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his week, Surfing the NASH Tsunami returns to a subject we have explored from time to time over the past two years: helping patients with cirrhosis. While the immediate stimulus for doing so was the semaglutide late-breaker at #ILC2022, our more general interest is that many patients with cirrhosis will start to decompensate and decline in a fairly short period of time. This conversation brings together key threads from earlier in the episode, focusing significantly on providing better cirrhosis patient support as a key element in improving NASH cirrhosis therapies.

As this final conversation starts, Jörn Schattenberg and Lars Johansson are discussing two points: (i) the idea that even when a patient is diagnosed, this might not make it into that patient's medical record or become a focus of therapy, and (ii) the idea that the 30,000-patient study Lars has mentioned is focusing on deriving outcomes without biopsying patients. Louise Campbell joins in to endorse both these ideas, focusing more on capturing patients' NAFLD, NASH or NASH cirrhosis in the medical record and making it actionable. In particular, she notes that the investment necessary to improve communication will be far lower than what will be necessary to create or dramatically enhance drugs and diagnostic technologies.

This leads to Roger Green's closing question about a likely area for short-term improvement in a treatment area the panelist touches every day. Panelists' answers are diverse and thought-provoking.