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Last week, roughly 5,000 liver community stakeholders gathered in London for the 2022 International Liver Congress (#ILC2022,) the first major hepatology Congress to be held in person since the start of the pandemic (smaller, but very valuable, meetings like NASH-TAG, LiverCONNECT and Paris NASH have taken place with an in-person component, but the International Liver Congress and The Liver Meeting have not). The first three days of the program focused on a range of issues, with specific emphasis on non-invasive tests (NITs) and their role at different stages in diagnosis and treatment. This conversation touches on two issues: how proper use and explanation of NITs can increase patient motivation and why adding NITs to quality measures can have such an effect on educating providers and increasing treatment.

This conversation starts with Michelle Long and Louise Campbell discussing studies that demonstrated that patients receiving a FibroScan changed behaviors in ways that lasted at least six months, whether or not they learned they had liver fat. From here, Zobair Younossi discusses the importance of front-line, primary care screening with FIB-4 for all patients with diabetes. Zobair suggests that we consider making use of FIB-4 as a test for co-morbidities in diabetes a formal quality measure, in the same way that providers are required to check creatinine to assess possible kidney damage. Michelle and Roger Green added to Zobair's comment to discuss the specific benefits of adding an electronic health record-generated FIB-4 test as a standard assessment for diabetic patients. Zobair goes back to the point that we need primary care to serve as a front line for diabetes testing. In this context, he suggests the importance of FIB-4 and gives reasons he believes FibroScan will never become widely used in primary care. Louise Campbell disagreed, saying that having FibroScan in primary care would educate patients and drive better care. Jörn Schattenberg discusses some sessions where the consensus supported early FIB-4 use. Roger Green wraps up this conversation by talking about the importance of having formal quality measures around FIB-4 use in the US by telling a story from his own medical history.