick Horne and April Morris from discuss the complexities of identifying and managing patients with metabolic-associated steatohepatitis (MASH). They explore clinical approaches, including the use of bloodwork, family history, and advanced diagnostic tools such as FibroScan, to recognize patients at risk. Patrick and April emphasize the importance of lifestyle interventions like diet and exercise alongside new medical therapies, while also offering practical tips for clinicians on patient monitoring and treatment management. Tune in for valuable insights into managing MASH in clinical practice.
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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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PCP Screening for MASH/MASLD: Identifying At-Risk Patients
July 2025
In this episode, Jeremy Davis, NP from Gastrointestinal Specialists in Shreveport, Louisiana, discusses the vital role of primary care screening for MASLD (metabolic dysfunction-associated steatotic liver disease) and MASH (metabolic-associated steatohepatitis). With the rising prevalence of metabolic co-morbidities like type 2 diabetes, hypertension, dyslipidemia, and obesity, early identification of at-risk patients is more critical than ever. Jeremy outlines practical and evidence-based strategies for screening in the primary care setting, starting with simple tools like the FIB-4 score—which relies on common lab values—and how to interpret results to guide referrals to hepatology or GI specialists. He also discusses the downstream workup upon referral, including non-invasive tests like FibroScan, ELF score, and liver ultrasound. Treatment fundamentals such as the Mediterranean diet, physical activity, and weight loss remain the cornerstone of care, while emerging therapies like GLP-1 agonists and resmetirom offer new options for high-risk patients. Whether you’re a PCP, APP, or specialist, this episode offers clear guidance on how to incorporate MASLD screening into everyday workflows to catch liver disease early and optimize outcomes.
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Monitoring for MASLD in Type 2 Diabetes
July 2025
In this episode, Kelly Smeester, PA-C from South Denver Gastroenterology, explores the critical intersection of type 2 diabetes and metabolic dysfunction-associated steatotic liver disease (MASLD). Drawing from her background in both hepatology and endocrinology, Kelly offers practical, evidence-based strategies for non-invasive monitoring of liver fibrosis in patients with diabetes who may initially appear low risk. She highlights the utility of tools like FIB-4, ELF score, FibroScan, and MR elastography, while emphasizing the limitations of relying solely on liver function tests (LFTs). Kelly recommends annual FIB-4 screening—easily calculated with existing lab values—and discusses when to escalate to more advanced diagnostics. She also shares how advanced practice providers (APPs) can seamlessly integrate MASH education, lifestyle counseling, and routine screening into the diabetes care workflow, supporting early intervention and long-term liver health. This episode is a must-listen for clinicians looking to optimize care for patients at risk of silent liver disease progression in the setting of metabolic co-morbidities.
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Lifestyle Management With Christina Hanson
July 2025
Join Christina Hanson, NP from South Denver GI, for a practical and in-depth discussion on lifestyle management of MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) and MASH (Metabolic Steatohepatitis). In this GHAPP MASLD/MASH Community Network session, Christina walks through the case of Albert, a 65-year-old patient with obesity, diabetes, and abnormal liver findings—representing a common clinical scenario in primary and specialty care. This session highlights how to apply non-invasive fibrosis assessment tools like FIB-4 and FibroScan, interpret metabolic risk factors, and differentiate patients based on fibrosis staging. Christina discusses how cultural dietary habits, access to care, and social determinants of health impact disease management, and emphasizes the importance of personalized counseling, accountability strategies, and gradual, sustainable changes to diet and exercise. The session also reviews the role of Resmetirom, the first FDA-approved treatment for MASH with F2-F3 fibrosis, and outlines guideline-recommended lifestyle interventions including the Mediterranean diet and combined aerobic/resistance exercise. Learn how to identify, stage, and manage patients with MASLD and MASH in a way that supports long-term adherence and improves liver-related outcomes. Educational support provided by Madrigal Pharmaceuticals.
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Diet and Nutrition: Tailoring Plans for Diverse Populations
July 2025
In this quick and practical video, Miu Lai Ng, a nurse practitioner at the hepatology clinic at Tufts Medical Center in Boston, shares simple, culturally sensitive, and cost-effective dietary tips to help patients manage fatty liver disease—also known as MASH (metabolic dysfunction–associated steatohepatitis). From avoiding white-colored refined carbs like sugar, white rice, and potatoes to smart swaps like oatmeal—rich in soluble fiber and low on the glycemic index—this video emphasizes realistic changes tailored to diverse backgrounds. Miu Lai Ng also covers powerful tools for sticking with a liver-friendly diet, including food tracking apps, photo logging, meal planning tools, and the importance of social support. Plus, she highlights the hidden dangers of liquid calories found in sodas, juices, and bubble tea, which spike liver fat and cost more than you think. Whether you're supporting a patient or managing MASH yourself, this video offers actionable advice that respects both culture and budget—because small changes can lead to big results for your liver and your life.
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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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The Role of Exercise in Liver Health
July 2025
In this episode, Suzanne Robertazzi, DNP at the Washington DC VA Medical Center, discusses the vital role of exercise in liver health, especially for patients at risk of or living with MASLD (metabolic dysfunction-associated steatotic liver disease) and MASH. With a background in liver transplant care, Suzanne emphasizes the importance of tailoring exercise recommendations to each patient’s abilities, goals, and environment. She outlines practical, empathetic strategies for setting realistic fitness goals, celebrating small milestones, and integrating physical activity with nutritional counseling and behavioral support. Whether it's walking, swimming, or group classes, Suzanne explores low-cost and community-based options for promoting long-term adherence. This episode also highlights the benefits of a multidisciplinary approach, including collaboration with physical therapists, mental health professionals, and dietitians. Packed with actionable insights, this conversation is essential for healthcare providers working to empower patients with fatty liver disease through sustainable lifestyle interventions.
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APP Insight: Common Questions from Patients About MASH
June 2025
In this insightful video, Patrick Horne, NP, from the University of Florida, addresses some of the most frequently asked questions from patients diagnosed with MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease) and MASH (Metabolic Dysfunction–Associated Steatohepatitis). Drawing from his clinical experience, he answers common concerns such as: “How did I get fatty liver if I don’t drink alcohol?”, clarifying that alcohol is not a necessary factor in developing these conditions—rather, metabolic risk factors like obesity, diabetes, hypertension, and genetic predisposition play a significant role. Patrick also dives into lifestyle recommendations, including the importance of adopting a mediterranean diet, engaging in regular physical activity, and setting realistic weight loss goals. Additionally, he tackles the nuanced question of alcohol consumption in patients with MASLD/MASH, emphasizing individualized care depending on the stage of liver disease. This session is a must-watch for both patients and providers seeking practical, evidence-based guidance on managing metabolic liver disease.
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MASLD Basics With Summer Collier
July 2025
Join Summer Collier, NP from UC San Diego Health, for an essential overview of MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) in this GHAPP MASLD Community Network session. Designed for clinicians and healthcare professionals, this case-based talk covers the evolving nomenclature shift from NAFLD/NASH to MASLD/MASH, including key definitions, diagnostic criteria, and practical tools for identifying and managing patients with steatotic liver disease. Summer walks through foundational concepts like the role of hepatic steatosis, cardio-metabolic risk factors, and the importance of excluding significant alcohol use to establish a MASLD diagnosis. She also provides clinical insights into non-invasive fibrosis staging using FIB-4, FibroScan, elastography, and blood-based tests, as well as how to differentiate patients who may require hepatology referral or biopsy. Emphasizing the importance of early detection and risk stratification in primary care, this session highlights how fibrosis stage impacts prognosis, treatment planning, and long-term liver-related outcomes. For more educational sessions and MASLD tools — visit the GHAPP MASLD Community Network.
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APP Insight: Misconceptions About Liver Health
June 2025
In this video, Christina Hanson, FNP-C, from South Denver Gastroenterology, dispels common myths around liver health and highlights a critical shift in how we identify and manage fatty liver disease. With the updated terminology from NAFLD/NASH to MASLD/MASH—Metabolic Dysfunction–Associated Steatotic Liver Disease—Christina explains how the new name more accurately reflects the underlying cardiometabolic drivers of the condition, such as obesity, type 2 diabetes, hypertension, and dyslipidemia. She emphasizes that liver enzyme abnormalities or incidental imaging findings should no longer be the only triggers for evaluation. Instead, clinicians—especially in primary care and endocrinology—should proactively screen high-risk patients using non-invasive tools like FIB-4 to assess for liver fibrosis. With over 50% of patients with type 2 diabetes and up to 90% of those with morbid obesity at risk for coexisting fatty liver, early identification and triage are vital to improving outcomes. This is a must-watch for healthcare providers seeking practical, guideline-driven strategies for detecting MASLD and MASH in everyday clinical practice.
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Monitoring for MASLD in Type 2 Diabetes
July 2025
In this episode of the GHAPP MASLD podcast series, Lavinia Iordache, PA-C from the University of Miami, shares expert guidance on monitoring metabolic dysfunction-associated steatotic liver disease (MASLD) in patients with type 2 diabetes—a group at particularly high risk for disease progression. Lavinia explains the bidirectional relationship between MASLD and diabetes, highlighting the importance of early screening, timely non-invasive testing (NITs), and proactive management strategies to prevent advanced fibrosis and cirrhosis. She reviews essential tools such as FIB-4, ELF score, FibroScan, and MRI-PDFF, and offers clear recommendations on when to escalate care, refer to specialty clinics, or intensify follow-up. The discussion also covers the role of lifestyle interventions including the Mediterranean diet, intermittent fasting, exercise, and coffee consumption, as well as strategies to improve adherence despite psychosocial, cultural, or financial barriers. Lavinia emphasizes a multidisciplinary approach to managing MASLD and provides practical tips for tracking lifestyle changes, such as journaling and the use of the EDAS questionnaire. Whether you’re a GI, endocrinology, or primary care provider, this episode offers an actionable roadmap for reducing liver-related complications in patients with diabetes.
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Podcast: Role of Exercise in Liver Health
June 2025
In this engaging episode of the GHAPP MASLD/MASH Community Network podcast, Jonathan Yeh, PA at Columbia University Medical Center, discusses the essential role of exercise in liver health—especially in managing MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease) and MASH (Metabolic Dysfunction–Associated Steatohepatitis). With over 14 years of hepatology experience, Jonathan breaks down the most effective types of physical activity, highlighting the benefits of combining aerobic and resistance training over high-intensity interval training (HIIT) alone. He provides practical, personalized exercise recommendations tailored to patients’ physical abilities, access to resources, and comorbidities—including suggestions for those with mobility limitations or time constraints. Jonathan also offers motivational strategies to help patients overcome common barriers such as lack of time, motivation, or access to fitness facilities. From parking farther from a destination to lunchtime walks and home-based workouts using resistance bands, he emphasizes creative and realistic ways to build physical activity into daily routines. Beyond weight loss, he explains how exercise directly improves liver function by reducing liver fat, enhancing insulin sensitivity, and preventing fat and sugar buildup in the liver. This episode is a must-watch for clinicians and patients alike seeking to understand and implement exercise as a cornerstone in the management of fatty liver disease.
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Addressing Health Disparities: Equity Considerations in MASH/MASLD Care
July 2025
In this powerful and timely episode, Robin Soto, FNP at UC San Diego Health, explores the deep-rooted health disparities impacting patients with MASH (metabolic dysfunction-associated steatohepatitis) and MASLD (metabolic dysfunction-associated steatotic liver disease). With a focus on equity in liver care, Robin highlights the disproportionate burden of disease in Hispanic and underserved populations and the complex interplay of genetics, socioeconomic status, healthcare access, and systemic bias that drives these outcomes. She shares actionable strategies for advanced practice providers (APPs) to implement culturally sensitive communication, bias-conscious screening protocols using tools like FIB-4, NAFLD fibrosis score, and transient elastography, and how to leverage telehealth and community partnerships to bridge gaps in care. Robin also addresses the importance of culturally relevant dietary counseling, inclusive family engagement, and motivational interviewing to enhance adherence and improve long-term outcomes. Whether you're in primary care, hepatology, or community health, this episode offers a roadmap to advance health equity in the management of fatty liver disease.
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NITs: A Practical Overview: Navigating the Basics
July 2025
Join Ellie Gonyeau, a nurse practitioner at Beth Israel in Boston, for an insightful podcast episode on metabolic dysfunction-associated steatotic liver disease (MASLD) and MASH, and how to effectively use non-invasive testing (NITs) to evaluate and manage patients with fatty liver disease. Ellie breaks down the differences between MASLD and MASH—explaining why distinguishing simple steatosis from inflammatory liver injury matters for long-term outcomes. She covers first-line serum-based tools like FIB-4 and ELF score, as well as imaging-based modalities including FibroScan and MR elastography, helping clinicians understand when and how to apply each test. With practical tips on interpreting fibrosis risk thresholds, stratifying patients with metabolic comorbidities, and educating primary care teams, this episode emphasizes the power of early identification, appropriate triage, and collaborative care to prevent disease progression. Whether you're working in general GI, primary care, or hepatology, this episode equips you with tools to make liver disease detection more proactive and patient-centered.
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NITs: A Practical Overview: Navigating the Basics
July 2025
In this episode, Christie Morrison breaks down the fundamentals of non-invasive testing (NITs) for evaluating patients with fatty liver disease, including MASLD and MASH. She explains the key differences between steatosis (MASLD) and steatohepatitis (MASH), highlighting how non-invasive tests can replace liver biopsy for staging fibrosis. Christy reviews common tools like FIB-4, NAFLD fibrosis score, Enhanced Liver Fibrosis (ELF) score, transient elastography (FibroScan), and MR elastography, and outlines how to choose the right test based on patient factors such as co-morbidities, geography, access to labs, and imaging availability. The episode also emphasizes the importance of fibrosis risk stratification, interpreting FIB-4 cutoffs, and monitoring liver stiffness or ELF scores after initiating lifestyle or pharmacologic treatment—including newer therapies like resmetirom. This is a must-watch for APPs, GI clinicians, and primary care providers seeking to improve care pathways and outcomes in patients with metabolic liver disease through practical, accessible strategies for fibrosis detection and management.
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Podcast: Alcohol and MASLD/MASH: Navigating the Complex Relationship
June 2025
In this powerful and highly educational episode, Scott Springer, PA-C at Erie County Medical Center in Buffalo, NY, explores the complex and often overlooked relationship between alcohol use and metabolic dysfunction–associated steatotic liver disease (MASLD/MASH). Drawing from his dual expertise in hepatology and addiction medicine, Scott outlines the importance of accurately assessing alcohol use when diagnosing MASLD, MASH, MetALD, or ALD—emphasizing that MASLD and MASH are diagnoses of exclusion and heavily influenced by alcohol consumption thresholds. He discusses best practices for screening, including patient-centered, nonjudgmental interviewing, the use of biomarkers like PEth and urine ethyl glucuronide, and how these tools enhance accuracy and accountability in care. Scott reviews national guidelines that recommend alcohol abstinence for patients with chronic liver disease and presents data showing how even small reductions in alcohol use can significantly lower the risk of cirrhosis. He also unpacks the challenges of interpreting liver tests in patients with ongoing alcohol use, the limitations of non-invasive testing like FibroScan and FIB-4, and how alcohol may disqualify patients from emerging pharmacotherapy such as resmetirom. Finally, he highlights the promising potential of GLP-1 medications in managing both liver fibrosis and alcohol use. This episode is essential listening for hepatology providers, addiction specialists, and any clinician involved in the care of patients with coexisting liver disease and substance use disorders.
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Beyond Basic NITs: When is Liver Biopsy or Advanced Imaging
July 2025
In this episode, Brian Lam, PA, Associate Director of Research at Inova’s Liver and Obesity Research Program in Northern Virginia, explores the nuanced decision-making involved in going beyond basic non-invasive tests (NITs) for diagnosing and managing MASH (metabolic dysfunction-associated steatohepatitis). While FIB-4 and transient elastography are useful initial tools, Brian breaks down when and why clinicians should consider more advanced diagnostics—such as MR elastography (MRE), proton density fat fraction (PDFF), and in certain cases, liver biopsy. Learn how to assess the reliability of a TE exam, interpret discordant NITs, and when to escalate to cross-sectional imaging or histologic confirmation. This podcast also highlights the evolving role of fat fraction in therapy response, limitations in current FDA indications for resmetirom, and how emerging data may shape future clinical pathways for patients with compensated cirrhosis. Whether you're in primary care, GI, or hepatology, this discussion offers critical insights to improve accuracy in staging liver disease and optimizing treatment strategies for patients with MASH.
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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: Viral Hepatitis and MASH/MASLD: Understanding the Connection
June 2025
In this episode, Patrick Horne, NP from the University of Florida, explores the important connection between viral hepatitis and MASLD/MASH (Metabolic Dysfunction–Associated Steatotic Liver Disease/Steatohepatitis). While patients may present with a presumed diagnosis of MASLD or MASH, Patrick emphasizes the critical need to rule out coexisting liver diseases such as hepatitis B and C. The presence of both metabolic and viral liver diseases can significantly accelerate liver inflammation, fibrosis progression, and ultimately cirrhosis—a concept he explains using the “two-hit” or even “three-hit” theory. Patrick walks through the recommended screening protocols, including one-time HCV testing for all adults over 18 and complete HBV panels to assess for immunity, past exposure, and chronic infection. He stresses that treating viral hepatitis—especially with today's highly effective antivirals—can and should occur alongside lifestyle modification strategies for MASLD/MASH. He also discusses how liver stiffness measurements can be skewed by active inflammation and suggests reassessing fibrosis after treating viral hepatitis. This episode is a must-watch for providers managing patients with liver disease, highlighting the need for a comprehensive, layered diagnostic approach.
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How is MASH severity staged? What would an ideal MASH NIT algorithm look like?
January 2025
Thank you to Madrigal for sponsoring this FAQ Video Module. In this GHAPP FAQ Video Module, Jonathan Yeh, a physician assistant at the Center for Liver Disease and Transplantation at Columbia University Irving Medical Center, discusses advancements in diagnosing and staging metabolic dysfunction-associated steatohepatitis (MASH). He explains the transition from traditional liver biopsy to non-invasive testing methods such as FibroScan and the Enhanced Liver Fibrosis (ELF) test for assessing fibrosis stages. Jonathan highlights the use of these methods, in combination with blood tests, to provide reliable staging of fibrosis in patients with MASH. For more information, visit the GHAPP website or ACE app.
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HCC Surveillance: Implementation in Patients with Advanced Fibrosis/Cirrhosis from MASH
July 2025
In this expert-led session, Elizabeth Alqueza, PA-C, from Beth Israel Deaconess Medical Center in Boston, discusses the critical importance of hepatocellular carcinoma (HCC) surveillance in patients with steatotic liver disease, including MASLD and MASH. HCC is a leading cause of cancer-related death worldwide, and early detection is vital for improving survival outcomes. Using a real-world case study, Elizabeth highlights risk factors such as obesity, type 2 diabetes, and advanced fibrosis—and underscores the growing role of MASH in HCC development, even in the absence of cirrhosis. She outlines best practices for staging, the importance of early referral to hepatology, and AASLD-recommended surveillance protocols using ultrasound and AFP testing every 6 months. The video also explores systemic barriers to screening and actionable strategies to improve adherence, such as EMR alerts, streamlined imaging protocols, and improved coordination between primary care and hepatology. This presentation is essential viewing for healthcare professionals managing patients with liver disease, offering practical tools to enhance HCC detection and optimize long-term outcomes.
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APP Insights: Common Questions from Community GI About MASH
June 2025
In this video, Lindsay Yoder, PA-C, a hepatology expert at Indiana University in Indianapolis, addresses some of the most common questions general GI providers have about diagnosing and managing MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease) and MASH (Metabolic Dysfunction–Associated Steatohepatitis). She explains the nuance of interpreting positive autoantibodies like ANA or ASMA, emphasizing that up to 30% of patients with MASLD/MASH may have non-specific reactive antibodies that are not clinically significant for autoimmune hepatitis. Lindsay walks viewers through how to evaluate serologic workups in context—considering IGG levels, ALT trends, and symptoms like fatigue or pruritus—and when to consider liver biopsy. She also shares expert guidance on when to refer patients to hepatology, particularly those with advancing fibrosis (F2-F4) or cirrhosis. Finally, she clarifies how to distinguish between MASLD and alcohol-associated liver disease (ALD), using daily alcohol consumption levels alongside cardiometabolic risk factors to help determine whether a patient falls into a MASLD, ALD, or mixed-etiology category like MetALD. This informative session is essential viewing for clinicians navigating the evolving landscape of metabolic liver disease.
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APP Insight: 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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Alcohol and MASLD/MASH: Navigating the Complex Relationship
July 2025
In this insightful video, Jordan Mayberry, a seasoned physician assistant at UT Southwestern in Dallas, explores the complex intersection of alcohol use and metabolic-associated steatotic liver disease (MASLD), including its progressive form, MASH. With over 12 years of hepatology experience, Jordan breaks down why accurate assessment of alcohol intake is essential—not just for diagnosis but for guiding patient management. Learn how to use motivational interviewing techniques to respectfully screen for alcohol use, quantify intake effectively, and differentiate between MASLD, MASH, and the emerging diagnosis of MetALD (metabolic dysfunction-associated alcoholic liver disease). Jordan also shares practical tips on managing patients with MASH who drink above recommended thresholds, including behavioral interventions, medications like acamprosate, and referral pathways such as SMART Recovery or addiction psychiatry. The video also highlights how ongoing alcohol use can skew liver function tests (LFTs), distort non-invasive testing (NIT) results like FibroScan or MRE, and potentially affect eligibility for future MASH pharmacotherapies. This session is a must-watch for clinicians aiming to provide holistic, evidence-based care to patients navigating the dual challenges of liver disease and alcohol use.
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HCC Surveillance: Implementation in Patients with Advanced Fibrosis/Cirrhosis from MASH
July 2025
In this episode of the GHAPP MASLD Community Network podcast, Lisa Richards, a hepatology-focused nurse practitioner in San Diego, shares expert insights on hepatocellular carcinoma (HCC) surveillance for patients with advanced fibrosis and cirrhosis due to MASH (metabolic dysfunction-associated steatohepatitis). Lisa outlines which patients require routine HCC surveillance, emphasizing the importance of staging—particularly stages F3 and F4—and how AASLD guidelines guide surveillance strategies. She discusses recommended surveillance modalities, including ultrasound with AFP every six months, and introduces the LIRADS visualization score to help interpret imaging quality and follow-up needs. Lisa also addresses practical challenges in implementation, from patient education and engagement to overcoming barriers like cost, transportation, and care coordination. For advanced practice providers (APPs), this podcast delivers clear guidance on what to do when new liver lesions are detected and how to proceed with diagnostic imaging and referrals for multidisciplinary review or intervention. Empower your clinical practice with strategies that promote early detection and improve outcomes in patients at risk of HCC.
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LFTs Demystified: A Practical Guide for APPs
July 2025
In this informative session, Anthony Derencius, PA-C and sub-investigator at Pinnacle Clinical Research, provides a practical and accessible breakdown of liver function tests (LFTs) and liver-associated enzymes, with a focus on their role in diagnosing and monitoring fatty liver disease—including MASLD (metabolic dysfunction-associated steatotic liver disease) and MASH (metabolic-associated steatohepatitis). Drawing from years of experience in both general and transplant hepatology, Anthony explains how to interpret key markers like ALT, AST, alkaline phosphatase, bilirubin, albumin, and GGT. He emphasizes why elevated or even normal LFTs don’t always tell the whole story, and how a full workup—including viral hepatitis panels, autoimmune markers, alcohol-related labs, imaging, and non-invasive fibrosis assessments—can help uncover the root cause of liver injury. This video also walks viewers through when to consider additional tools like FIB-4, ELF score, FibroScan, or even liver biopsy. Whether you're a primary care provider or hepatology specialist, this session will sharpen your ability to distinguish between benign lab variations and signs of serious liver disease, ultimately supporting earlier diagnosis and better outcomes for your patients.
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PCP Screening for MASH/MASLD: Identifying At-Risk Patients
July 2025
In this essential FAQ video, Jennifer Geremia, PA-C, a seasoned gastroenterology provider practicing in Boston, outlines current primary care screening guidelines for identifying patients at risk for metabolic dysfunction-associated steatohepatitis (MASH) and MASLD. With nearly two decades of experience caring for GI and liver patients, Jennifer emphasizes the importance of integrating liver health into routine health maintenance—particularly for individuals with type 2 diabetes, obesity, metabolic syndrome, and related conditions. She reviews practical steps for risk stratification, beginning with FIB-4 scoring using readily available labs, and discusses how to interpret and act on the results, including when to refer for further testing like elastography or ELF testing. Viewers will also gain insight into patient counseling strategies, alcohol intake guidance, and the urgency of acting early—even in asymptomatic patients. This video is a must-watch for primary care clinicians aiming to improve detection and management of MASH and MASLD through evidence-based screening and timely intervention.
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APP Insight: 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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Podcast: Pharmacotherapy for MASH/MASLD: An Overview
June 2025
In this informative episode, Lindsay Yoder, PA, a hepatology expert at Indiana University, provides a comprehensive overview of current pharmacotherapy options for MASH (Metabolic Dysfunction–Associated Steatohepatitis), focusing on the first FDA-approved medication, resmetirom (brand name: Rezdiffra). Speaking directly to the MASLD/MASH Community Network, Lindsay breaks down the key histologic endpoints that led to resmetirom’s conditional approval—namely, fibrosis improvement without worsening of steatohepatitis, and MASH resolution without worsening fibrosis. She shares real-world data from clinical trials showing that resmetirom nearly doubles the rate of fibrosis improvement and triples MASH resolution compared to placebo. Lindsay also explains how the drug works: as a thyroid hormone receptor beta agonist, resmetirom improves hepatic lipid metabolism, reduces liver fat, and dampens inflammation—all key drivers of MASH progression. She outlines ideal patient criteria (stage F2–F3 fibrosis without cirrhosis), safety considerations, tolerability, potential side effects, and statin interactions. With an emphasis on combining pharmacotherapy with lifestyle changes, this episode serves as a practical guide for clinicians treating patients with MASH who qualify for advanced intervention.
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Discordant NITs, the Gray Zone
July 2025
Join Lindsay Pratt, PA-C, from the University of Colorado School of Medicine’s Hepatology and Liver Transplant Department, as she unpacks the challenges of interpreting discordant results between non-invasive liver testing tools such as FIB-4 and FibroScan in patients with MASLD and MASH. With over 15 years of clinical experience, Lindsay walks viewers through how age, transaminase levels, platelet count, and patient factors like BMI and fasting status can impact test accuracy and reliability. She emphasizes when to consider advanced diagnostics like MRI elastography (MRE) or liver biopsy, and how to tailor decisions to the individual patient, especially when results don't align. This practical session is ideal for hepatology and GI providers navigating complex liver disease management, and includes tips for communicating test limitations and next steps with patients. Learn how to make informed decisions using non-invasive tests while maintaining patient-centered care in the management of fatty liver disease.
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Lifestyle Management With Robin Soto
July 2025
Join Robin Soto, NP from UC San Diego Health, for a practical and case-based discussion on lifestyle management in patients with MASLD and MASH (Metabolic dysfunction-associated steatotic liver disease and steatohepatitis). In this presentation, Robin walks through the diagnosis and management of a representative patient case, highlighting how to assess fibrosis risk using non-invasive tools like FIB-4 and FibroScan, and emphasizing the critical role of lifestyle intervention. Learn how diet, exercise, and behavioral counseling can slow or reverse liver disease progression—especially in patients with cardiometabolic risk factors such as type 2 diabetes, obesity, and hyperlipidemia. Robin also addresses real-world barriers to dietary change, including cultural preferences, food accessibility, and socioeconomic challenges, while offering practical strategies for behavior change and patient engagement. This session is part of the GHAPP MASLD/MASH Community Network and includes educational resources on MASH and promotional information about Rezdiffra, a new treatment option for patients with advanced disease. Whether you're a hepatology provider or managing liver disease in primary care, this presentation offers essential, real-world guidance to support your clinical decision-making.
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APP Insight: Common Questions from Community GI About MASH
July 2025
In this episode, HoChong Gilles, DNP, FNP-BC, a seasoned hepatology expert and Clinical Program Director at the Central Virginia VA Health Care System, addresses a frequently asked question from primary care and community GI providers: How do you risk stratify patients without access to a FibroScan? Drawing on over 25 years of clinical experience, HoChong outlines practical strategies for assessing liver fibrosis using the FIB-4 score—a simple calculation based on patient age, ALT, AST, and platelet count. She also discusses how tools like the Enhanced Liver Fibrosis (ELF) test, available through Quest or Labcorp, can serve as valuable alternatives in the absence of elastography. Whether you're managing incidental hepatic steatosis or evaluating elevated liver enzymes, this episode offers step-by-step guidance for using non-invasive biomarkers to stratify liver disease risk and guide referrals effectively. Perfect for clinicians in primary care, GI, and hepatology seeking practical, accessible tools for early liver disease assessment.
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Lifestyle Management With Anthony Derencius
July 2025
Join Anthony Derencius, PA-C, at Pinnacle Clinical Research, for an in-depth, case-based discussion on the role of lifestyle management in MASH and MASLD. In this educational session from the GHAPP MASLD Community Network, Anthony walks through the real-world case of a 65-year-old patient with obesity, diabetes, and suspected metabolic liver disease, highlighting how to interpret non-invasive diagnostics like FIB-4 scores and transient elastography. He explains the clinical significance of metabolic risk factors, genetic predispositions (such as PNPLA3), and how personalized approaches to nutrition and exercise can alter the progression of fatty liver disease. With evidence-based insights on the Mediterranean diet, aerobic vs resistance training, and behavior change strategies, this video offers frontline strategies to support patients in reversing or slowing fibrosis. Watch to learn how providers can combine patient education, lifestyle interventions, and emerging pharmacotherapy to manage MASLD and MASH more effectively. Educational support provided by Madrigal Pharmaceuticals. For more disease state content, visit the GHAPP MASLD Community Network.
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HCC Surveillance: Implementation in Patients With Advanced Fibrosis/Cirrhosis From MASH
July 2025
Learn when and how to effectively screen for hepatocellular carcinoma (HCC) in patients at risk, especially those with metabolic dysfunction-associated steatotic liver disease (MASLD). In this informative video, Maribeth Capuno, an adult nurse practitioner at the Richmond Veterans Affairs Medical Center, shares her clinical approach to early HCC surveillance. While AASLD guidelines recommend screening only after cirrhosis has been diagnosed, Maribeth highlights the growing evidence that patients with stage 3 fibrosis can still develop liver cancer—and why she begins surveillance earlier. She discusses the recommended tools, including liver ultrasound every six months and alpha-fetoprotein testing, and explores practical workflow tips to ensure patients remain adherent. Learn how imaging modalities like MRI and CT with liver protocol, along with tools like LI-RADS and tumor board consultations, contribute to timely and accurate diagnosis. The video also emphasizes key risk factors—such as obesity, diabetes, viral hepatitis, and lifestyle behaviors—and how managing these can help prevent the progression to HCC.
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APP Insight: Misconceptions About Liver Health
June 2025
In this video, Anthony Derencius, PA-C at Pinnacle Clinical Research, clears up some of the most common misconceptions about liver health—offering valuable insights for both patients and healthcare providers. With extensive experience in hepatology, Anthony emphasizes that liver disease is often silent and asymptomatic, meaning many individuals may feel completely fine while living with a significant liver issue. He cautions against relying on a single lab result or imaging test to determine liver status, especially when assessing for conditions like cirrhosis, and stresses the importance of confirming findings through multiple diagnostic tools over time. Anthony also highlights the need for proactive screening, particularly in patients with risk factors such as obesity, diabetes, or a family history of liver disease. Early detection is key, and he encourages patients to advocate for their liver health by seeking evaluation—even if their provider hasn’t suggested it. This is a must-watch for anyone aiming to better understand the complexities of liver disease and the importance of early and accurate diagnosis.
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APP Insight: Misconceptions About Liver Health
June 2025
In this video, Kelly Smeester, PA-C from South Denver Gastroenterology, addresses some of the most common and harmful misconceptions about liver health. One major myth she tackles is the belief that liver disease only affects those who drink excessive amounts of alcohol. Kelly explains that liver disease has many causes—including autoimmune conditions, viral infections, and metabolic dysfunction—meaning even individuals who don’t drink at all may still be at risk. She emphasizes the dangers of relying on unregulated “liver detox” supplements, clarifying that the liver is a natural detox organ and doesn’t require external cleanses, which may actually do more harm than good. Kelly also highlights how liver disease can be entirely asymptomatic, particularly in patients with conditions like type 2 diabetes, obesity, hypertension, and high cholesterol. Finally, she reinforces that cirrhosis is not solely alcohol-related and can result from steatotic liver disease, making regular liver evaluations and screenings crucial for early detection and management. This video is an essential resource for patients and providers aiming to better understand liver health beyond outdated myths.
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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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Lifestyle Management With Michelle Barnett
July 2025
Join Michelle Barnett, PA-C, for an in-depth clinical case presentation as part of the GHAPP MASLD Community Network. With over 25 years of experience in GI and hepatology, Michelle walks through the real-world management of Albert, a 65-year-old patient newly diagnosed with MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease). In this session, she outlines key diagnostic criteria, the role of non-invasive tests (NITs) like FIB-4 and FibroScan, and how to risk-stratify patients using updated care pathways. Learn how to differentiate low-, moderate-, and high-risk cases and when to refer for hepatology evaluation or consider biopsy. Michelle also explores the clinical role of Resmetirom—the first FDA-approved medication for patients with MASH and F2-F3 fibrosis—and emphasizes the importance of sustained lifestyle modification, dietary change, and exercise in liver disease management. This expert discussion includes cultural and socioeconomic considerations, adherence strategies, and patient tools like the Exercise and Diet Adherence Scale. Visit the GHAPP MASLD Community Network for more resources, disease-state education, and updates on the evolving care landscape. Educational content supported by Madrigal Pharmaceuticals.
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APP Insight: Common Questions from Primary Care Providers About MASH
June 2025
In this informative video, Michelle Barnett, PA-C, a hepatology expert based in Colorado Springs, answers frequently asked questions about elevated liver enzymes in the context of MASH (Metabolic Dysfunction–Associated Steatohepatitis) and MASLD (Metabolic Dysfunction–Associated Steatotic Liver Disease). She breaks down how to interpret common liver enzyme patterns—such as ALT greater than AST versus AST greater than ALT—and what these patterns may indicate, from MASH to alcohol-related liver disease and other potential causes like autoimmune hepatitis or drug-induced liver injury. Michelle outlines how to perform a thorough workup, including patient history, medication review, and physical exam findings, and emphasizes the importance of using tools like FIB-4 and abdominal ultrasound to assess for fibrosis and portal hypertension. The discussion also covers the clinical value of GGT, alkaline phosphatase, bilirubin, albumin, and platelets in evaluating liver function. Michelle shares practical guidance on when to refer patients to hepatology and how to monitor liver enzymes over time, particularly in those undergoing lifestyle changes or pharmacologic treatment. This comprehensive Q&A is an essential resource for providers managing patients with suspected or confirmed metabolic liver disease.
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MASH Bootcamp Q&A
March 2025
In this interactive Q&A session, a panel of liver disease experts discusses key challenges in diagnosing and treating metabolic dysfunction-associated steatohepatitis (MASH) using non-invasive testing and the latest therapeutic advancements. The panel explores the role of FibroScan, ELF scores, and cardiometabolic risk factors in diagnosing fibrosis, especially in patients with limited access to MRI or VCTE-based assessments. They also discuss how serologic testing can be a viable alternative in resource-limited settings and when a liver biopsy may not be necessary for diagnosis. The discussion highlights the FDA approval criteria for Resmetirom, its limitations in F4 patients, and practical strategies for determining treatment eligibility. The experts address real-world challenges, including diagnosing MASH in rural areas, evaluating confounding factors in fibrosis assessment, and ensuring comprehensive liver disease workups to rule out autoimmune conditions.
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