Personalized Approaches to Metabolic Liver Disease and MASH Management

In this episode of MD Newsline, Dr. Christopher Kaisa, Assistant Professor of Medicine in the Section of Gastroenterology, Hepatology, and Nutrition at the University of Chicago Medicine, provides an in-depth discussion on Metabolic Dysfunction-Associated Steatohepatitis (MASH) and the evolving strategies for its management. He explains the latest non-invasive diagnostic tools, pharmacologic advancements, and the importance of multidisciplinary care in improving outcomes for patients with metabolic liver disease.

Episode Highlights: Patient Populations and Risk Factors Dr. Kaisa describes how obesity, type 2 diabetes, and hypertension significantly increase the risk of developing MASH. He notes that up to 75% of patients with obesity and diabetes may have some form of fatty liver disease—underscoring the urgent need for early detection and intervention. Gaps in Primary Care and Early Detection

He discusses existing gaps in primary care screening, emphasizing the importance of education and access to specialized metabolic liver clinics. Early identification of at-risk patients using tools like FibroScan and non-invasive fibrosis scores can dramatically change patient trajectories.

Risk Stratification and Fibrosis Assessment

Dr. Kaisa details how fibrosis staging correlates with both cardiovascular and liver-related mortality. He explains the use of non-invasive tests (NITs)—including FibroScan and fibrosis scores—to monitor disease progression and therapy response over time.

Therapies and Monitoring

The episode highlights new treatments, such as resmetirom and GLP-1 receptor agonists (e.g., semaglutide), which have shown fibrotic and inflammatory benefits in clinical trials. Dr. Kaisa explains how these agents are monitored, when to adjust dosages, and how to manage common gastrointestinal side effects.

Multidisciplinary Collaboration

Dr. Kaisa emphasizes the value of a multidisciplinary team, including hepatologists, endocrinologists, dietitians, and pharmacists, to manage the complex comorbidities associated with MASH. This integrated approach enables personalized and effective care for each patient.

The Role of Genetics and Personalized Medicine

He also discusses the PNPLA3 genetic variant, a known risk factor among certain ethnic groups, particularly those of Hispanic descent. Recognizing genetic predispositions helps clinicians counsel patients on modifiable risk factors such as diet, exercise, and metabolic control.

Clinical Trials and Access to New Treatments

Dr. Kaisa explains how clinical trials serve as vital access points for emerging therapies, especially for patients who may not tolerate or qualify for current treatments. He stresses the need to broaden patient participation in research to ensure equitable advancement in the field.

Key Takeaway

Dr. Kaisa underscores the critical importance of early detection, comprehensive metabolic management, and multidisciplinary collaboration in treating MASH. With the recent FDA approval of semaglutide for MASH, and ongoing advancements in personalized medicine, clinicians have powerful new tools to change the trajectory of this increasingly prevalent disease.

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