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S2-E49 – Finally, a Clinical Care Pathway For a Hidden Pandemic!

Last author and leading endocrinology Fatty Liver Opinion Leader Ken Cusi joins co-author Stephen Harrison, Louise Campbell and Roger Green to discuss the recent Clinical Care Pathway published in Gastroenterology.

Clinical Care Pathway for the Risk Stratification and Management of Patients with Nonalcoholic Fatty Liver DiseaseLast week, Gastroentrology published the article “Clinical Care Pathway for the Risk Stratification and Management of Patients with Nonalcoholic Fatty Liver Disease.” This paper and its predecessor, “Preparing for the NASH Epidemic: A Call to Action,” was the result of collaboration between leaders in endocrinology, diabetes care, bariatric medicine and obesity care, primary care, gastroenterologists and hepatologists. This paper presents a clear, straightforward multidisciplinary pathway for the identification, screening, diagnosis, risk stratification and management of NAFLD and NASH patients. It is truly a groundbreaking piece of work.

Dr. Kenneth Cusi, who served as last author on both papers, joins the Surfers to discuss the effort that went into development of the pathway and critical elements for its adoption and use.

Highlights include:
7:40 – Ken Cusi begins to discuss his history with Stephen Harrison and work on the Clinical Care Pathways paper
10:41 – Louise Campbell’s initial reaction: “A pivotal piece”
12:29 – Stephen Harrison discusses the way the group worked together
13:54 – Ken’s first goal: “to build the muscle” for non-hepatologists to think about Fatty Liver whenever treating a patient in the three targeted groups
17:26 – Stephen identifies a key discussion point in the group: identifying at-risk patients to target
18:48 – Why the group chose FIB-4 as its initial standard test
20:57 – Ken’s hope: medical societies asking their clinician members to screen the three groups regularly for Fatty Liver
22:42 – Three items that struck Roger Green immediately
22:35 – Ken’s “down to earth” study of asymptomatic patients
25:38 – Increasing awareness might drive two changes in prescribing behavior: doctors might select diabetes drugs with the liver in mind and not stop the patient’s statins
26:46 – Stephen reviews the 2021 San Antonio prevalence study
29:54 – Stephen: What’s changed since the 2011 San Antonio prevalence study? Moderate-to-severe NASH more than doubled!
32:00 – Louise: liver disease should become part of the WHO initiative on diabetes
33:07 – Ken explains elastography in simple terms
35:10 – Stephen discusses principles of screening for NASH patients with significant cirrhosis risk
36:07 – Stephen lists blood-based and imaging confirmatory options for clinicians who cannot access FibroScan or other in-office elastography
38:11 – Roger: How does this translate into the last 5 or 10 patients a clinician saw?
39:20 – Ken expresses optimism that new obesity drugs will motivate non-hepatologists to look for NASH harder and treat it more aggressively
40:41 – Louise raises two more questions
42:14 – Stephen’s closing comments: we’re at the beginning, like the Wright Brothers
43:32 – Louise’s closing comments: education, education, education…and advocacy
44:22 – Ken’s closing comments: share hepatologists’ knowledge with other specialties to improve screening and care of Fatty Liver disease
46:04 – Roger’s closing comment: if a journey of 1,000 miles starts with a single step, this is like starting with a marathon
47:17 – Business report — CME credits for Surfing the NASH Tsunami, the reason for two sponsors and an exciting schedule ahead

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