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After a month of major Fatty Liver medical meetings, Jörn Schattenberg, Louise Campbell and Roger Green explore emerging stories that will shape the next 6-12 months in Fatty Liver disease. This conversation explores the role of multiple biomarker tests in the diagnostic process and how these might vary in the panelists’ home countries.

To begin, Louise notes that in the UK, many primary care physicians do not perform even basic liver tests, making it impossible to compute FIB-4. Roger questions whether publicizing of guidelines like the AACE or EASL guidelines will speed uptake of FIB-4. The guidelines recommend that front-line physicians not screen their T2DM patients for NAFLD, since 80+% will test positive. Instead, they recommend using a FIB-4 test to identify patients at risk due to current fibrosis. Roger then asks whether these guidelines will move into actual practice. Louise and Jörn each note that in their countries, front-line professionals are not required to perform liver enzyme blood work. Yet, these tests are pivotal for early liver screening. Louise doubts that change will come until after an expensive drug is approved, at which point there will be economic motivation to test. Jörn is more hopeful that with simple tests, he and other hepatologists can educate endocrinologist colleagues on the reasons to adopt this testing strategy over time.

As the conversation wraps up, Jörn begins to segue from the future of care pathways to the exciting future of drug development.