Liver Disease - Testing & Treatment

Welcome to a new season of podcasts from Dr. Robert Gish!

In this latest podcast, Dr. Robert Gish discusses bepirovirsen (BEPI), an antisense oligonucleotide in development for the treatment of chronic hepatitis B. He explains how BEPI targets hepatitis B viral RNA and why this emerging therapy could represent an important step beyond long-term nucleos(t)ide therapy.

Dr. Gish reviews key results from the B-Well 1 and B-Well 2 Phase 3 studies, including functional cure rates and the potential for finite therapy and treatment discontinuation in selected patients. He also highlights the importance of quantitative hepatitis B surface antigen (qHBsAg) in identifying patients who may benefit.

With new data showing substantially higher functional cure rates than those typically achieved with nucleos(t)ide analogues, BEPI could open new doors and bring new hope to the treatment of chronic hepatitis B.

Please feel free to send any questions or feedback to Dr. Gish via email [email protected] or via his website www.robertgish.com

Thank you for listening!

With the recent renaming of NASH to MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) and the evolving landscape of treatment, when is the right time to use resmetirom? In this episode, we explore how this thyroid hormone receptor-β agonist is changing the management of MASLD, particularly in patients with significant fibrosis. We also break down non-invasive testing methods—for instance, elastography, CAP scores, (FibroScan), ELF score, and FIB4—to help stage patients and guide treatment decisions.

Tune in as we discuss the science, clinical guidelines, and real-world considerations for incorporating resmetirom into patient care!

Please feel free to send any questions or feedback to Dr. Gish via email [email protected] or via his website www.robertgish.com

Thank you for listening!

In this episode, Dr. Robert Gish, a leading expert in liver diseases, dives deep into second-line therapies for Primary Biliary Cholangitis (PBC), a chronic autoimmune liver disease. Dr. Gish explores key treatment options, including Ursodeoxycholic Acid (UDCA/"Urso" first-line), obeticholic acid (OCA/Ocaliva), elafibranor, and eeladelpar, discussing their mechanisms, benefits, and how they can be used to manage PBC. He also addresses the persistent challenge of managing pruritus (itch), a common symptom for patients. With a variety of treatment options available, Dr. Gish emphasizes that no PBC patient, in our ideal patient management world, should be progressing to the point of needing a liver transplant, and discusses how careful management can prevent disease progression. This episode provides valuable insights for both patients and healthcare providers looking to improve outcomes in PBC treatment.

Please feel free to send any questions or feedback to Dr. Gish via email [email protected] or via his website www.robertgish.com

Thank you for listening!

Join Dr. Robert Gish, a leading expert in liver health and diagnostics, in this deep dive into HepQuant DuO, a groundbreaking tool for assessing liver function. Dr. Gish will discuss how HepQuant DuO works, its significance in clinical practice, and the impact it has on patient care. Whether you're a healthcare professional, a student, or simply curious about liver health, this podcast promises to enhance your understanding of modern diagnostics and the future of liver disease management. Tune in to discover how HepQuant DuO is revolutionizing the way we approach liver assessment!

As always, you can send questions or feedback to Dr. Gish via email [email protected] or via his website www.robertgish.com

Thank you for listening!

In this episode, Dr. Robert Gish explores liver function tests (bilirubin, albumin and INR), with a focus on total and more importantly on direct bilirubin. He explains how these tests help doctors assess liver health and clarifies the difference between liver function tests and liver enzyme tests.

Many providers and patients are very confused when we use the term "liver function test" in our conversations. It is important to differentiate liver enzymes from function specifically in our dialogue with providers and patients to provide reassurance about liver health status. Bilirubin is the best liver function test, and direct bilirubin is the most useful inside measuring a total bilirubin. Albumin and INR are also helpful function tests. AST, ALT alkaline phosphate and GGT are not liver function tests. These are liver enzymes, and we should only use that term.

Dr. Gish also discusses Gilbert Syndrome, a common condition that can affect bilirubin levels. Tune in for expert insights on how to interpret direct bilirubin lab results and gain a better understanding of what your liver function tests can reveal. Whether you're a patient looking to make sense of your results or a healthcare professional seeking clarity, this episode offers valuable information.

Be sure to send any questions to Dr. Gish via email [email protected] or via his website www.robertgish.com. Thank you for listening!

In this enlightening episode, Dr. Robert Gish, a renowned expert in hepatology, explores the complexities of Hepatitis Delta (HDV), a deadly form of viral hepatitis. Dr. Gish emphasizes why all Hepatitis B (HBV) patients must be tested for HDV total antibodies, and if positive, further tested for HDV RNA quantification. He explains the significant risks HDV poses to liver health, its interaction with HBV, and the urgent need for proper diagnosis and management.

With new treatments on the horizon, Dr. Gish highlights the latest advancements in therapy, offering hope for more effective care. Whether you're a healthcare professional or someone interested in learning more about Hepatitis Delta, this episode provides crucial insights into testing, treatment options, and the future of HDV care.

Tune in for valuable info on how to navigate the challenges of Hepatitis Delta and the promising new approaches to treatment.

Be sure to send any questions to Dr. Gish via email [email protected] or via his website www.robertgish.com. Thank you for listening!

In this episode Dr. Gish takes a deep dive into statins—one of the most widely prescribed medications for managing cholesterol and preventing heart disease. Dr. Gish breaks down the risks and benefits of statins for chronic liver disease, offering clear, evidence-based insights on how to effectively incorporate them into patient care.

Statins historically (more than 20 years ago) carried some baggage about potential liver toxicity. But that fake news has been dispelled, and now we know the statins in general are liver protective. The risk of severe liver injury from a statin is in the range of 1:80000.

Whether you're a healthcare professional looking to enhance your understanding or simply interested in learning more about statins, this episode provides practical knowledge and clarity on this vital topic.

Be sure to send any questions to Dr. Gish via email [email protected] or via his website www.robertgish.com. Thank you for listening!

Join Dr. Robert Gish in this insightful episode as he discusses the latest breakthrough in Wilson disease treatment: Cuvrior. This innovative medication offers a new option for patients with Wilson disease, featuring a remarkable safety profile, the convenience of no refrigeration, and future possibility of once-a-day dosing (research in progress). Dr. Gish explores how Cuvrior is revolutionizing care with its potential to be more affordable than traditional treatments like trientine, depending on insurance and contracts. Listen in for an in-depth discussion on how Cuvrior is setting a new standard in the management of Wilson disease, providing hope for patients seeking effective, accessible, and safe treatment options. There is also a new assay in development for nonceruloplasmin copper concentration that will help with patient management (research update to follow).

Be sure to send any questions to Dr. Gish via email [email protected] or via his website www.robertgish.com. Thank you for listening!

In this episode, Dr. Robert Gish discussed the evolving world of Noninvasive Testing (NITs) for liver disease, focusing on their critical role in diagnosing and staging liver conditions. Dr. Gish breaks down the latest Noninvasive Liver Disease Assessment (NILDA), with an emphasis on fibrosis staging, and explores how these cutting-edge tools can also assess liver fat, inflammation, and disease activity. He explains why NITs are a cornerstone in providing optimal care for liver patients, how these tools should be part of your toolchest and are foundational for the best care of your liver patients

Whether you're a healthcare professional or someone interested in liver health, this episode is packed with valuable insights for enhancing patient outcomes and improving the staging and management of liver diseases.

Please send any questions to Dr. Gish via email [email protected] or via his website www.robertgish.com. Thanks for listening!

In this episode, Dr. Robert Gish, a renowned expert in hepatology, examines the critical role of the Gamma-Glutamyl Transferase (GGT) test in assessing liver health. Dr. Gish explains why GGT is an essential part of the liver enzyme panel and how it provides vital insights into a patient's inflammatory status, especially when alkaline phosphatase (ALP) alone may not be sufficient due to its limited sensitivity and specificity.

Tips for Providers:

• When ordering a liver enzyme panel, remember the "4 pillars" for a comprehensive evaluation of a patient's liver health, and always include GGT.
• Very high GGT values, when used in conjunction with PEth (Phosphatidylethanol) testing, can be an effective tool in identifying alcohol use disorder and alcohol-related liver disease.
• Disparate GGT and ALP levels can identify genetic diseases such as PFIC and other cholestatic variants.
• Keep in mind that high alkaline phosphatase levels can sometimes be misleading, as they may be caused by conditions like hyperparathyroidism or vitamin D deficiency, rather than liver disease.

Join Dr. Gish as he shares practical tips, clinical insights, and expert advice for better interpreting these vital lab tests to improve patient outcomes. Whether you're a seasoned clinician or just starting out, this episode is packed with valuable takeaways for anyone involved in liver care.

Please send any questions to Dr. Gish via email [email protected] or via his website www.robertgish.com. Thanks for listening!