Thread by @mqkMD

@AmCollegeGastro Virtual Grand Rounds meets #livertwitter - NASH - 🔑 Pts:
🩺 NAFLD Dx ➡️5% steatosis ; NASH has specific path criteria (🎈 dilatation, M-D bodies, etc); Exclude🍻 and other etiologies; Assoc w/ met. RFs
🌎 Prevalence 25%👨; 7-10%👧🧒 ; In DM II ➡️ 55.5%;

🍃 History - NAFLD➡️NASH➡️Cirrhosis➡️HCC. Non-linear progression also exists! HCC w/o cirrhosis (0.592%/year);
📈Predictors of Progress: (a) Met. RFs; (b) Stage of Fibrosis (>= F2)
⚕️ #2 indication for LT and ⬆️; #1 in ♀️
⬆️DALYs (07-17)
📊By 2030 ~800,000 excess liver deaths;

NAFLD assoc. w/ ⬆️🫀 events AND non-liver CA.! Also assoc. w/ FATIGUE ➡️👎 QOL
💱 Economic Burden -- $95.4 billion 💰lifetime cost of adv. NASH
NASH Diagnosis: 🪙 Standard = Liver Bx; But ⚠️; Can use Non-invasive Tests/Biomarkers e.g. U/S, TE, MRE, FLI, CK-18, FIB4, NFS, ELF etc

🩸Biomarkers for Fibrosis: FIB4, APRI, NFS +/- ELF
📸 for Fibrosis: TWE, SWE, MRE
💡2 step algorithm for Risk Stratification
MGMT ➡️ Public Interventions and Patient 🎯 (NASH +/- AF)

⚖️ WEIGHT LOSS is🔑! 7-10% improves steatosis, NASH and fibrosis! But, only 15% keep it off ☹️
🥗 Mediterranean vs. 🍲Low-fat Diet➡️ ⬆️ improvement of steatosis
💊Pioglitazone: 👍histology w/ or w/o DM w/ BIOPSY-proven NASH
💊Vit. E - 👌for non-DM w/o cirrhosis;

💉 GLP-1 agonists : ⬆️Weight Loss and ⬇️ NASH, Steatosis and Fibrosis
🔵PPAR Pathways - Elafibranor ➡️NASH resolution, but Fibrosis improvent NS
🔵Selonsertib - 🚫endpoints;
🔵Cenicriviroc - ⬇️Fibrosis but NASH resolution not met

💊OCA - FLINT, REGENERATE - ⬇️ fibrosis by ≥1 stage w/o ⬆️NASH; Post-hoc: NASH resolution w/ no ⬆️fibrosis and improved histology!
⚠️Pruritus (>50% in OBC 25 mg) and ⬆️LDL

⚕️Future Directions - 🎯 Multiple Pathways: 1⃣ASK1 + NS FXR agonist; 2⃣PPAR alpha/delta + FXR agonist; OR 3⃣ CCR2/CCR5 blockers + FXR agonist
🏥 Multi-Disciplinary Approach 👍: Primary Care, Hepatology, Endocrinology, Nutrition, PT, etc.