S2-E47 - Ask Opinion Leaders: The Biggest NAFLD/NASH Stories of Summer

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Ian Rowe, Michelle Long and Manal Abdelmalek reveal what they consider the most important NAFLD/NASH stories of summer.

Which NAFLD/NASH stories did they choose? The newly-appointed Professor Rowe discusses the importance of the FDA approval of the ELF test as a prognostic for cirrhosis. True to her epidemiological background, Professor Long reviews the prospective prevalence study that Stephen Harrison, Naim Alkhouri and others conducted in San Antonio. Finally, Professor Abdelmalek uses a comment she received at a presentation this summer as a jumping-off point to discuss potential value currently available generic drugs -- metformin, statins, carvedilol -- in treating portal pressure among cirrhosis patients. Some highlights:

4:39 - Ian Rowe's understated announcement
6:31 - Ian's event: FDA approves ELF
9:49 - ELF (and other NITs) will improve risk stratification by replacing ordinal Fibrosis scores with continuous test results
11:37 - Louise Campbell raises the issue of testing for the increasing NAFLD/NASH prevalence in Third World countries with fewer resources than the West has
13:02 - Ian notes that widespread population screening must start with a simple, inexpensive test, even in wealthier countries
14:54 - Roger Green raises the value of visual (picture) test results and asks how blood-based tests can overcome the fact that they do not produce pictures. Discussion and friendly debate about relative value of risk scores and visual outputs ensues.
18:39 - Ian discusses his work on patients' understanding of cirrhosis, which demonstrates the value of nursing in cirrhosis care clinics. Louise amplifies his point.
22:34 - Wrap-up question for Ian's interview
24:20 - Conversation with Michelle Long begins
26:49 - MIchelle's event: Stephen Harrison and Naim Alkhouri's paper on "Prospective Evaluation of the Prevalence of Fatty Liver Disease and NASH in an Unselected Middle-age Cohort"
28:28 - MIchelle mentions NAFLD/NASH prevalence rates among study participants
32:35 - Louise revealed what she learned in a high-level qualitative scan of patient records
33:36 - Louise discusses recent paper on the long-term of simple steatosis
35:27 - Louise wonders about the level of NAFLD/NASH education and awareness among endocrinologists.
40:10 - Louise raises the idea of scanning patients who have come to physician for other procedures, just as Stephen did in the prevalence study
44:56 - Conversation with Manal Abdelmalek begins
47:40 - Manal's event: NIH funding the new liver cirrhosis network
49:22 - Manal focuses on the urgency of doctors and patient today, the need to propose helpful therapies. At 50:30, she discusses a recent single-dose 1000mg metformin study checking its effect on portal pressure in patients with cirrhosis.
53:35 - Manal notes that statins, beta blockers have some reported positive effects in cirrhosis
56:27 - Roger raises the idea of maintaining fibrosis level as a clinically meaningful endpoint for approval
59:28 - Louise describes a way that even general practice physicians can track cirrhosis using their FibroScan machines or other equipment
1:03:19 - Manal raises the idea that this is drug help we can provide for some patients now, before approval
1:07:19 - Closing question for the third conversatio