GHAPPcast

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, discusses the serious consequences of untreated Metabolic Dysfunction-Associated Steatohepatitis (MASH) and how Advanced Practice Providers (APPs) can play a crucial role in patient education and early intervention.

MASH is often a silent liver disease, meaning symptoms may not appear until significant damage has occurred. If left untreated, MASH can progress to liver inflammation, fibrosis, cirrhosis, and even liver failure. Alarmingly, MASH is now the fastest-growing cause of liver cancer and the leading indication for liver transplants in the U.S.. Beyond liver complications, the metabolic dysfunction associated with MASH—including insulin resistance, obesity, and dyslipidemia—increases the risk of cardiovascular disease, heart attack, and stroke. Additionally, poorly managed MASH can worsen insulin resistance, leading to the development or progression of type 2 diabetes. These life-threatening consequences make early detection and proactive management essential in preventing long-term health complications.

APPs, including nurse practitioners (NPs) and physician assistants (PAs), play a vital role in educating patients about MASH and the importance of early intervention. One of the most effective strategies is to simplify complex medical concepts by using layman's terms, visual aids, and relatable analogies to explain MASH, its progression, and how it affects liver health. Avoiding medical jargon ensures that patients fully understand the risks associated with the disease.

Another key approach is to highlight the connection between MASH and metabolic health. Educating patients about the links between MASH, obesity, type 2 diabetes, and high cholesterol helps them understand how managing metabolic syndrome can help prevent or slow MASH progression. It’s also crucial to emphasize the benefits of early intervention, explaining that MASH progression can be prevented through lifestyle changes, medical management, and early detection. Taking action early can help prevent MASH from advancing to cirrhosis, liver failure, or cancer.

Encouraging lifestyle modifications is another essential role for APPs. Providing patients with practical, achievable strategies for improving diet, exercise, and metabolic health can lead to long-term success. Offering referrals to dietitians, structured fitness plans, and nutrition guidelines can support sustainable changes without overwhelming patients.

Finally, staying updated on the latest research, treatment guidelines, and clinical recommendations for MASH allows APPs to provide the most effective and up-to-date patient education. Sharing real-life patient success stories can also be a powerful motivator, demonstrating that early lifestyle modifications and treatment can significantly improve patient outcomes.

By implementing these education and engagement strategies, APPs can enhance patient understanding of MASH, encourage early intervention, and ultimately help reduce the growing burden of MASH-related liver disease and metabolic complications.

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

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

In this FAQ Video Module, Jonathan Yeh, PA, from Columbia University Irving Medical Center, discusses the evolution of Metabolic Dysfunction-Associated Steatohepatitis (MASH) diagnosis and fibrosis staging. Formerly known as NASH, MASH was traditionally diagnosed through liver biopsy, but non-invasive testing (NITs) is now widely accepted for fibrosis assessment.

Key non-invasive methods include FibroScan, which uses Vibration-Controlled Transient Elastography (VCTE), the Enhanced Liver Fibrosis (ELF) Test, and the FibroSure Blood Test. When used together, these tests provide a reliable assessment of fibrosis stage, significantly reducing the need for invasive liver biopsy.

Fibrosis staging follows the METAVIR system, which categorizes fibrosis from Stage 0 (no fibrosis) to Stage 4 (cirrhosis). Additionally, necroinflammatory activity is scored from A0 to A3, representing increasing hepatitis severity. By integrating FibroScan with ELF or FibroSure blood test results, healthcare providers can improve diagnostic accuracy and ensure more effective patient management.

As non-invasive fibrosis staging continues to evolve, incorporating these advanced diagnostic tools allows for earlier detection, better disease monitoring, and improved treatment strategies for patients with MASH.

For more expert insights, visit the GHAPP website or download the GHAPP ACE app on IOS or Android.

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

In this Medication Review Video Module, Whitney Steinmetz, NP, provides an in-depth discussion on the clinical profile of Retam (Resd) for Metabolic-Associated Steatohepatitis (MASH) with moderate to advanced F2 or F3 fibrosis. While Retam is not currently FDA-approved for patients with cirrhosis, ongoing trials are evaluating its potential in this population.

As a partial agonist of the thyroid hormone receptor beta, Retam targets hepatic metabolism, reducing intrahepatic triglycerides and improving liver health without significantly affecting thyroid hormone receptor alpha—which mediates effects on the heart and bones. The 52-week study demonstrated its effectiveness in resolving steatohepatitis and improving fibrosis without worsening inflammation.

Available in 60 mg, 80 mg, and 100 mg tablets, dosage is weight-based, with 80 mg recommended for patients under 100 kg and 100 mg for those over 100 kg. Due to its metabolism via CYP2C8, Retam should not be used with strong inhibitors like gemfibrozil, and statin doses may require adjustment.

Common side effects include nausea and diarrhea, which typically resolve over time. Mild serum aminotransferase elevations may occur early in treatment but often decrease within 3-6 months, correlating with reductions in hepatic fat and steatohepatitis.

For more expert insights on MASH management, visit the GHAPP website or the GHAPP ACE app.

Thank you to Madrigal for your support of this GHAPPcast episode.

In this GHAPPcast episode, Patrick Horne, NP, from the University of Florida, and April Morris, NP, from Richmond VA, discuss how to recognize the severity of MASH, identify at-risk patients, and implement early intervention strategies to prevent disease progression.

MASH is strongly linked to metabolic dysfunction, making certain populations more vulnerable to developing the disease. Some of the key risk factors include type 2 diabetes, obesity, hypertension, and high cholesterol. Family history also plays a crucial role, as many patients with MASH have relatives who have experienced early heart attacks, strokes, or diabetes. As Patrick Horne, NP, points out, genetic predisposition often contributes to metabolic diseases, making a detailed family history essential for identifying at-risk individuals.

One of the biggest challenges in MASH management is that liver enzyme levels (ALT, AST) do not always indicate disease severity. Many patients with advanced fibrosis or cirrhosis can have completely normal liver function tests, leading to missed diagnoses. To accurately stage MASH and assess fibrosis risk, providers should rely on non-invasive liver assessments in addition to bloodwork. Tools like the FIB-4 Score, FibroScan, MRI Elastography (MRE), and ultrasound help stratify risk, guide treatment decisions, and reduce the need for liver biopsy in many cases.

While pharmacologic treatment for MASH has recently emerged, lifestyle modification remains the foundation of management. Healthcare providers should emphasize dietary changes and exercise to slow MASH progression. The Mediterranean diet is often recommended due to its benefits in liver and metabolic health. Increasing intake of vegetables, lean proteins, and fiber-rich foods while reducing processed foods and sugar-sweetened beverages is key. Exercise is equally critical, as regular physical activity helps reduce liver fat, improve insulin sensitivity, and lower cardiovascular risk. One simple but effective intervention is eliminating sugar-sweetened beverages, such as sodas and energy drinks, which can significantly contribute to liver fat accumulation.

Until recently, there were no FDA-approved medications for MASH, but in March 2024, the FDA approved Resmetirom as the first therapy for non-cirrhotic MASH with moderate to advanced fibrosis (F2-F3). Resmetirom is a thyroid hormone receptor beta (THR-β) selective agonist that targets liver fat metabolism, inflammation, and fibrosis progression. Clinical trials have shown that Resmetirom significantly improves MASH resolution and reduces fibrosis progression, making it a breakthrough therapy for patients at risk of cirrhosis. However, insurance coverage varies, and providers may need to assist with prior authorizations to ensure patient access to treatment.

Once a patient is diagnosed with MASH, regular follow-up and monitoring are essential. For those started on medication therapy, providers typically schedule follow-up visits every 4-6 weeks to evaluate symptoms and ensure medication adherence. Lab work and imaging studies (FibroScan, MRI elastography) may also be used to track treatment response and liver fibrosis progression over time. Weight loss goals should be individualized, but even a 7-10% reduction in body weight has been shown to significantly improve liver health. Patients should be encouraged to approach weight loss gradually, as rapid weight loss can actually worsen liver disease.

MASH is a serious yet manageable disease that requires early recognition, metabolic risk assessment, and proactive intervention. With the availability of new non-invasive diagnostics and FDA-approved treatments, providers now have more tools than ever to improve patient outcomes and reduce the burden of MASH-related liver disease. By emphasizing early detection, lifestyle interventions, and personalized treatment strategies, healthcare providers can help patients mitigate their risk of fibrosis progression and improve overall metabolic health.

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

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

In this FAQ Video Module, Kim Orleck, PA-C, from Atlanta Gastroenterology Associates, discusses best practices to accelerate the process of identifying the right therapy for patients with Irritable Bowel Syndrome with Constipation (IBS-C). A timely and accurate diagnosis is the foundation for effective treatment, helping reduce unnecessary testing, lower financial burdens, and get patients on the right therapy as quickly as possible.

One of the most significant advancements in managing IBS-C is the shift to a positive diagnostic strategy. Rather than relying on extensive exclusion-based testing, this approach allows providers to confidently diagnose IBS-C sooner, reducing diagnostic delays and improving patient outcomes. A faster diagnosis leads to earlier treatment, which not only improves symptoms sooner but also builds patient trust and confidence in their healthcare provider.

Once patients begin therapy, follow-up at 2-3 months is essential to assess both bowel symptom improvement and global symptom relief. If a patient has not achieved their therapeutic goals by this time, providers should reevaluate treatment options and consider alternative therapies. Factors influencing treatment selection include dosing frequency (once daily vs. multiple doses per day), timing of medication in relation to meals, side effect profile and individual patient tolerance, patient preferences and lifestyle considerations.

Shared decision-making is crucial in selecting the best treatment for IBS-C. Involving patients in the discussion helps ensure better adherence and satisfaction with the prescribed therapy. Additionally, cost and insurance coverage should always be factored into the treatment plan to avoid delays in access to medications. Keeping detailed records of previous treatment trials and patient responses helps prevent unnecessary medication switches and streamlines insurance approvals.

By adopting a structured and patient-centered approach, providers can significantly reduce the time to effective IBS-C treatment, enhance patient-provider relationships, and improve long-term management of IBS-C symptoms.

For more expert insights on IBS-C diagnosis, treatment strategies, and patient management, visit the GHAPP website or download the GHAPP ACE mobile app.

Thank you to Ardelyx for your support of this GHAPPcast episode.

In this episode of GHAPPcast, the official podcast for Gastroenterology and Hepatology Advanced Practice Providers, host Christina Hanson, NP, is joined by Kim Kearns, NP, to explore the complex pathophysiology of IBS-C (Irritable Bowel Syndrome with Constipation) and the evolving neuromodulation strategies that enhance patient care.

The discussion kicks off by addressing IBS as a disorder of gut-brain interaction (DGBI)—a paradigm shift from the older classification of functional GI disorders. The speakers dive deep into the physiological and neurological pathways that contribute to IBS symptoms, including visceral hypersensitivity, dysbiosis, motility dysfunction, and altered mucosal immunity. Kim and Christina explain how neurotransmitters like serotonin and dopamine play a critical role in gut function, and how disruption in their signaling can exacerbate abdominal pain, bloating, and altered bowel habits.

With a growing arsenal of IBS-C treatments, this episode highlights the clinical utility of neuromodulators such as tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). Kim shares practical insights into when and how to implement neuromodulation for patients with persistent pain and visceral hypersensitivity while addressing common patient concerns about antidepressant use for GI conditions. The conversation also explores cognitive behavioral therapy (CBT) and gut-directed hypnotherapy as emerging non-pharmacologic interventions that can reduce symptom severity and improve patient outcomes.

A central theme of the episode is patient-centered care and shared decision-making. The speakers emphasize the importance of validating the patient experience, educating them on the biopsychosocial model of IBS, and setting realistic expectations for symptom management. They discuss effective communication strategies, the role of digital therapeutics, and ways to enhance patient-provider trust to ensure adherence to treatment plans.

Tune in to GHAPPcast for this expert-led discussion on best practices for IBS-C management and learn how to integrate neuromodulation, cognitive therapy, and patient education into your clinical approach. For more information, visit GHAPP.org or download the GHAPP ACE app for more information.

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

Join Tedra Gray, NP, as she dives into what it means for a biosimilar to be interchangeable. Interchangeability is a key designation in the world of biosimilars, ensuring that these medications can be substituted for their reference products at the pharmacy level without the need for prescriber approval. Only a select few biosimilars have earned interchangeability status, meaning they have undergone rigorous FDA evaluation to demonstrate that switching between the biosimilar and the reference product does not compromise safety, efficacy, or patient outcomes. This designation plays a critical role in reducing healthcare costs for both patients and payers by allowing for seamless substitutions when the reference product is unavailable.

To receive FDA approval as an interchangeable biosimilar, manufacturers must conduct extensive clinical studies assessing safety and effectiveness when patients alternate between the reference product and the biosimilar. The results must confirm no loss of effectiveness or increase in safety risks associated with switching. This process ensures that patients receive continuous treatment without unnecessary delays or interruptions in care.

Interchangeable biosimilars are essential in improving access to treatment and managing diseases in a cost-efficient manner. To learn more about biosimilars, interchangeability, and their impact on patient care, visit www.ghapp.org or visit the GHAPP ACE mobile app.

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

In this FAQ Video Module, Kim Orleck, PA-C, from Atlanta Gastroenterology Associates, shares the most valuable resources for staying up to date on the latest approaches to managing IBS-C patients. As treatment strategies continue to evolve, leveraging evidence-based guidelines, professional conferences, industry expertise, and peer discussions can enhance patient care and optimize treatment outcomes.

One of the most critical resources for managing IBS-C is clinical guidelines. Both the American College of Gastroenterology (ACG) and American Gastroenterological Association (AGA) guidelines offer comprehensive, evidence-based recommendations for diagnosing and treating IBS-C. These guidelines align closely on key management strategies, making them essential reading for any healthcare provider treating patients with IBS-C.

Beyond published guidelines, attending conferences is an invaluable way to stay current with emerging research and treatment advancements. Events like GHAPP’s regional and national conferences provide networking opportunities, peer collaboration, and expert-led discussions tailored for advanced practice providers (APPs) in gastroenterology and hepatology. Additionally, the ACG Annual Meeting is another excellent platform for learning about the latest research, therapeutic innovations, and clinical best practices in IBS-C management.

Industry partnerships also play a crucial role in expanding knowledge about new therapies, clinical trial data, and medication access. Engaging with pharmaceutical representatives and medical science liaisons (MSLs) can provide deeper insights into treatment efficacy, side effect profiles, and insurance coverage considerations. Attending industry-sponsored dinners, webinars, and educational programs can further enhance clinical understanding and keep providers informed on the latest advancements in IBS-C treatment.

Lastly, peer-to-peer discussions are a valuable and often underutilized resource. Collaborating with fellow APPs, supervising physicians, and GI specialists fosters shared learning and exchange of best practices. Discussing real-world cases and patient experiences with colleagues can provide practical insights that go beyond textbook knowledge and help refine individualized patient care approaches.

By utilizing clinical guidelines, conferences, industry expertise, and peer collaboration, APPs can ensure they are delivering evidence-based, patient-centered care for individuals with IBS-C.

For more expert insights on IBS-C diagnosis, treatment strategies, and patient management, visit the GHAPP website or download the GHAPP ACE app.

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

In this episode, Kim Orleck, PA-C, discusses key strategies for evaluating treatment response in patients with IBS-C (Irritable Bowel Syndrome with Constipation). With multiple therapeutic options now available, it is essential for providers to take a patient-centered approach to ensure meaningful symptom improvement and treatment satisfaction.

A critical component of effective IBS-C management is setting realistic treatment goals and ensuring that both providers and patients align on expectations. Since bowel symptoms typically improve faster than pain and bloating, clinicians must educate patients on realistic timelines for symptom relief. Additionally, understanding which symptoms are most bothersome allows providers to focus on personalized treatment strategies that target the patient's specific concerns.

Kim Orleck emphasizes the importance of open-ended questioning, as this allows providers to gain deeper insights into the patient's experience rather than relying on simple yes/no answers. Evaluating global symptom relief, including pain, bloating, and overall quality of life, ensures a more comprehensive assessment of treatment success. With more treatment options available than ever before, it is essential that patients feel empowered to explore alternative therapies if their current treatment is not delivering optimal results.

Watch now to learn how to optimize IBS-C treatment strategies and improve patient outcomes. For more resources, visit the GHAPP website or download the GHAPP ACE mobile app on IOS or Android.

Thank you to Boehringer Ingelheim for your support of this podcast.

Welcome to GHAPPcast, the official podcast for gastroenterology and hepatology advanced practice providers. Hosted by Gabriella McCarty, a nurse practitioner at NorthShore Gastroenterology in Cleveland, this episode dives into a crucial topic—biosimilars from a patient’s perspective. As a founding member of GHAPP and a provider with 25 years of experience in general GI, IBD, and hepatology, Gabriella is excited to explore the real-world impact of biosimilars through the eyes of a patient.

In this episode, we welcome Emily, a Crohn’s disease patient who has firsthand experience transitioning to and from biosimilars. She shares her journey, initial concerns, and how switching medications impacted her health. With insurance-driven transitions from Remicade to Inflectra and back, Emily provides valuable insights into the realities of biosimilar treatment, debunking misconceptions, and highlighting the importance of open communication with healthcare providers.

For patients, providers, and caregivers navigating biosimilar treatments, this discussion offers a unique perspective on the transition process, medication efficacy, and long-term remission maintenance. Whether you’re a clinician seeking to guide patients or someone facing a biosimilar switch, this episode provides essential takeaways for ensuring a smooth and informed treatment journey.

Subscribe to GHAPP for more expert insights into gastroenterology, hepatology, IBD, and patient-centered care. Visit ghapp.org and download the GHAPP ACE app for more educational content.