GHAPPcast

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

In this FAQ video module, Erica Heagy, NP, from Alaska Digestive and Liver Disease, breaks down the key differences between humoral immunity and cell-mediated immunity, two crucial components of the adaptive immune system that protect the body from infections.

Adaptive immunity is triggered when the body is exposed to antigens, allowing it to mount a targeted defense against viruses, bacteria, and toxins. Within this system, humoral and cell-mediated immunity function in distinct but complementary ways.

Humoral immunity, also known as antibody-mediated immunity, is driven by B cells, which produce antibodies to neutralize extracellular pathogens such as bacteria and toxins. This response develops rapidly, offering quick protection, but it tends to be shorter-lasting compared to cellular immunity.

In contrast, cell-mediated immunity is primarily led by T cells and plays a crucial role in combating intracellular pathogens, including virus-infected cells. This response takes longer to activate, but it provides long-term protection by directly targeting and eliminating infected cells.

Understanding the balance between humoral and cellular immunity is essential in infectious disease management, vaccine development, and autoimmune disorder research. A strong grasp of these immune responses helps healthcare providers make informed decisions about treatments, immunotherapies, and disease prevention strategies.

For more information on immune system functions, immunotherapy, and advancements in gastroenterology, visit GHAPP.org or download the GHAPP ACE app on IOS and Android. Follow us on LinkedIn, YouTube, X (Twitter), and Instagram for expert insights and updates.

Live from the GHAPP National 2024 Conference, Dr. Dakesh Patel, a gastroenterologist with the GI Alliance of Illinois, joins Kate Scarlata, MPH, RD, a nationally renowned dietitian and bestselling author, and Kaitlin Colella, PA, to discuss congenital sucrase-isomaltase deficiency (CSID), a frequently overlooked digestive disorder. CSID affects the body's ability to break down sugar and starch due to enzyme deficiencies, often leading to misdiagnosis as IBS. Many patients struggle for years with chronic bloating, diarrhea, constipation, and severe abdominal discomfort without realizing the root cause of their symptoms.

In this insightful discussion, the experts explore the science behind CSID and how sucrase-isomaltase deficiency impacts digestion. They break down the common symptoms that mimic IBS, the challenges in diagnosing the condition, and the importance of proper testing, such as the C13 breath test and small bowel biopsy. Insurance barriers often make it difficult for patients to access enzyme replacement therapy, leaving many untreated or mismanaged. The conversation also covers effective dietary strategies, emphasizing how food choices, portion control, and timing influence symptoms. Caitlyn Colella shares her personal journey of living with CSID, highlighting the struggle of being misdiagnosed for years and how she successfully manages her condition through a combination of dietary adjustments and enzyme therapy.

With CSID affecting a significant percentage of adults previously diagnosed with IBS, this discussion sheds light on an under-recognized condition that has a profound impact on gut health. Healthcare providers and patients alike will gain valuable insights into the latest advancements in diagnosis, treatment, and lifestyle management. Watch now to learn how proper diagnosis and treatment can drastically improve quality of life. For more resources, visit the GHAPP website or download the GHAPP ACE app.

Welcome back to Part 2 of our three-part Primary Biliary Cholangitis (PBC) miniseries, where we explore the latest advancements in PBC treatment and disease management. In this episode, Elizabeth Goacher, FNP, Jeremy Davis, NP, and Allison Moser, NP discuss new therapeutic options, including seladelpar and elafibranor, and how these emerging treatments are transforming the PBC landscape.

With the approval of seladelpar and elafibranor, clinicians now have more tools to not only lower alkaline phosphatase (ALP) levels but also to improve cholestatic pruritus, a debilitating symptom that has long remained difficult to manage. Our experts share insights on how these new therapies are addressing both biochemical and symptomatic aspects of PBC, creating a more comprehensive approach to patient care.

This discussion also highlights key considerations for integrating these second-line PBC therapies into clinical practice, including insurance approvals, specialty pharmacy access, and patient support programs that are helping to streamline the prescribing process. The conversation delves into real-world experiences with initiating treatment, the challenges of prior authorizations, and how pharmaceutical support programs are making it easier for patients to access these breakthrough medications.

Watch now to learn how new therapies are shaping the future of PBC management and stay tuned for Part 3 of this series! For more resources, visit the GHAPP website or download the GHAPP ACE app.

Welcome to Part 1 of our three-part miniseries on Primary Biliary Cholangitis (PBC), recorded live at GHAPP 2024! In this episode, Elizabeth Goacher, FNP (Duke University), Jeremy Davis, NP (Gastrointestinal Specialists, Louisiana), and Allison Moser, NP (Rush University Medical Center, Chicago) discuss the rising prevalence of PBC, increased awareness, and improved identification strategies in clinical practice.

Although PBC is classified as a rare disease, its identification rates are increasing, thanks to better diagnostic tools, heightened primary care awareness, and expanded hepatology workups. Our experts explore whether this trend represents a true increase in prevalence or if improved screening and referrals are leading to earlier diagnosis and more accurate detection.

With newly approved treatments bringing renewed focus to PBC, this conversation also examines how greater access to healthcare, advanced liver disease diagnostics, and growing provider awareness are transforming PBC management. The panel highlights key statistics, such as the estimated prevalence of 1 in 1,000 women over the age of 40, and discusses how evolving treatment landscapes are shaping clinical decision-making.

Watch now to stay informed on the latest developments in PBC awareness and diagnosis. Be sure to check out Parts 2 and 3 for more insights into new therapies and treatment strategies. For additional resources, visit GHAPP.org or download the GHAPP ACE app.

Welcome back to the final installment of our three-part miniseries on Primary Biliary Cholangitis (PBC) from the GHAPP National 2024 Conference! In this episode, Elizabeth Goacher, FNP, Jeremy Davis, NP, and Allison Moser, NP discuss the most impactful updates in PBC management, treatment goals, and evolving clinical strategies.

A major highlight from this year’s meeting is the shifting treatment paradigm in PBC, moving beyond traditional Poise criteria to a more aggressive target of achieving completely normal alkaline phosphatase (ALKP) levels and a bilirubin of ≤0.6. Experts emphasize that new therapies, including seladelpar and elafibranor, are helping clinicians push treatment goals further, optimizing patient outcomes and disease management.

With the PBC treatment landscape evolving, the panel discusses how the mindset around ALKP reduction has changed, underscoring the importance of setting normalization as the primary goal rather than just achieving a modest reduction. With new and emerging therapies, there is growing excitement about more effective disease control and improved long-term prognosis for patients with PBC.

Watch now to stay ahead on the latest PBC treatment advancements, and don’t forget to check out the full miniseries! For more resources, visit GHAPP.org or download the GHAPP ACE app.

Live from the GHAPP 2024 Conference in Washington, D.C., Dr. Renee Pozza, NP (Southern California GI & Liver Centers) and Allysa Saggese, NP (Weill Cornell Medicine, Manhattan) discuss the latest FDA-approved therapies for Primary Biliary Cholangitis (PBC) and how they fit into the evolving treatment landscape. With new medications offering both biochemical improvements and symptom relief, particularly for cholestatic pruritus, clinicians now have more options to personalize treatment plans. These second-line therapies can be used in addition to or as a replacement for ursodeoxycholic acid (UDCA) in cases of intolerance or inadequate response. The discussion also emphasizes the importance of achieving complete normalization of alkaline phosphatase (ALP) and bilirubin, rather than just targeting reductions, to improve long-term liver health and reduce the risk of disease progression.

The conversation explores how new treatments are addressing fatigue and itching, two of the most challenging symptoms for PBC patients, while also improving overall liver function. The panel highlights the advantages of monotherapy options for patients who cannot tolerate UDCA, as well as strategies to optimize UDCA dosing to maximize effectiveness. They also stress the importance of regularly assessing pruritus and fatigue during patient visits, as many patients may not recognize these symptoms as part of their disease. Additionally, they discuss how once-daily dosing of new medications is improving treatment adherence and patient compliance compared to older regimens.

With PBC treatment strategies evolving, these newly approved medications provide greater flexibility, enhanced safety profiles, and improved long-term disease management. The discussion highlights why now is an exciting time in liver disease care, offering new hope for PBC patients. Watch now to stay ahead on the latest PBC treatment advancements! For more resources, visit GHAPP.org or download the GHAPP ACE app.

In this episode, Jordan Mayberry, PA-C from UT Southwestern Medical Center, discusses how newly approved therapies are transforming the management of cholestatic pruritus in Primary Biliary Cholangitis (PBC). With pruritus being one of the most challenging symptoms for PBC patients, these emerging treatments offer a targeted approach to improving patient quality of life.

As PBC patients often struggle with persistent itching that significantly impacts daily activities, the availability of FDA-approved therapies specifically addressing PBC-related pruritus represents a major advancement. Jordan Mayberry emphasizes the importance of screening for PBC in patients experiencing chronic pruritus, as early diagnosis and treatment can lead to better disease management and improved symptom control.

With more therapeutic options available, providers can now offer a comprehensive treatment plan that not only targets disease progression but also alleviates pruritus, a symptom that has long been difficult to manage. Watch now to learn more about these groundbreaking therapies and how they are reshaping PBC treatment strategies. For additional resources, visit the GHAPP website or download the GHAPP ACE mobile app.

Thank you to Madrigal for your support of this Journal Club Video Module.

In this Journal Club Video Module, Lisa Richards, NP, a hepatology specialist with over 20 years of experience at UC San Diego Health, presents the pivotal findings of the Phase 3 randomized controlled trial of Resmetirom for the treatment of Metabolic Dysfunction-Associated Steatohepatitis (MASH) with liver fibrosis. Published in The New England Journal of Medicine in February 2024, this study provided the data that led to FDA approval of Resmetirom in March 2024 for adults with moderate to advanced fibrosis (F2-F3) due to MASH.

MASH, formerly known as Non-Alcoholic Steatohepatitis (NASH), is a progressive liver disease characterized by hepatic steatosis, hepatocellular damage, and inflammation. Once fibrosis reaches Stage 2 or 3, the risk of cirrhosis, liver failure, and hepatocellular carcinoma (HCC) significantly increases. Resmetirom is an oral, liver-directed, thyroid hormone receptor beta (THR-β) selective agonist designed to improve mitochondrial function, enhance fatty acid oxidation, and reduce fibrosis progression. The MAESTRO-NASH trial assessed its safety and efficacy in adults with biopsy-confirmed MASH and liver fibrosis.

The 52-week results from 966 patients demonstrated that Resmetirom at both 80 mg and 100 mg doses significantly improved MASH resolution and fibrosis reduction compared to placebo. In the study, MASH resolution without worsening fibrosis was achieved in 25.9% of patients in the 80 mg group and 29.9% in the 100 mg group, compared to just 9.7% in the placebo group. Similarly, fibrosis improvement by at least one stage without worsening MASH was observed in 24.2% of the 80 mg group and 25.9% of the 100 mg group, whereas only 14.2% of placebo patients showed fibrosis improvement. Both primary endpoints were statistically significant, confirming the therapeutic potential of Resmetirom.

In addition to its effects on liver health, Resmetirom also demonstrated benefits in lipid metabolism. LDL cholesterol levels decreased by 13.6% in the 80 mg group and by 16.3% in the 100 mg group, compared to a 0.1% increase in the placebo group, indicating a potential cardiometabolic advantage of this treatment.

The overall safety profile of Resmetirom was favorable, with the incidence of serious adverse events comparable across treatment groups: 10.9% (80 mg group), 12.7% (100 mg group), and 11.5% (placebo group). The most commonly reported side effects were diarrhea and nausea, though they were generally well tolerated and did not lead to treatment discontinuation in most cases.

These findings led to the FDA approval of Resmetirom on March 14, 2024, making it the first approved therapy for non-cirrhotic MASH with moderate to advanced fibrosis. The MAESTRO-NASH trial is ongoing for up to 54 months to further assess long-term liver outcomes, including the progression to cirrhosis.

The approval of Resmetirom represents a major breakthrough in MASH treatment, providing the first targeted therapy that directly addresses liver fat accumulation, inflammation, and fibrosis progression. With MASH being a leading cause of liver failure, cirrhosis, and liver transplantation, this approval marks a significant advancement in the management of the disease.

For more expert discussions on MASH and liver disease management, visit the GHAPP website or download the GHAPP ACE mobile app.

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

In this FAQ Video Module, Corrie Berk, NP, Director of Hepatology and Transplant Outreach Programs at the Texas Liver Institute, answers key questions about Metabolic Dysfunction-Associated Steatohepatitis (MASH)—a progressive liver disease that was previously known as Non-Alcoholic Steatohepatitis (NASH).

MASH is the inflammatory form of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and is caused by the buildup of excess fat in the liver in individuals who consume little to no alcohol. This condition can lead to liver inflammation, fibrosis, cirrhosis, and an increased risk of liver cancer. While genetics may play a role, MASH is closely linked to metabolic disorders such as obesity, insulin resistance, type 2 diabetes, and dyslipidemia, which contribute to disease progression.

Diagnosing MASH requires a combination of clinical evaluation, imaging studies, and non-invasive tests. Physicians often use ultrasound or MRI to detect liver fat, while FibroScan helps assess liver stiffness and fibrosis. In some cases, a liver biopsy may be necessary to confirm the diagnosis and rule out other liver diseases. By integrating these diagnostic tools, healthcare providers can better assess the severity of MASH and guide treatment decisions.

The transition from NASH (Non-Alcoholic Steatohepatitis) to MASH (Metabolic Dysfunction-Associated Steatohepatitis) reflects a major shift in medical understanding. The previous term emphasized the absence of alcohol use but failed to highlight the metabolic dysfunction driving the disease. By renaming it MASH, the medical community now recognizes that metabolic health plays a critical role in disease progression. The name change also aligns research efforts and public health messaging, emphasizing the importance of early detection, lifestyle interventions, and emerging treatments that address both liver disease and metabolic risk factors.

With MASH now recognized as a metabolic-driven condition, healthcare providers are shifting their focus toward comprehensive management strategies that target obesity, insulin resistance, and dyslipidemia alongside liver-specific treatments. This new approach aims to improve patient outcomes by addressing the root causes of MASH rather than just its symptoms.

For more expert insights on MASH diagnosis, treatment, and management, visit the GHAPP website or download the GHAPP ACE App.

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

In this Medication Review Video Module, Robin Soto, NP, from UC San Diego Health Hepatology, provides an in-depth look at the mechanism of action of Resmetirom, the first and only FDA-approved drug for the treatment of Metabolic Dysfunction-Associated Steatohepatitis (MASH) in adults with F2, F3, or mild to moderate fibrosis.

Resmetirom is an oral, liver-directed, beta-selective thyroid hormone receptor agonist (THR-β agonist). In MASH, the accumulation of lipotoxic lipids leads to hepatocyte injury, inflammation, and hepatic stellate cell activation, resulting in progressive fibrosis and an increased risk of cirrhosis and hepatocellular carcinoma (HCC). By activating THR-β receptors primarily in the liver, Resmetirom reduces fat accumulation, enhances fatty acid oxidation, and lowers lipotoxicity, helping to slow disease progression.

Resmetirom works by regulating lipid metabolism, enhancing cholesterol conversion, and improving mitochondrial health. It upregulates genes involved in fatty acid oxidation, which helps reduce intrahepatic fat accumulation and improve overall lipid profiles. Additionally, Resmetirom increases the expression of bile acid synthesis enzymes, promoting cholesterol conversion to bile acids, which assists in lowering excess cholesterol in the liver.

Beyond its role in metabolism, Resmetirom enhances mitochondrial biogenesis and removes unhealthy mitochondria, increasing the liver's ability to metabolize free fatty acids. By reducing hepatic stellate cell activation, Resmetirom also decreases collagen deposition, which helps slow the progression of fibrosis and reduces inflammation associated with MASH.

Unlike systemic thyroid hormone therapies, Resmetirom selectively targets the liver, minimizing systemic thyroid-related side effects and making it a safe and effective treatment option for MASH.

For more expert insights, visit the GHAPP website and download the GHAPP ACE mobile app.