GHAPPcast

Cirrhosis is often considered an irreversible liver disease, but is there a chance for early-stage reversal? In this episode, Janet Gripshover, CRNP, Nurse Manager for the Cedars-Sinai Liver Transplant Program, dives deep into the latest advancements in cirrhosis treatment, liver transplant eligibility, and the evolving landscape of transplantation. She discusses the critical role of early detection, how decompensated cirrhosis impacts survival rates, and the growing trend of earlier liver transplants across the nation.

Janet also explores how alcohol use disorder (AUD) and metabolic-associated steatotic liver disease (MASLD) are shaping transplant needs, along with groundbreaking efforts to incorporate AUD treatment into hepatology clinics. With MASLD (formerly known as NAFLD) now being the fastest-growing cause of cirrhosis and liver transplantation, she emphasizes the importance of weight loss as a key strategy for disease management. Research shows that a 7% weight loss can significantly improve liver health by mobilizing fat out of the liver and reducing disease progression.

Additionally, she highlights why identifying a surrogate decision-maker is crucial for patients with advanced cirrhosis. Once a patient experiences their first decompensated episode, the average life expectancy is less than two years, and some complications can impair decision-making. Having a surrogate involved early ensures that medical choices align with the patient’s values and preferences.

For more expert insights on liver disease and transplantation, subscribe now and visit the Gastroenterology & Hepatology Advanced Practice Provider (GHAPP) website or download the GHAPP app on iOS and Android. Stay informed, stay empowered, and improve patient care.

Cirrhosis is a progressive liver disease that requires early detection, effective management, and patient education to improve outcomes. In this video, Allison Moser, NP, a Transplant Hepatology Nurse Practitioner at Rush University Medical Center, shares key strategies for healthcare professionals to enhance patient care.

She discusses the importance of early screenings for high-risk individuals, including those with a history of alcohol use, metabolic syndrome, and viral hepatitis. By utilizing blood tests, imaging, and elastography, providers can detect cirrhosis early and intervene before complications arise. Managing the root cause—whether through antivirals, alcohol cessation, or lifestyle modifications—is critical to slowing disease progression.

As cirrhosis advances, patients may develop ascites, esophageal varices, and hepatic encephalopathy. Allison explains how medications like diuretics, beta-blockers, lactulose, and rifaximin help manage these complications and reduce hospitalizations. For patients with end-stage liver disease, early referral for liver transplant evaluation using MELD score assessments can be life-saving.

Beyond medical treatment, patient education and mental health support play a crucial role. Healthcare professionals must emphasize healthy lifestyle choices, alcohol avoidance, and emotional well-being to empower patients in managing their condition. A multidisciplinary approach, involving hepatologists, dietitians, and mental health specialists, ensures comprehensive patient care.

Stay informed on the latest research and treatment options to provide the best possible outcomes for cirrhosis patients. Subscribe for more expert insights and visit the Gastroenterology & Hepatology Advanced Practice Provider (GHAPP) website for additional resources. #Cirrhosis #LiverHealth #Hepatology #Transplant #Gastroenterology

Explore the latest findings on Guselkumab as a maintenance therapy for moderate to severe ulcerative colitis from the Phase 3 QUASAR Maintenance Study. In this Journal Club video module, Shayla Schoenoff, PA-C, reviews key efficacy and safety outcomes in patients who demonstrated a clinical response to Guselkumab IV induction. The randomized, placebo-controlled trial assessed subcutaneous Guselkumab (100 mg every 8 weeks or 200 mg every 4 weeks), showing significant improvements in clinical remission, symptomatic remission, endoscopic response, and steroid-free remission compared to placebo. Additionally, safety outcomes remained consistent across treatment groups, with no new major safety concerns. Watch now to learn how Guselkumab maintenance therapy is shaping treatment options for ulcerative colitis.

Visit the GHAPP website or GHAPP ACE app for more educational content.

Thank you to Johnson & Johnson for your support of this FAQ Video Module.

In this video, Erin Darguzas, NP, from the Inflammatory Bowel Disease Center at Northwestern Medicine, discusses how Guselkumab data aligns with STRIDE II guidelines for monitoring IBD (Inflammatory Bowel Disease) patients over time. Developed by International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) members, STRIDE II provides a treat-to-target framework that outlines short-term, intermediate, and long-term goals for achieving disease control.

Erin explains how Guselkumab's clinical trials align with these treatment targets. In induction studies, patients were evaluated at Baseline and Week 12, with clinical remission as the primary outcome—matching STRIDE II's short-term targets. The results showed symptom improvement and mucosal healing by Week 12, supporting early treatment efficacy.

In maintenance trials, clinical responders from the induction phase were randomized into maintenance arms, with Week 44 clinical remission as the primary endpoint. Additional key outcomes included corticosteroid-free remission, sustained clinical response, endoscopic improvement, and mucosal healing—meeting intermediate and long-term STRIDE II targets.

By demonstrating both short- and long-term efficacy, Guselkumab shows potential for long-term IBD management in alignment with STRIDE II treatment goals. For more expert insights on IBD treatment strategies, visit the Gastroenterology & Hepatology Advanced Practice Provider (GHAPP) website.

Thank you to Johnson & Johnson for your support of this Medication Review Video Module.

In this video, Anne Feldman, NP, from Cleveland Clinic, discusses Guselkumab (Tremfya), an FDA-approved treatment for adults with moderate to severe ulcerative colitis, plaque psoriasis, and psoriatic arthritis. With promising Phase 3 clinical trial results, Guselkumab is expected to receive FDA approval for Crohn’s disease, making it a potential first-line advanced therapy or an option for patients who have failed other advanced treatments.

Beyond gut-related inflammation, extraintestinal manifestations (EIMs)—affecting the skin, joints, and eyes—are common in IBD (Inflammatory Bowel Disease), especially Crohn’s disease. Up to 40% of IBD patients experience EIMs, sometimes even before their IBD diagnosis. Because Guselkumab is already FDA-approved for psoriasis and psoriatic arthritis, it offers a multisystem treatment approach, addressing both IBD and associated autoimmune conditions. By targeting multiple inflammatory pathways, this therapy has the potential to reduce disease burden and significantly improve quality of life.

For more information on IBD treatment strategies and Guselkumab’s role in patient care, visit the Gastroenterology & Hepatology Advanced Practice Provider (GHAPP) website or download the GHAPP ACE mobile app.

In this video, Sherona Bau, NP, at Pfleger Institute at UCLA, shares the latest advancements in cirrhosis management, including newly FDA-approved medications and updated AASLD (American Association for the Study of Liver Diseases) guidelines. While there are still limited medications specifically for cirrhosis, recent developments provide promising options for patients with liver disease.

One key update is in the management of portal hypertension, where AASLD now recommends non-selective beta blockers like carvedilol for variceal bleeding prophylaxis, particularly due to its vasodilatory effects. Patients with medium or large varices are advised to take these medications to reduce bleeding risks. Another significant procedure being emphasized is the TIPS (Transjugular Intrahepatic Portosystemic Shunt), which is considered for patients with recurrent variceal bleeding or refractory ascites. However, it is generally preferred for those already on a liver transplant list, as there is a small risk of liver failure.

There have also been notable advancements in treating Primary Biliary Cholangitis (PBC) with two newly FDA-approved medications: Ivarix (approved June 10) and Cadazopa (approved August 14). While these treatments are not approved for decompensated cirrhosis, they are safe for Child-Pugh Class A patients, though providers are advised to discontinue treatment if the disease progresses to Child-Pugh Class B or C. Additionally, for patients with Metabolic Dysfunction-Associated Steatohepatitis (MASH), the FDA recently approved Rivumet on April 9, marking the first-ever FDA-approved therapy for MASH with liver fibrosis (F2-F3). Although it is not yet approved for cirrhotic patients, further data is expected soon.

As liver disease management continues to evolve, staying informed on new treatments and best practices is crucial for improving patient outcomes. For more details, visit the GHAPP website and subscribe for expert insights on liver disease care!

In this video, Shayla Schoenoff, PA-C, reviews the Phase 3 QUASAR maintenance study, evaluating the efficacy and safety of Guselkumab as a maintenance therapy for moderately to severely active ulcerative colitis. This randomized, double-blind, placebo-controlled study assessed patients who previously had an inadequate response to conventional or advanced therapies and demonstrated a clinical response to GUS IV induction therapy.

Key findings show that GUS subcutaneous maintenance therapy significantly improved clinical remission rates, symptomatic remission, endoscopic improvement, and steroid-free remission at Week 44 compared to placebo. Patients receiving 100 mg GUS every 8 weeks and 200 mg GUS every 4 weeks showed higher remission rates, with 50% of patients in the 200 mg group achieving clinical remission, compared to 18.9% in the placebo group. Additionally, 69% of GUS-treated patients in clinical remission also achieved endoscopic remission, reinforcing its effectiveness in managing ulcerative colitis.

The study also evaluated safety outcomes, showing that the proportion of patients experiencing adverse events was similar across treatment groups. The most common adverse events included COVID-19, ulcerative colitis flare-ups, and arthralgia, with no cases of death, active tuberculosis, anaphylaxis, or serious hepatic adverse events reported.

This comprehensive review provides essential insights into GUS maintenance therapy, highlighting its role in long-term ulcerative colitis management. Watch now for a detailed breakdown of the study results, and don’t forget to subscribe for more updates on IBD treatments and clinical trials. Visit the GHAPP website or download the GHAPP ACE app for more information and educational content.

In this video, Janet Gripshover, CRNP, Nurse Manager at Cedars-Sinai Liver Transplant Program, discusses essential steps for managing cirrhosis to improve quality of life and longevity. The most critical action for anyone living with liver disease is to completely eliminate alcohol consumption, as alcohol accelerates liver damage, increases fibrosis, and raises the risk of decompensated cirrhosis, which can severely impact daily functioning and overall health.

A low-sodium, high-protein diet is also vital for cirrhosis management. Reducing sodium intake helps prevent fluid retention, which can cause discomfort, swelling, and difficulty breathing. Adequate protein intake—about 1.2 grams per kilogram of body weight—is crucial to prevent muscle loss often associated with cirrhosis. Since the body struggles to absorb protein efficiently, maintaining proper nutrition and engaging in strength training can help preserve lean muscle mass and overall strength.

Regular exercise and staying active play a crucial role in supporting liver function and overall health. Additionally, individuals with cirrhosis should ensure they are up to date on preventive health screenings, including mammograms, prostate exams, and colonoscopies, especially if a liver transplant is a future consideration.

Watch this video to learn more about cirrhosis management and practical steps to enhance your health. For additional resources, visit the GHAPP website or download the GHAPP ACE app on iOS and Android.

#Cirrhosis #LiverHealth #LiverDisease #CirrhosisManagement #TransplantCare #Hepatology #LiverTransplant #HealthyLiving #LowSodiumDiet #HighProteinDiet #PreventiveCare

Thank you to Johnson & Johnson for your support of this FAQ Video Module.

In this FAQ video module, Erin Darguzas, NP, Gastroenterology Specialist at Northwestern Medicine, discusses the predictive risk factors for disease severity in Crohn’s disease and ulcerative colitis. Over the past 15 years, researchers have identified multiple prognostic factors that can help predict disease progression and guide individualized IBD management.

For moderate to severe Crohn’s disease, key factors include age at diagnosis (before 40), disease location (small bowel, colonic, or upper GI involvement), and disease behavior (structuring, penetrating, or perianal disease). Additional concerns include deep ulcers on endoscopy, significant weight loss, low albumin levels, smoking history, and genetic markers.

For ulcerative colitis, predictors of severity include age at diagnosis (before 50), frequency of disease flares, need for frequent therapy changes, and failure to achieve endoscopic remission. Pathology findings, such as persistent neutrophil infiltration, and treatment adherence history are also crucial in determining long-term outcomes.

Early identification of these prognostic factors allows for a more personalized treatment approach, improving patient outcomes in inflammatory bowel disease (IBD) management. Watch this video to learn more about Crohn’s disease and ulcerative colitis risk factors. For additional resources, visit the GHAPP website or download the GHAPP ACE app.

In this video, Sherona Bau, NP, from the Pfleger Liver Institute at UCLA, discusses the essential lifestyle changes for effectively managing cirrhosis. Maintaining a healthy lifestyle is key to slowing disease progression and preventing complications. One of the most critical recommendations is completely avoiding alcohol, as it accelerates liver damage and increases the risk of decompensation.

A low-sodium diet is also essential, with a daily limit of no more than 2,000 mg of sodium to help reduce fluid retention, leg swelling, and abdominal ascites. Patients should avoid processed and canned foods, which are often high in sodium, and eliminate raw or undercooked shellfish to prevent infections. Additionally, reducing sugary drinks, refined sugar, and red meat intake can support overall liver health.

It’s also important to avoid NSAIDs (nonsteroidal anti-inflammatory drugs), as they can increase the risk of kidney injury, and refrain from using herbal supplements without consulting a healthcare provider. Lastly, regular physical activity—such as walking 20 to 30 minutes daily—can help maintain overall health and improve disease outcomes.

Making these lifestyle changes can significantly improve quality of life and liver function for patients with cirrhosis. Watch this video for expert insights, and visit the GHAPP website or download the GHAPP ACE app for more information.