Podcasts about liver diseases aasld

In this episode, Patricia D. Jones, MD, MSCR; Mindie H. Nguyen, MD, MAS, AGAF, FAASLD; and patient advocate, Jennifer Wild, MS, RN, OCN, discuss practical strategies to overcome barriers to hepatitis B virus (HBV) care, including: Overcoming health insurance navigation Improving access to HBV care in immigrant communitiesDispelling HBV myths and stigmaSolutions to language barriersCommunity-based interventionsPresenters:Patricia D. Jones, MD, MSCRAssociate Professor of Clinical MedicineDirector of Clinical Operations-HepatologyDivision of Digestive Health and Liver DiseasesDepartment of MedicineUniversity of Miami Miller School of MedicineSylvester Comprehensive Cancer CenterMiami, FloridaMindie H. Nguyen, MD, MAS, AGAF, FAASLDProfessor of Medicine (GI & Hepatology,Liver Transplant)Professor of Epidemiology & Population Health(by Courtesy)Director of Hepatology ClerkshipFaculty Search LENS Advocates,Stanford Department of MedicineFaculty Fellow, Stanford Center for Innovationin Global HealthMember, Stanford Cancer Institute, Maternal &Child Health Research Institute, & Stanford Bio-CStanford, CaliforniaPast Chair: HBV SIG, The American Association for the Study of Liver Diseases (AASLD)28th President: The International Association for the Study of the Liver (IASL)Jennifer Wild, MS, RN, OCNClinical Nurse – GI Medical OncologyUCSF Cancer CenterSan Francsico, CaliforniaLink to full program: https://bit.ly/4j973TNDownloadable slides: https://bit.ly/3WQkIWlGet access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify.

Drs Carol H. Wysham and Scott Isaacs discuss incorporating the screening and management of metabolic dysfunction–associated steatotic liver disease in endocrine practice. Relevant disclosures can be found with the episode show notes on Medscape https://www.medscape.com/viewarticle/1002045. The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Type 2 Diabetes Mellitus https://emedicine.medscape.com/article/117853-overview Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): A State-of-the-Art Review https://pubmed.ncbi.nlm.nih.gov/37700494/ Fibrosis-4 (FIB-4) Calculator https://www.hepatitisc.uw.edu/page/clinical-calculators/fib-4 Liver Fibrosis Assessment: MR and US Elastography https://pubmed.ncbi.nlm.nih.gov/34687329/ Using the FIB-4, Automatically Calculated, Followed by the ELF Test in Second Line to Screen Primary Care Patients for Liver Disease https://pubmed.ncbi.nlm.nih.gov/38806580/ American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings: Co-Sponsored by the American Association for the Study of Liver Diseases (AASLD) https://pubmed.ncbi.nlm.nih.gov/35569886/ Mediterranean Diet and Nonalcoholic Fatty Liver Disease https://pubmed.ncbi.nlm.nih.gov/29785077/ Drug Treatment for Metabolic Dysfunction-Associated Steatotic Liver Disease: Progress and Direction https://pubmed.ncbi.nlm.nih.gov/39470028/ Current Status of Glucagon-Like Peptide-1 Receptor Agonists in Metabolic Dysfunction-Associated Steatotic Liver Disease: A Clinical Perspective https://pubmed.ncbi.nlm.nih.gov/39801787/ Sodium-Glucose Transport Protein 2 (SGLT2) Inhibitors https://www.ncbi.nlm.nih.gov/books/NBK576405/ Update on the Applications and Limitations of Alpha-Fetoprotein for Hepatocellular Carcinoma https://pubmed.ncbi.nlm.nih.gov/35110946/

In this episode, Patricia D. Jones, MD, MSCR; Mindie H. Nguyen, MD, MAS, AGAF, FAASLD; and patient advocate, Jennifer Wild, MS, RN, OCN, discuss best practices in hepatitis B virus (HBV) care, including: 2023 CDC HBV screening recommendationsSummary of guideline recommendations for hepatitis delta virus (HDV) screening Use of HDV reflex testing to avoid loss to follow-up2024 WHO HBV treatment recommendations, including recommendations for pregnant persons Presenters:Patricia D. Jones, MD, MSCRAssociate Professor of Clinical MedicineDirector of Clinical Operations-HepatologyDivision of Digestive Health and Liver DiseasesDepartment of MedicineUniversity of Miami Miller School of MedicineSylvester Comprehensive Cancer CenterMiami, FloridaMindie H. Nguyen, MD, MAS, AGAF, FAASLDProfessor of Medicine (GI & Hepatology,Liver Transplant)Professor of Epidemiology & Population Health(by Courtesy)Director of Hepatology ClerkshipFaculty Search LENS Advocates,Stanford Department of MedicineFaculty Fellow, Stanford Center for Innovationin Global HealthMember, Stanford Cancer Institute, Maternal &Child Health Research Institute, & Stanford Bio-CStanford, CaliforniaPast Chair: HBV SIG, The American Association for the Study of Liver Diseases (AASLD)28th President: The International Association for the Study of the Liver (IASL)Jennifer Wild, MS, RN, OCNClinical Nurse – GI Medical OncologyUCSF Cancer CenterSan Francsico, CaliforniaLink to full program: https://bit.ly/4j973TNDownloadable slides: https://bit.ly/3WQkIWlGet access to all of our new podcasts by subscribing to the CCO Infectious Disease Podcast on Apple Podcasts, Google Podcasts, or Spotify.

On this episode, we review the 2023 Hepatitis C Guidance that was recently published by the Infectious Diseases Society of America (IDSA) and the American Association for the Study of Liver Diseases (AASLD). We discuss the pre-treatment work-up, various treatment options, and drug-drug interactions/clinical pearls for the most commonly used direct-acting antivirals.  Cole and I are happy to share that our listeners can claim ACPE-accredited continuing education for listening to this podcast episode! We have continued to partner with freeCE.com to provide listeners with the opportunity to claim 1-hour of continuing education credit for select episodes. For existing Unlimited (Gold) freeCE members, this CE option is included in your membership benefits at no additional cost! A password, which will be given at some point during this episode, is required to access the post-activity test. To earn credit for this episode, visit the following link below to go to freeCE's website: https://www.freece.com/ If you're not currently a freeCE member, we definitely suggest you explore all the benefits of their Unlimited Membership on their website and earn CE for listening to this podcast. Thanks for listening! We want to give a big thanks to our sponsor, High-Powered Medicine. HPM is a book/website database of summaries for over 150 landmark clinical trials. You can get a copy of HPM, written by Dr. Alex Poppen, PharmD, at the links below:  Purchase a subscription or PDF copy - https://highpoweredmedicine.com/ Purchase the paperback and hardcover - Barnes and Noble website We want to give a big thanks to our main sponsor Pyrls. Try out their drug information app today. Visit the website below for a free trial: www.pyrls.com/corconsultrx If you want to support the podcast, check out our Patreon account. Subscribers will have access to all previous and new pharmacotherapy lectures as well as downloadable PowerPoint slides for each lecture. You can find our account at the website below:  www.patreon.com/corconsultrx If you have any questions for Cole or me, reach out to us on any of the following: Text - 415-943-6116 Mike - mcorvino@corconsultrx.com Cole - cswanson@corconsultrx.com Instagram and other social media platforms - @corconsultrx  This podcast reviews current evidence-based medicine and pharmacy treatment options. This podcast is intended to be used for educational purposes only and is intended for healthcare professionals and students. This podcast is not for patients and not intended as advice or treatment.

During the 2023 American Association of the Study of Liver Diseases (AASLD) conference, exciting and important results from many primary biliary cholangitis (PBC) clinical trials were reported, including 3 late-breaking studies on the PPAR-delta agonist seladelpar, the dual PPAR agonist elafibranor, and the combination of the FXR agonist obeticholic acid and a fibrate.In this episode, Stuart C. Gordon, MD, FAASLD, discusses topline results from one of these late-breaking studies and more, including: A phase III study of an investigational PPAR-delta agonist (seladelpar) in people with PBC who had failed to respond to ursodeoxycholic acidA study that explored racial differences as they relate to the presentation and diagnosis of PBCPresenter: Stuart C. Gordon, MD, FAASLDDirector of HepatologyHenry Ford Health SystemProfessor of MedicineWayne State University School of MedicineDetroit, MichiganLink to commentary:https://bit.ly/3GzRMt2Link to reviews of other PBC studies from AASLD 2023:https://bit.ly/3RvXXEI

During the 2023 American Association of the Study of Liver Diseases (AASLD) conference, exciting and important results from many primary biliary cholangitis (PBC) clinical trials were reported, including 3 late-breaking studies on the PPAR-delta agonist seladelpar, the dual PPAR agonist elafibranor, and the combination of the FXR agonist obeticholic acid and a fibrate.In this episode, Marlyn J. Mayo, MD, discusses topline results from several of these studies and more, including: A phase III study of an investigational dual PPAR α/δ agonist (elafibranor) in people with PBC who did not respond to or were intolerant of ursodeoxycholic acid (UDCA)A study that evaluated the effectiveness and safety of second-line therapy in PBC where obeticholic acid with or without a fibrate was added to the treatment regimen of people with PBC with an incomplete response to UDCAA retrospective review of the rates of hyperlipidemia, atherosclerosis, and/or hepatic steatosis in patients with PBCPresenter: Marlyn J. Mayo, MDProfessor of Internal MedicineDivision of Digestive & Liver DiseasesUT Southwestern Medical CenterDallas, TexasLink to commentary:https://bit.ly/47PmGdcLink to reviews of other PBC studies from AASLD 2023: https://bit.ly/3RvXXEI

In this episode, we interview two guests, Dr. Guadalupe Garcia Tsao and Dr. Andrew Yu. Dr. Yu is the Emory transplant Hepatology fellow currently. We discuss the Baveno VII guidelines on Portal Hypertension and some major takeaways from #TLM or the American Association for the Study of Liver Diseases (AASLD) meeting in Washington D.C.  Dr. Guadalupe Garcia Tsao is a Professor of Medicine at Yale University School of Medicine and Chief of Digestive Diseases at the VA-Connecticut Healthcare System. She also serves as director of the Clinical Core of the NIH-funded Yale Liver Center and is the Associate Editor of the New England Journal of Medicine. She was president of AASLD in 2012.   FIB4+ Scoring Algorithm - http://fib4plus.com/ Host: Dr. Chuma Obineme (GI Fellow) –  https://twitter.com/TypicallySilent    Co-Host: Jason Brown - https://med.emory.edu/directory/profile/?u=JMBROW2    Guest: Guadalupe Garcia-Tsao - https://twitter.com/ggarciatsao https://medicine.yale.edu/profile/guadalupe-garcia-tsao/   Guest: Andrew Yu - https://twitter.com/michaelandrewyu   Link to Review: https://www.sciencedirect.com/science/article/pii/S0168827821022996   Link to Emorid Digest visual Summary: https://med.emory.edu/departments/medicine/_documents/yu-preventing-decompensation-in-cirrhosis-tips-from-baveno-vii.pdf   Link to Emoroid Digest Website: https://med.emory.edu/departments/medicine/divisions/digestive-diseases/education/emoroid-digest.html  

Recorded onsite in Washington DC, Scott Friedman, Jörn Schattenberg, Rachel Zayas and Roger Green discuss takeaways from the first three days at the 73rd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD). The group encapsulates the dynamic, vibrant energy of returning to this momentous event which welcomed back over 7,000 in-person attendees.Jörn starts this conversation by introducing a paper titled, The Effect of a Dual Receptor Glucagon-Like Peptide-1 and Glucagon Agonist, Cotadutide, on Serum Metabolome in Biopsy-Proven Non-Cirrhotic NASH with Fibrosis. He describes Cotadutide followed by the study design which added metabolomic analyses to more standard liver NITs. Serum metabolomics is an emerging non-invasive tool that may identify novel biomarkers for disease stratification and treatment efficacy. Jörn advocates for drug developers to consider adding metabolomic assessments to clinical trials.Scott shifts focus to note that while our community is liver-centric, Fatty Liver disease is complex and therapies can affect other organs. He wonders how the benefit of these therapies may accrue from effects outside the liver, particularly muscle and adipose tissues. Rachel cautions that emerging gene therapies ought to evaluate the potential off target effects that might be introduced by silencing a gene expression in the liver. In agreement, Scott aptly responds that gene therapy has arrived. In an example from the COVID-19 pandemic, he highlights the development of finely tuned lipid nanoparticle carriers. Roger suggests there is considerable value in the approach of finding a solution, fixing the problem and then figuring out what happened.The group continues on to discuss an abstract presented by Amrik Shah titled, Histologic Endpoints in NASH Clinical Trials: The Emperor Has No Clothes. This paper evaluated the effects of the imprecision of histologic reading and the consequent effects in therapeutic trials. Scott asserts the need for digital pathologies to enter the mainstream as endpoints in clinical trials. This sparks comments around Arun Sanyal's redefinition of the REGENERATE data in Late Breaking Oral Abstract, Session 2. As the session winds down, Scott notes the licensing board in the US is no longer requiring liver biopsy as part of gastroenterology or liver training. “People are voting with their feet whether someone wants a claim to biopsy or not. It's only a matter of a generation.” 

Recorded onsite in Washington DC, Scott Friedman, Jörn Schattenberg, Rachel Zayas and Roger Green discuss takeaways from the first three days at the 73rd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD). The group encapsulates the dynamic, vibrant energy of returning to this momentous event which welcomed back over 7,000 in-person attendees.In this conversation, Rachel injects fascinating new considerations to the podcast through her lens from the microbiome. She begins by highlighting a poster presented by Curtis Gabriel. The study, titled Diabetic Persons with HIV and Hepatic Steatosis Have Reduced Intestinal Microbial Diversity, links intestinal dysbiosis and hepatic steatosis in patients with HIV. Rachel notes the topic to be compelling yet underexplored. Her curiosity questions, what does the normal microbiome look like initially and how does this change over time? Scott suggests society-wide changes in our food and use of antibiotics are important indices to investigate. Discussion digresses to other related phenomena as antibiotics are not the only agent society has introduced to ecosystems.Scott distills what he determined to be an eye-opening theme of the meeting in saying, “the Devil is in the details.” He describes himself as always looking to reduce complex topics to main, big picture themes. Contrarily, this meeting made clear to him how complex NAFL-D really is. He regards the complexities and differences in cell backgrounds, microbiota and treatment patterns as components of a longer-term challenge. Despite this challenge, he is confident the disease will yield to therapies incrementally and effectively.NAFLD is noted to be a complex disease with a set of interrelated issues. Scott provides several examples of this, including Stephen Harrison's presentation on a fatty acid synthase inhibitor (discussed in a later conversation). Jörn points out that a drug does not have to affect every key target to have an impact on the disease. This leads Rachel to ask in addition to what is driving disease, what are the protective mechanisms? Do they lie in epigenetics? Scott concurs and provides an example based on hyperlipidemia and the PCSK9 class. As this session winds down, Roger comments that we might not need to know exactly why an agent or therapeutic approach works to know that it does work. Instead, we can expect to solve the why as reverse engineers.

In an insight-laden conversation recorded on site from Washington DC, Scott Friedman, Jörn Schattenberg, Rachel Zayas and Roger Green discuss takeaways from the first three days at the 73rd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD). The group encapsulates the dynamic, vibrant energy of returning to this momentous event in person:Scott illustrates how progress in the field of Fatty Liver is more a journey of many milestones and not an all-in-one blockbuster conclusion.Rachel injects fascinating new considerations to the podcast through her lens from the microbiome.Jörn investigates the mechanistic components of compelling research stories emerging from this conference.Stay tuned and surf on for the full coverage!

In a follow-up preview, Jörn Schattenberg, Louise Campbell, Mazen Noureddin, Ian Rowe and patient advocate Jeff McIntyre join Roger Green to discuss key presentations and posters of interest at the 73rd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD). On November 4th-8th in Washington DC, as many as 10,000 attendees will convene in an effort to advance and disseminate the science and practice of hepatology, and to promote liver health and quality patient care. Ian leads with a reference to the preceding conversation on a poster that describes ways to utilize AI or other analytics of items in basic medical charts to predict NAFLD. He endorses the idea of putting as few barriers in the way of primary care as possible, speaking to FIB-4 as an excellent front-line tool for primary care initial triage. He discusses the value of BMI as being a superior predictor to more complex measures and recalls Stephen Harrison's KISS principle as a goal. He notes that patients will be referred for obesity if their BMIs are high enough regardless of whether they exhibit proven NAFLD. Next, he describes the process the NHS used in the UK to select reimbursed programs. He suggests that while there are questions regarding diet and rate of weight loss relevant to the Fatty Liver community, patients with obesity should be treated for weight loss as a simple solution. From here the other panelists provide final thoughts and closing comments on what the field can do to drive NAFLD care and screening to primary care providers. Surf on for their response, and stay tuned for more 2022 AASLD coverage.

In a follow-up preview, Jörn Schattenberg, Louise Campbell, Mazen Noureddin, Ian Rowe and patient advocate Jeff McIntyre join Roger Green to discuss key presentations and posters of interest at the 73rd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD). On November 4th-8th in Washington DC, as many as 10,000 attendees will convene in an effort to advance and disseminate the science and practice of hepatology, and to promote liver health and quality patient care. Continuing from the previous conversation, Roger starts by questioning what the right long-term commercial model for remote patient wellness management companies might be. He recalls the early successes of Jenny Craig or Nutrisystem, achieved from selling food and Weight Watchers by branding other companies' white-or black-labled food products. Is there the potential for these companies to marry strong coaching to services offering high-quality, pre-cooked foods for an integrated offering? Jeff agrees and refers to his own experience working with groups on medically-tailored meals. He briefly notes the push he sees to get these meals paid for by Medicare or private insurers. Louise mentions that the kinds of programs described exist at Safari parks as part of a full-wellness program for the animals. From a different perspective, she notes the importance of patient volition in program success and that volitional assessments are not included in trial design. The app Tawazun Health recently launched adds a volitional element. Roger returns to a comment made in the first preview episode.  He had talked about finding improved primary care screening tools that might serve a dual purpose by also educating front-line providers how NAFLD often sits at the core of the galaxy of metabolic diseases. Two abstracts for posters are described that address this issue. The first of which is a meta-analysis of 121,975 patients. This study looked at significance of the odds and hazard ratios of the TyG index, computed based on triglyceride and glucose levels. It also investigated the ability over time for that ratio to predict disease. All results were highly significant and clinically meaningful. The second poster  is titled Performance of Artificial Intelligence Enabled Electrocardiogram and the Prediction of Fatty Liver Disease. This paper showed that an AI analysis of ECG results based on a convolutional neural network produced an area under the curve far superior to FIB-4. It also showed to be superior or equal to BMI and simple metabolic parameters. Roger's general point: using these metrics can improve on FIB-4 while, at the same time, focusing on the links between NAFLD and other metabolic diseases. As the conversation winds down, Mazen and Jörn agree with a few additional comments.

In a follow-up preview, Jörn Schattenberg, Louise Campbell, Mazen Noureddin, Ian Rowe and patient advocate Jeff McIntyre join Roger Green to discuss key presentations and posters of interest at the 73rd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD). On November 4th-8th in Washington DC, as many as 10,000 attendees will convene in an effort to advance and disseminate the science and practice of hepatology, and to promote liver health and quality patient care.This conversation focuses on a presentation by Laurent Castera from Parallel Session 33 on Monday afternoon. The abstract looks to validate and compare head-to-head the FASTTM, MAST, and MEFIB scores as well as FIB-4 and NAFLD fibrosis score in a large cohort of T2D patients with NAFLD. Mazen points out that while the paper compares the various tests, the key is to ask which test is best for each specific purpose. In general, these results show that MAST and FAST perform better than the other three tests in terms of area under curve. Results also indicate that MAST has an indeterminate range of around 20%, as compared to 44% for FAST and MEFIB. The latter result suggests to Mazen that the researcher will need fewer biopsies to classify patients using MAST and MAST should score better on true classifications. Roger refers to last week's discussion around which test to use at different points in the patient screening process. Mazen notes that while he has concerns with FIB-4, it remains as one of the best primary test options today. He repeats Stephen Harrison's question from last week on whether we should start primary screening with FibroScan instead of FIB-4.As the session ends, Jörn suggests that the discussion on best clinical use will continue. He notes that the goal of this paper is to contribute to discussion around the value of each test, ‘the true task of academia.'

In a follow-up preview, Jörn Schattenberg, Louise Campbell, Mazen Noureddin, Ian Rowe and patient advocate Jeff McIntyre join Roger Green to discuss key presentations and posters of interest at the 73rd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD). On November 4th-8th in Washington DC, as many as 10,000 attendees will convene in an effort to advance and disseminate the science and practice of hepatology, and to promote liver health and quality patient care.Jörn starts this conversation by noting his anticipation for Parallel 12: NASH therapeutics and OMICs. Specifically, he points to an abstract titled Novel Mobile Health Delivered Lifestyle Intervention Program (Noom Health Weight) in Patients with NASH: a randomized controlled proof of concept study. This is a small trial in patients with NASH and obesity. The study sought to measure weight loss alongside weekly engagement with the Noom Healthy Weight app. 70% of patients met the engagement goal and lost an average of 5.3 kg over 16 weeks. Patients undergoing a more typical lifestyle management lost an average of 1 kg. Jeff joins to highlight the potential of a remote technology to generate 70% weekly engagement. He also finds this data promising in terms of providing a program that patients can use to measure health and manage fatty liver disease. By contrast, Jeff discusses recent conversations with a patient recently diagnosed with NAFLD who was not maintaining successful self-management due to obscurity of direction. Roger cautions that while this trial reported “no adverse event,” it consisted of a small sample size and short study duration. He also raises questions around the commercial model buttressing this study: who is paying and for how long can they maintain motivation? He envisions a more viable approach will be supported by commercial payers, who in return are investing in health care data. Given this may take some time to play out, Roger casts a third suggestion: FDA-approved digital therapeutic apps. He predicts this to be fertile grounds for patient empowerment over the next few years.As this session winds down, Jeff responds to several of Roger's comments and notes the turbulent impact of a pandemic on participation in wellness apps. This topic extends into the next conversation.

In a follow-up preview, Jörn Schattenberg, Louise Campbell, Mazen Noureddin, Ian Rowe and patient advocate Jeff McIntyre join Roger Green to discuss key presentations and posters of interest at the 73rd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD). On November 4th-8th in Washington DC, as many as 10,000 attendees will convene in an effort to advance and disseminate the science and practice of hepatology, and to promote liver health and quality patient care.Louise leads this conversation with commentary carrying over from last week's discussion on FibroScan as an essential test. Her hope remains that FibroScan be utilized in the early screening process, noting that many patients with poor liver health are still captured much too late in the process. She agrees with the consensus that, while imperfect, FIB-4 currently has the potential to improve patient capture rates. Mazen follows up with a comment on the nature of PPV being highly subjective to both test accuracy and patient population.Ian suggests that some of the preceding conversation anchors performance of these tests to biopsy. Interested in moving beyond biopsy, he points out presentations which compare outcomes of patients according to either biopsy or associated noninvasive tests. The first paper he notes is titled Prognostic Value of Non-Invasive Tests in Patients with NAFLD. This study looks at outcomes for 1,700 patients with various non-invasive tests and demonstrates the value of each in predicting outcomes. Ian explains the conclusion is that NITs should be accepted as surrogate tests for clinical trials. He then looks at a presentation by Samer Gawrieh which correlates VCTE values with progression to cirrhosis and clinical events. He believes this to be the direction in which the field should move.Mazen agrees with the idea that as data accumulates around NITs, we can better understand how longitudinal changes impact outcomes. He then briefly describes other presentations and posters at this meeting that address similar topics. His final comments describe the FDA's interest in NITs: how do we give meaning to improvements in the efficacy of NITS and how do these improvements translate into better outcomes.

In a follow-up preview, Jörn Schattenberg, Louise Campbell, Mazen Noureddin, Ian Rowe and patient advocate Jeff McIntyre join Roger Green to discuss key presentations and posters of interest at the 73rd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD). On November 4th-8th in Washington DC, as many as 10,000 attendees will convene in an effort to advance and disseminate the science and practice of hepatology, and to promote liver health and quality patient care.Mazen begins by highlighting a presentation by Laurent Castera which covers an abstract the two collaborated on. The paper looks to validate and compare head-to-head the FASTTM, MAST, and MEFIB scores as well as FIB-4 and NAFLD fibrosis score in a large cohort of T2D patients with NAFLD. Roger notes last week's discussion on use of FIB-4 as a primary screening tool, commending its performance in NPV but not PPV. He suggests this study offers a way forward for an enriched population who would benefit from a test offering high PPV and a narrow indeterminate zone. Jörn and Louise respond with their thoughts on FIB-4 as a cheap, accessible tool for primary care. Their analysis aligns with a conclusion from last week's preview: FIB-4 is not a tool for the specialist's office but, instead for primary care practices conducting first-line screening.Ian suggests some of the preceding conversation anchors performance of these tests to biopsy. Interested in moving beyond biopsy, he points out presentations which compare outcomes of patients according to either biopsy or associated noninvasive tests. The first paper investigates whether screening for advanced fibrosis in the community can identify the subgroup of people with NAFLD at higher risk for development of liver-related complications. The study aimed to determine the prognostic value of baseline noninvasive fibrosis tests for predicting liver-related outcomes and mortality in patients with NAFLD from T2D clinics or primary care. Ian then looks at a presentation by Samer Gawrieh which provides data on progression. Mazen agrees with the idea that as data accumulates around NITs, we can better understand how longitudinal changes impact outcomes.Jörn highlights his anticipation for Parallel 12: NASH therapeutics and OMICs. He specifically points to a presentation by Jonathan Stine on answering an unmet need to develop effective lifestyle intervention programs. This randomized proof of concept trial evaluates the feasibility, acceptability and safety of a novel commercially available mobile health app. This topic immediately resonates with Jeff, who is encouraged by two elements: the development of remote personalized technologies and the resulting patient empowerment. Roger raises questions around the commercial model buttressing this study: who is paying and for how long can they maintain motivation? He envisions a more viable approach will be supported by commercial payers, who in return are investing in health care data. Given this may take some time to play out, Roger casts a third suggestion: FDA-approved digital therapeutic apps. He predicts this to be fertile grounds for patient empowerment over the next few years. After some back and forth with Jeff, Roger shifts focus to his interest in posters on primary care screening and the metabolic-NAFLD link. Mazen shares his enthusiasm for the potential of machine learning to ensure accuracy in the use of NITs.As time winds down, the panelists provide closing comments touching on a number of topics. It's noted that this data-rich, insight-laden conference will host a dynamic inclusion of presentations on therapeutics, drug development and solutions deployed to market. Stay tuned for the upcoming live recorded coverage from Washington DC.

The 73rd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD) takes place on November 4th-8th in Washington DC. As many as 10,000 attendees will convene in an effort to advance and disseminate the science and practice of hepatology, and to promote liver health and quality patient care. Key Opinion Leaders Stephen Harrison, Jörn Schattenberg and patient advocate Jeff McIntyre join Roger Green to preview key presentations and posters of interest.This conversation continues from the theme that NAFLD is not a disease of affluence. Roger notes data from Zobair Younossi which reveals extremely high rates of NAFLD in the Middle East and North Africa region - a region recognized for the wealth of its residents. Jeff connects this prevalence to growth in easy-to-access, overprocessed, low nutrition foods. “If anything, it is not a question of ease of access, but which foods are easy to access.” He is enthusiastic that with the possibility of earlier diagnosis in identifying F2 patients, earlier intervention can follow.Jörn suggests another issue that might help: NAFLD is a precursor to hepatic cell carcinoma (HCC). For many patients, HCC comes before progression to cirrhosis. Roger expands this observation, noting NAFLD to be a predictor of a range of non-liver cancers in addition. Stephen expresses the need to draw attention to treating Fatty Liver, which is the “canary in the metabolic dysregulation coal mine.” He says that if all we do is raise awareness of the need to treat, we have accomplished quite a lot.Roger briefly references posters that take innovative looks at how to create inexpensive, widely available screening through tests and/or analysis of medical records. At the end, he invites everyone back next week to discuss more of the presentations and this data-rich, insight-laden conference. The closing question explores one important thought about the meeting each panelist wants to raise before the next preview discussion. 

The 73rd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD) takes place on November 4th-8th in Washington DC. As many as 10,000 attendees will convene in an effort to advance and disseminate the science and practice of hepatology, and to promote liver health and quality patient care. Key Opinion Leaders Stephen Harrison, Jörn Schattenberg and patient advocate Jeff McIntyre join Roger Green to preview key presentations and posters of interest.This conversation starts with Stephen's comments on the presentation covering fibrosis progression rates for diabetic vs. non-diabetic patients with biopsy-proven NAFLD. Stephen says it highlights important elements of the diabetes population, who are known to have significantly higher rates of NASH and fibrosis. This study demonstrates faster progression rates for this population. He makes two notes of interest: First, this is a relatively young population. Second, while the mean BMI is clearly obese at 34, it is lower than many patients seen by hepatologists in clinic. He suggests that older patients with progressed obesity might demonstrate more dramatic results. In closing, he wonders whether duration or severity of diabetes impacts the speed of fibrosis progression. Focus shifts to papers and presentations identified by Jeff McIntyre. He notes two items, the first of which is Donna Cryer's Patient Keynote address titled, Liver Health Equity: Overcoming Stigma, Access and Policy Barriers. Jeff comments that stigma, access and policy barriers are themes that actually run through the entire agenda. He cites a range of issues that reflect on challenges facing health equity, but also overall patient care and support. For example, he mentions the broadened use of NITs. He also points specifically to a session called Liver and Queer, an introduction to the AASLD LGBTQ task force.With Louise Campbell absent, Roger looks to Jörn for a response to challenges facing health equity. Jörn states, “NAFLD has inequality written all over it,” citing far reaching factors including food distribution, access to care and green spaces where people feel safe while exercising. He looks forward to Donna discussing how to overcome these issues from a patient advocacy perspective. Finally, Jeff and Jörn agree on two public perceptions that need to be addressed: NAFLD as a disease of affluence and food issues standing somewhat independent of health.

The 73rd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD) takes place on November 4th-8th in Washington DC. As many as 10,000 attendees will convene in an effort to advance and disseminate the science and practice of hepatology, and to promote liver health and quality patient care. Key Opinion Leaders Stephen Harrison, Jörn Schattenberg and patient advocate Jeff McIntyre join Roger Green to preview key presentations and posters of interest.The preceding conversation finished with Jörn discussing the proper use for FIB-4 (in referral pathways) and the improper use (in specialty practices and clinics). This conversation picks up with Jörn listing tests he prefers in his clinic: MRE and FAST. Stephen notes that many guidelines recommend FIB-4 followed by FAST. He asks, why not start with both and improve our ability to identify patients who need therapy? Roger responds by mentioning a poster from Mayo Clinic (#2309, Performance of AGA Clinical Care Pathway for the Risk Stratification of Patients with NAFLD in the US population). The poster suggests defining the AGA guidelines so that only patients with Type 2 diabetes and FIB-4 >1.3 would reduce the number of scans by almost 10 million, or 70% of demand. This would not significantly affect how many patients are missed. The group agrees this is a good approach in specialty practices, but probably not easy to implement or cost-effective in primary care.Jörn shifts focus to Daniel Huang's presentation at Sunday's Presidential Plenary session. The presentation compares fibrosis progression rates for diabetic vs. non-diabetic patients with biopsy-proven NAFLD. He notes two key findings of interest: First, while it has always been assumed that fibrosis progresses one level in seven years, the number for patients with diabetes may be closer to one level every six years. Second, the cumulative progression over the entire populations in a 12-year period was 93% for patients with diabetes and 76% for patients without diabetes. Jörn notes this to be a significant difference in patient numbers, highlighting an urgent need for treatment in the diabetic population.

The 73rd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD) takes place on November 4th-8th in Washington DC. As many as 10,000 attendees will convene in an effort to advance and disseminate the science and practice of hepatology, and to promote liver health and quality patient care. Key Opinion Leaders Stephen Harrison, Jörn Schattenberg and patient advocate Jeff McIntyre join Roger Green to preview key presentations and posters of interest.This conversation focuses on a presentation by Rohit Loomba that will review results from MAESTRO-NASH, a 2,000-patient Phase 3 trial. Stephen highlights that this analysis demonstrated FIB-4 with a cutoff of 1.3 failed to identify 57% of F2 patients, 40% of F3 and 26% of F4. To Stephen, this implies that if we rely solely on FIB-4, “we're probably leaving behind a lot of patients that should be treated.”  He suggests adding VCTE to FIB-4 to improve precision in screening these patients. As the session ends, Jörn shares his impressions and agrees with Stephen that FIB-4 is inappropriate for specialty clinics. He notes that the primary anticipated use is to screen patients in referral pathways where the number of patients with clinical fibrosis is far lower.

The 73rd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD) takes place on November 4th-8th in Washington DC. As many as 10,000 attendees will convene in an effort to advance and disseminate the science and practice of hepatology, and to promote liver health and quality patient care. In this preview, Key Opinion Leaders Stephen Harrison, Jörn Schattenberg and patient advocate Jeff McIntyre join Roger Green to discuss key presentations and posters of interest.Earlier this month, Stephen and Jörn joined Roger, Louise Campbell and Mazen Noureddin to review a string of recent press releases on NASH drug development. Many of these are AASLD late-breakers. Today's podcast covers presentations and posters not discussed previously.Stephen begins by mentioning an analysis Rohit Loomba will present from MAESTRO-NASH results, a 2,000-patient Phase 3 trial. This analysis demonstrated that FIB-4 with a cutoff of 1.3 failed to identify 57% of F2 patients, 40% of F3 and 26% of F4. To Stephen, this says if we rely solely on FIB-4, “we're probably leaving behind a lot of patients that should be treated.”  He suggests adding VCTE to FIB-4 to improve precision in screening these patients.Jörn and Roger have a common reaction: FIB-4 is not a tool for the specialist's office but, instead for primary care practices conducting first-line screening. Jörn states that the guideline referrals for FIB-4 use apply specifically to primary care and that in his clinic, he would never evaluate a patient solely based on FIB-4. Roger comments about a large number of papers at the conference seeking to improve efficiency and reduce cost of front-line screening, not to add literally millions of VCTE tests per year to primary care schedules and budgets. Jörn closes the discussion by saying that the common message to the field today is that FIB-4 is an important primary care tool, but it is far from perfect and we should seek better options over time. Jörn focuses on Dr. Daniel Huang's presentation at Sunday's Presidential Plenary session comparing fibrosis progression rates for diabetic vs. non-diabetic patients with biopsy-proven NAFLD. He notes that while conventional wisdom is that NASH progresses by one stage of fibrosis every seven years, the rate for diabetic patients in this study is reported to be one stage every six years. This leads to a broader discussion about screening and treatment for patients with diabetes, where the emerging consensus is to assume NAFLD and screen for NASH and fibrosis.Jeff McIntyre focuses on patient issues by discussing Donna Cryer's “Health Equity” talk on Saturday morning. Jeff suggests while we all think of health equity in context of stigma, access and policy barriers, these are broader than simple equity issues.  “Access,” he notes, can refer to how adoption of NITs in clinical trial programs will make trials practical for a larger number of patients. “Stigma” refers not only to the stigma of liver disease, but also to whether stigmatized groups such as the obese or people living with HIV get care sensitive to their needs. To that end, he points specifically to a session at 10:30a Saturday morning called “Liver and Queer,” an introduction to the AASLD LGBTQ task force. This bridges into discussions about obesity and its global implications, one of which is that Fatty Liver leads to HCC and other cancers… and from there to ways to draw attention to the need to treat Fatty Liver, which Stephen describes as the “canary in the metabolic dysregulation coal mine.”As time winds down, Roger briefly references a couple of posters that take innovative looks at how to create inexpensive, widely available screening through tests and/or analysis of medical records. He invites everyone back next week to discuss some more of the presentations and this data-rich, insight-laden conference.

Nonalcoholic fatty liver disease (NAFLD) is a major public health problem that will only worsen in the future, as it is closely linked to the epidemics of obesity and type 2 diabetes mellitus. Given this link, endocrinologists and primary care physicians are in an ideal position to identify persons at risk to prevent the development of cirrhosis and comorbidities. Join endocrine expert Vin Tangpricha, M.D., Ph.D., as he interviews AACE Co-Chairs, guideline task force experts, Kenneth Cusi, MD, FACP, FACE, and Scott D. Isaacs, MD, FACP, FACE, about the newly released 2022 clinical practice guideline for the diagnosis and management of nonalcoholic fatty liver disease, published in the May 2022 issue of Endocrine Practice (https://www.endocrinepractice.org/article/S1530-891X(22)00090-8/fulltext).

Dr David Johnson provides clinicians with an overview of the new guidelines from the American Association for the Study of Liver Diseases (AASLD) on hepatocellular carcinoma.

Today we are pleased to post the parting lecture that Darryn R. Potosky, MD gave to the attendants of the December 2016 UMMC Critical Care conference. Dr. Potosky was an undergrad, medical student, resident, and fellow of the University of Maryland system. During his tenure as staff at UMMC, Dr. Potosky was the director of Hepatology and Assistant Professor of Medicine. In addition, he has published numerous articles in peer-reviewed publications on liver transplantation, spoken at national and international meetings including the American Association for the Study of Liver Diseases (AASLD). Today he is breaking down a problem plaguing ICUs around the country: the massive influx of pre-transplant liver failure patients. This is an issue I can assure you is not just effecting the doctors here in Baltimore!

Following acute exposure to the hepatitis C virus, most people develop chronic infection that increases the risk for long-term hepatic complications. Current treatment with oral direct-acting agents aims to eradicate the virus. Jawad Ahmad, Professor of Medicine in the Division of Liver Diseases at The Mount Sinai Hospital in New York, discusses hepatitis C infection with BMJ Knowledge Centre's U.S. Clinical Lead Sheila Feit, including future directions for a rapidly evolving field. More information available at the BMJ Best Practice website: http://bestpractice.bmj.com. About BMJ Best Practice BMJ Best Practice takes you quickly and accurately to the latest evidence based information, whenever and wherever you need it. Our step by step guidance on diagnosis, prognosis, treatment and prevention is updated daily using robust evidence based methodology and expert opinion. We support you in implementing good practice. Sign up to a free 7 day trial here*: bestpractice.bmj.com/info/subscribe/free-trial/ The below topics will be made freely available for 2 weeks from World Hepatitis Day (28th July 2017): Hepatitis C Step-by-step management: http://bestpractice.bmj.com/best-practice/monograph/128/treatment/details.html Treatment guidelines including American Association for the Study of Liver Diseases (AASLD) and European Association for Study of the Liver (EASL) http://bestpractice.bmj.com/best-practice/monograph/128/treatment/guidelines.html Hepatitis C Clinical Update in The BMJ (free access until 10th August 2017) http://www.bmj.com/content/358/bmj.j2861 *Please note that free personal trials and personal subscriptions are not available in North America. _ The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.

Most people with chronic hepatitis B infection are asymptomatic, but long-term complications may include cirrhosis, hepatocellular carcinoma, or liver failure. Jawad Ahmad, Professor of Medicine in the Division of Liver Diseases at The Mount Sinai Hospital in New York, discusses hepatitis B virus infection with BMJ Knowledge Centre's U.S. Clinical Lead Sheila Feit, including how to approach diagnostic serologies and treatment to help reduce the risk of advanced liver disease. More information available at the BMJ Best Practice website: http://bestpractice.bmj.com. About BMJ Best Practice BMJ Best Practice takes you quickly and accurately to the latest evidence based information, whenever and wherever you need it. Our step by step guidance on diagnosis, prognosis, treatment and prevention is updated daily using robust evidence based methodology and expert opinion. We support you in implementing good practice. Sign up to a free 7 day trial here*: bestpractice.bmj.com/info/subscribe/free-trial/ The below topics will be made freely available for 2 weeks from World Hepatitis Day (28th July 2017): Hepatitis B Diagnostic investigations: http://bestpractice.bmj.com/best-practice/monograph/127/diagnosis/tests.html Hepatitis B Step-by-step management: http://bestpractice.bmj.com/best-practice/monograph/127/treatment/details.html Treatment guidelines including American Association for the Study of Liver Diseases (AASLD) and European Association for Study of the Liver (EASL) http://bestpractice.bmj.com/best-practice/monograph/127/treatment/guidelines.html *Please note that free personal trials and personal subscriptions are not available in North America. _ The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner’s judgement, patient care or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.

-ANCHE IN ITALIA BOCEPREVIR, FARMACO PER EPATITE C Annunciato ufficialmente l'arrivo in Italia di boceprevir, nel corso del Congresso American Association for the Study of Liver Diseases (AASLD) a Boston. Il farmaco sarà a disposizione dei pazienti italiani con l'istituzione dei Registri di monitoraggio AIFA, prevista a breve. Boceprevir, farmaco antivirale di ultima generazione, grazie all'azione diretta sul virus HCV, raddoppia e addirittura triplica la percentuale di guarigione dei pazienti, aprendo la strada all'eradicazione definitiva del virus. -SPORTELLO MAMMA: UN NUMERO VERDE PER INFORMAZIONI ALLE PARTORIENTI Un numero verde 800 100 081 interamente dedicato alle partorienti e alle puerpere è stato attivato dall'Unità operativa di Ostetricia e Ginecologia del San Raffaele Giglio di Cefalù. Si tratta di un servizio per essere più vicine alle neo mamme sia nella fase di preparazione al parto che nel decorso clinico e durante all'allattamento al seno. Una continuità assistenziale fuori dalle prestazioni ambulatoriali e dal ricovero. -LOTTA ALL'OBESITA': UN FUMETTO DEL BAMBINO GESU' La storia di Ric, bambino simbolo di chi riesce a sconfiggere l'obesità grazie all'attività fisica, alla sana alimentazione e a tanto impegno diventa un fumetto firmato Ospedale Pediatrico Bambino Gesù. Grazie all'esperienza di medici da anni impegnati sul fronte dell'obesità, del fegato grasso e delle patologie collegate (come il diabete e le complicanze cardiache) le vicende dei tanti piccoli con i quali quotidianamente vengono in contatto hanno trovato una sintesi esemplare nelle trentaquattro pagine di fumetti, nati dalla matita di Elena Casagrande, dal titolo 'Torna in campo, Ric'. -INFLUENZA, RIMOSSO BLOCCO VACCINI NOVARTIS E' stato rimosso il divieto di utilizzo dei vaccini antinfluenzali fabbricati dalla Novartis V&D adottato in via precauzionale a tutela della salute pubblica. Ciò è stato possibile in seguito alle accurate verifiche effettuate sulla documentazione prodotta dall'Azienda in risposta alle richieste di condurre approfondite indagini su un possibile difetto di qualità presente in alcuni lotti di vaccino e alle concomitanti analisi straordinarie effettuate sia dall'Azienda, sia dall'Istituto Superiore di Sanità. Va sottolineato che i lotti non sono mai stati distribuiti e quindi non sono mai stati presenti sul mercato. Gli ulteriori controlli, aggiuntivi a quelli che vengono espletati di routine, hanno confermato l'assenza di difetti di qualità sui lotti commercializzati. -PINZETTE MOLECOLARI CONTRO L'ALZHEMIER Ricercatori dell2019Università Cattolica del Sacro Cuore di Roma -Policlinico A. Gemelli insieme con colleghi dell'Università di Los Angeles (UCLA) hanno dimostrato l'efficacia di 'pinzette molecolari' che potrebbero risultare importanti nella cura della malattia di Alzheimer: le pinzette 'pizzicano' le proteine tossiche che si aggregano nel cervello dei pazienti e, così facendo, ne bloccano l'aggregazione, impedendo che avvelenino i neuroni.