As part of our ongoing dialogue around clinical care pathways and the complex of metabolic diseases, SurfingNASH dedicates a session to focus on the key relationship and interplay between endocrinology and hepatology.
This topic rings familiar in the Rising Tide series, our podcast for frontline education, where Ken Cusi often notes the need for endocrinologists to become comfortable diagnosing Fatty Liver disease (and prescribing pioglitazone) and for hepatologists to become more comfortable prescribing GLP-1s. To expand on these critical ideas with the SurfingNASH community, Jörn Schattenberg, Louise Campbell and Roger Green are joined by Cyrielle Caussy, Professor of Nutrition and Endocrinologist-Diabetologist at Lyon 1 University and Lyon South Hospital, Hospices Civils de Lyon (France). Cyrielle is an expert in the clinical care of metabolic disease, including type 2 diabetes, obesity and NAFLD, and is leading a clinical and research program focused on metabolic liver disease at the Lyon Hepatology Institute.
This conversation begins with Roger’s note that around 50% of all cirrhosis is diagnosed for the first time during a decompensation event at the emergency department. He asks whether the endocrinology clinic is the right place to identify patients much sooner. Jörn suggests the answer is yes considering that we know the risk and prevalence of advanced fibrosis in this population to be high. The group goes on to discuss requesting and receiving lab results in their respective different systems and how hitching a test, like FIB-4, to routine care protocols could be an effective route for implementation. Cyrielle suggests that “the most important thing is convincing the endocrinologists” of NAFLD/NASH prevalence and our concerted ability to identify disease and stop progression at their clinics. She goes on to highlight the building momentum and consensus of guidelines from a range of different fields and organizations that formally recognize the relevance of Fatty Liver and the adoption of FIB-4 as a simple and cheap frontline test. She points out that In the most recent wave of published guidelines, there is a notedly improved sense of clarity in recommendations around how to identify and respond to patients with NAFLD/NASH.
Roger raises the point that the US might be one of the only countries, if not the only, that includes ALT values on blood panels. He asks Cyrielle what the process looks like in France for requesting ALT values to which she describes a relatively simple set of protocols. Jörn next describes his experiences within the German system. As the conversation winds down, discussion focuses on patient management and the importance of risk stratification in identifying those with more severe progression of disease.
If you enjoy the episode, have questions or interest around endocrinology and Fatty Liver disease, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at questions@SurfingNASH.com.
Stay Safe and Surf On!