Surfing the MASH Tsunami

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In continuation of the Surfing NASH interview series, Roger Green talks to Professor Oren Shibolet, Head of Gastroenterology and Hepatology at the Tel Aviv Medical Center. This is a powerful discussion which touches on the Hamas invasion on October 7 and its aftermath on the Israeli people and the practice of medicine today.

In this conversation, Oren discusses ways that the Hamas invasion and slaughter have affected the collective perspective of Israelis. At the end, he also shares concerns about the long-term impact of the invasion and likely war to come on the practice of hepatology at his center, which has been until now a leading clinical trial site. This description cannot begin to touch on the gravity of this conversation, so surf on for the full account.

If you have questions or comments stemming from this episode, or the interview series in general, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at [email protected].

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In continuation of the Surfing NASH interview series, Roger Green talks to Professor Oren Shibolet, Head of Gastroenterology and Hepatology at the Tel Aviv Medical Center. This is a powerful discussion which touches on the Hamas invasion on October 7 and its aftermath on the Israeli people and the practice of medicine today. In this conversation, Oren discusses how the events of October 7 have affected the Israeli medical system, focusing largely on the practice of hepatology. Along the way, you will get a flavor of what it is like to live in a place where air raid sirens ring 5-6 times per day and there are strict, life-saving protocols about what to do when you hear the sirens. This description cannot begin to touch on the gravity of this conversation, so surf on for the full account.

If you have questions or comments stemming from this episode, or the interview series in general, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at [email protected].

Stay Safe and Surf On!

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In continuation of the Surfing NASH interview series, this week Roger Green talks to Professor Oren Shibolet, Head of Gastroenterology and Hepatology at the Tel Aviv Medical Center. This is a powerful discussion which touches on the Hamas invasion on October 7 and its aftermath on the Israeli people and the practice of medicine today. This first conversation starts with Professor Shibolet talking about his career history. From there he shifts to discuss his experiences of October 7, the devastating day of the Hamas terrorist attack.

If you have questions or comments stemming from this episode, or the interview series in general, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at [email protected].

Stay Safe and Surf On!

Send us Fan Mail

In continuation of the Surfing NASH interview series, this week Roger Green talks to Professor Oren Shibolet, Head of Gastroenterology and Hepatology at the Tel Aviv Medical Center. This is a powerful discussion which touches on the Hamas invasion on October 7 and its aftermath on the Israeli people and the practice of medicine today. Surf on to learn more about this current complex issue and more.

If you have questions or comments stemming from this episode, or the interview series in general, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at [email protected].

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One of the most important challenges facing Fatty Liver stakeholders involves improving early diagnosis for patients with clinically relevant or advanced fibrosis (F2/3). Today, a significant percentage of patients learn they are living with cirrhosis in the Emergency Department during a decompensating event. Four in ten of these patients in the UK do not leave the hospital. This episode From the Vault reviewed a model that Ian Rowe and Richard Parker developed to determine the most cost-effective strategy for F2/3 diagnosis.

In this conversation, Ian Rowe describes the factors that motivated him and Richard Parker to build a decision model focusing on early NASH diagnosis. He identifies three data points demonstrating how severely NASH stakeholders need a better early diagnosis paradigm and then describes the five diagnostic strategies his model will test. :

1. the high percentage of people whose liver disease is picked up for the first time when they present in the ED with decompensating disease or hepatic encephalopathy
2. the fact that roughly four in ten of these patients will die during treatment for this initial round of liver disease
3. the inefficiencies around diagnostic current methods, whereby practitioners flag abnormal liver enzyme tests and refer to specialists, where it may take months to get a specialist appointment.
4. He then describes the five early diagnostic strategies that will be tested and contrasted in this decision curve model.

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This week on SurfingNASH, we introduce the audience to new guest, Dr Roberta Forlano, who's been awarded an EASL Juan Rodes PhD Fellowship and has completed a PhD in Translational Hepatology at Imperial college London in 2022. Her current research interest are screening strategies for NAFLD in primary care, automated quantitation of histological features , lifestyle management, CV risk assessment and non-invasive markers in NAFLD. These interests and much more are shared and discussed with Jörn Schattenberg, Louise Campbell and Roger Green in a compelling episode with an overarching theme focusing on screening strategies for gender-based SLD challenges. To offer an example of how immensely productive and busy Roberta and her team have been, they recently presented 6 posters at the recently concluded SLD Summit.

This final conversation covers the other paper discussed in the episoe at large, a literature review looking at how MASH and MASLD might differ in women compared to men. Roberta starts by noting the gap in literature about gender differences in MASH studies, and that women appear represented in most clinical trials. Most of the rest of the conversation involves Roberta and Louise commenting on gender differences and the impact of menopausal status on MASH and MASLD in women. When this finishes, Roger asks Louise and Jörn to describe one thing we discussed that might affect their practices or patterns. He also asks Roberta what she would like listeners to take away from the conversation.

With that as a very brief introduction to a fascinating conversation well-worth a listen, surf on to learn more about Roberta and critical ideas around screening strategies and much more. If you have questions or comments stemming from this episode, or any others for that matter, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at [email protected].

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This week on SurfingNASH, we introduce the audience to new guest, Dr Roberta Forlano, who's been awarded an EASL Juan Rodes PhD Fellowship and has completed a PhD in Translational Hepatology at Imperial college London in 2022. Her current research interest are screening strategies for NAFLD in primary care, automated quantitation of histological features , lifestyle management, CV risk assessment and non-invasive markers in NAFLD. These interests and much more are shared and discussed with Jörn Schattenberg, Louise Campbell and Roger Green in a compelling episode with an overarching theme focusing on screening strategies for gender-based SLD challenges. To offer an example of how immensely productive and busy Roberta and her team have been, they recently presented 6 posters at the recently concluded SLD Summit.

This conversation starts with Roger asking Roberta to describe the demographics of the population in the northwest London region where the study of interest was done. Roberta comments on the robust diversity of the population, after which Louise amplifies this point by noting the large number of Arabic and South Asian patients in the study population. She discusses why culturally this might matter and the challenges that those populations might present. From there, we discuss the P-values associated with different diabetes drug therapies and their impact on MASH and simple diagnostic methods. Finally, ideas are shared around challenges which may present to patients which ultimately persuade them not to participate in a study. 

With that as a very brief introduction to a fascinating conversation well-worth a listen, surf on to learn more about Roberta and critical ideas around screening strategies and much more. If you have questions or comments stemming from this episode, or any others for that matter, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at [email protected].

Stay Safe and Surf On!

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This week on SurfingNASH, we introduce the audience to new guest, Dr Roberta Forlano, who's been awarded an EASL Juan Rodes PhD Fellowship and has completed a PhD in Translational Hepatology at Imperial college London in 2022. Her current research interest are screening strategies for NAFLD in primary care, automated quantitation of histological features , lifestyle management, CV risk assessment and non-invasive markers in NAFLD. These interests and much more are shared and discussed with Jörn Schattenberg, Louise Campbell and Roger Green in a compelling episode with an overarching theme focusing on screening strategies for gender-based SLD challenges. To offer an example of how immensely productive and busy Roberta and her team have been, they recently presented 6 posters at the recently concluded SLD Summit.

This conversation starts with your Jörn returning to a key point from Roberta's paper around a 38% false negative rate for FIB-4 screening. Jörn notes that while this feels like a high rate for false negatives, it might not present as much of a diagnostic challenge if treaters repeat the screening every 2 to 3 years. Roberta agrees and notes how remarkably cost effective this screening strategy is. Even in an environment with no approved drugs for MASH, Louise notes that the false negative rate for Enhanced Liver Fibrosis (ELF™) Test was far higher, which Roberta attributed to the test thresholds which were set for severe disease. She suggests that if health is to be used in these situations, the cutoffs need to be far lower. From there, the group goes into several issues of the paper the value of VCTE diagnostics, the common theme that most patients come from a background of lower socioeconomic status and the idea that simple ultrasound produced reasonably reliable results. This last point matters tremendously because primary care clinics throughout the world are more likely to have access to ultrasound than VCTE, and in some countries, ultrasound is the only imaging technique reimbursed by the health care system.

With that as a very brief introduction to a fascinating conversation well-worth a listen, surf on to learn more about Roberta and critical ideas around screening strategies and much more. If you have questions or comments stemming from this episode, or any others for that matter, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at [email protected].

Stay Safe and Surf On!

Send us Fan Mail

This week on SurfingNASH, we introduce the audience to new guest, Dr Roberta Forlano, who's been awarded an EASL Juan Rodes PhD Fellowship and has completed a PhD in Translational Hepatology at Imperial College London in 2022. Her current research interest are screening strategies for NAFLD in primary care, automated quantitation of histological features , lifestyle management, CV risk assessment and non-invasive markers in NAFLD. These interests and much more are shared and discussed with Jörn Schattenberg, Louise Campbell and Roger Green in a compelling episode with an overarching theme focusing on screening strategies for gender-based SLD challenges. To offer an example of how immensely productive and busy Roberta and her team have been, they recently presented 6 posters at the recently concluded SLD Summit.

This conversation starts with Louise introducing our new guest Surfer and why she felt the various recent papers might be so important for our audience. For Louise, the common thread in much of Roberta's work, and certainly the two papers we discuss in this episode, is the focus on at-risk populations, patients with Type-2 diabetes in primary research, and postmenopausal women in literature review. Most of the conversation entails Roberta discussing the reasons she and her team pursued the issue of screening done by frontline treaters among a high-risk patient group, and in this case, patients with Type-2 diabetes in the northwest area of London. She describes all the key elements of the paper, from how the group selected patients to screen and how to screen them to then what the researchers learned in the process of doing the study. When she finishes, Jörn commends the study and notes that the results described are similar to what he has seen when evaluating patients in this clinic 

With that as a very brief introduction to a fascinating conversation well-worth a listen, surf on to learn more about Roberta and critical ideas around screening strategies and much more. If you have questions or comments stemming from this episode, or any others for that matter, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at [email protected].

Stay Safe and Surf On!

Send us Fan Mail

This week on SurfingNASH, we introduce the audience to new guest, Dr Roberta Forlano, who's been awarded an EASL Juan Rodes PhD Fellowship and has completed a PhD in Translational Hepatology at Imperial college London in 2022. Her current research interest are screening strategies for NAFLD in primary care, automated quantitation of histological features , lifestyle management, CV risk assessment and non-invasive markers in NAFLD. These interests and much more are shared and discussed with Jörn Schattenberg, Louise Campbell and Roger Green in a compelling episode with an overarching theme focusing on screening strategies for gender-based SLD challenges. To offer an example of how immensely productive and busy Roberta and her team have been, they recently presented 6 posters at the recently concluded SLD Summit.

With that as a very brief introduction to a fascinating conversation well-worth a listen, surf on to learn more about Roberta and critical ideas around screening strategies and much more. If you have questions or comments stemming from this episode, or any others for that matter, we kindly ask that you submit reviews wherever you download the discourse. Alternatively, you can write to us directly at [email protected].

Stay Safe and Surf On!