Liver Disease - Testing & Treatment
This podcast, hosted by renowned hepatologist Dr. Robert Gish, will delve into various topics related to liver disease. These will include hepatitis, cholestatic liver disease, diagnostics, testing methods, treatment options, stigma and other related topics. If you are a gastroenterologist, hepatologist, liver disease fellow or a patient with liver disease, this podcast is for you!
info_outline
When Do I Use Resmetirom for Nonalcoholic Steatohepatitis (NASH)
03/14/2025
When Do I Use Resmetirom for Nonalcoholic Steatohepatitis (NASH)
With the recent renaming of NASH to MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease) and the evolving landscape of treatment, when is the right time to use resmetirom? In this episode, we explore how this thyroid hormone receptor-β agonist is changing the management of MASLD, particularly in patients with significant fibrosis. We also break down non-invasive testing methods—for instance, elastography, CAP scores, (FibroScan), ELF score, and FIB4—to help stage patients and guide treatment decisions. Tune in as we discuss the science, clinical guidelines, and real-world considerations for incorporating resmetirom into patient care! Please feel free to send any questions or feedback to Dr. Gish via email or via his website Thank you for listening!
/episode/index/show/b260931e-bd3b-44ea-8194-57c71cf0c9fd/id/35676095
info_outline
Primary Biliary Cholangitis & Second Line Therapy
02/27/2025
Primary Biliary Cholangitis & Second Line Therapy
In this episode, Dr. Robert Gish, a leading expert in liver diseases, dives deep into second-line therapies for Primary Biliary Cholangitis (PBC), a chronic autoimmune liver disease. Dr. Gish explores key treatment options, including Ursodeoxycholic Acid (UDCA/"Urso" first-line), obeticholic acid (OCA/Ocaliva), elafibranor, and eeladelpar, discussing their mechanisms, benefits, and how they can be used to manage PBC. He also addresses the persistent challenge of managing pruritus (itch), a common symptom for patients. With a variety of treatment options available, Dr. Gish emphasizes that no PBC patient, in our ideal patient management world, should be progressing to the point of needing a liver transplant, and discusses how careful management can prevent disease progression. This episode provides valuable insights for both patients and healthcare providers looking to improve outcomes in PBC treatment. Please feel free to send any questions or feedback to Dr. Gish via email or via his website Thank you for listening!
/episode/index/show/b260931e-bd3b-44ea-8194-57c71cf0c9fd/id/35415255
info_outline
Exploring HepQuant DuO - Liver Function Test
02/13/2025
Exploring HepQuant DuO - Liver Function Test
Join Dr. Robert Gish, a leading expert in liver health and diagnostics, in this deep dive into HepQuant DuO, a groundbreaking tool for assessing liver function. Dr. Gish will discuss how HepQuant DuO works, its significance in clinical practice, and the impact it has on patient care. Whether you’re a healthcare professional, a student, or simply curious about liver health, this podcast promises to enhance your understanding of modern diagnostics and the future of liver disease management. Tune in to discover how HepQuant DuO is revolutionizing the way we approach liver assessment! As always, you can send questions or feedback to Dr. Gish via email or via his website Thank you for listening!
/episode/index/show/b260931e-bd3b-44ea-8194-57c71cf0c9fd/id/33395097
info_outline
When and How to Use the Direct Bilirubin
01/16/2025
When and How to Use the Direct Bilirubin
In this episode, Dr. Robert Gish explores liver function tests (bilirubin, albumin and INR), with a focus on total and more importantly on direct bilirubin. He explains how these tests help doctors assess liver health and clarifies the difference between liver function tests and liver enzyme tests. Many providers and patients are very confused when we use the term “liver function test” in our conversations. It is important to differentiate liver enzymes from function specifically in our dialogue with providers and patients to provide reassurance about liver health status. Bilirubin is the best liver function test, and direct bilirubin is the most useful inside measuring a total bilirubin. Albumin and INR are also helpful function tests. AST, ALT alkaline phosphate and GGT are not liver function tests. These are liver enzymes, and we should only use that term. Dr. Gish also discusses Gilbert Syndrome, a common condition that can affect bilirubin levels. Tune in for expert insights on how to interpret direct bilirubin lab results and gain a better understanding of what your liver function tests can reveal. Whether you're a patient looking to make sense of your results or a healthcare professional seeking clarity, this episode offers valuable information. Be sure to send any questions to Dr. Gish via email or via his website . Thank you for listening!
/episode/index/show/b260931e-bd3b-44ea-8194-57c71cf0c9fd/id/34873135
info_outline
Hepatitis Delta
01/02/2025
Hepatitis Delta
In this enlightening episode, Dr. Robert Gish, a renowned expert in hepatology, explores the complexities of Hepatitis Delta (HDV), a deadly form of viral hepatitis. Dr. Gish emphasizes why all Hepatitis B (HBV) patients must be tested for HDV total antibodies, and if positive, further tested for HDV RNA quantification. He explains the significant risks HDV poses to liver health, its interaction with HBV, and the urgent need for proper diagnosis and management. With new treatments on the horizon, Dr. Gish highlights the latest advancements in therapy, offering hope for more effective care. Whether you're a healthcare professional or someone interested in learning more about Hepatitis Delta, this episode provides crucial insights into testing, treatment options, and the future of HDV care. Tune in for valuable info on how to navigate the challenges of Hepatitis Delta and the promising new approaches to treatment. Be sure to send any questions to Dr. Gish via email or via his website . Thank you for listening!
/episode/index/show/b260931e-bd3b-44ea-8194-57c71cf0c9fd/id/34675100
info_outline
Statins in Chronic Liver Disease
12/21/2024
Statins in Chronic Liver Disease
In this episode Dr. Gish takes a deep dive into statins—one of the most widely prescribed medications for managing cholesterol and preventing heart disease. Dr. Gish breaks down the risks and benefits of statins for chronic liver disease, offering clear, evidence-based insights on how to effectively incorporate them into patient care. Statins historically (more than 20 years ago) carried some baggage about potential liver toxicity. But that fake news has been dispelled, and now we know the statins in general are liver protective. The risk of severe liver injury from a statin is in the range of 1:80000. Whether you’re a healthcare professional looking to enhance your understanding or simply interested in learning more about statins, this episode provides practical knowledge and clarity on this vital topic. Be sure to send any questions to Dr. Gish via email or via his website . Thank you for listening!
/episode/index/show/b260931e-bd3b-44ea-8194-57c71cf0c9fd/id/34563890
info_outline
Cuvrior: A New Treatment for Wilson Disease
12/05/2024
Cuvrior: A New Treatment for Wilson Disease
Join Dr. Robert Gish in this insightful episode as he discusses the latest breakthrough in Wilson disease treatment: Cuvrior. This innovative medication offers a new option for patients with Wilson disease, featuring a remarkable safety profile, the convenience of no refrigeration, and future possibility of once-a-day dosing (research in progress). Dr. Gish explores how Cuvrior is revolutionizing care with its potential to be more affordable than traditional treatments like trientine, depending on insurance and contracts. Listen in for an in-depth discussion on how Cuvrior is setting a new standard in the management of Wilson disease, providing hope for patients seeking effective, accessible, and safe treatment options. There is also a new assay in development for nonceruloplasmin copper concentration that will help with patient management (research update to follow). Be sure to send any questions to Dr. Gish via email or via his website . Thank you for listening!
/episode/index/show/b260931e-bd3b-44ea-8194-57c71cf0c9fd/id/34291965
info_outline
How To Use Noninvasive Testing (NITs) in Your Practice Today
11/22/2024
How To Use Noninvasive Testing (NITs) in Your Practice Today
In this episode, Dr. Robert Gish discussed the evolving world of Noninvasive Testing (NITs) for liver disease, focusing on their critical role in diagnosing and staging liver conditions. Dr. Gish breaks down the latest Noninvasive Liver Disease Assessment (NILDA), with an emphasis on fibrosis staging, and explores how these cutting-edge tools can also assess liver fat, inflammation, and disease activity. He explains why NITs are a cornerstone in providing optimal care for liver patients, how these tools should be part of your toolchest and are foundational for the best care of your liver patients Whether you’re a healthcare professional or someone interested in liver health, this episode is packed with valuable insights for enhancing patient outcomes and improving the staging and management of liver diseases. Please send any questions to Dr. Gish via email or via his website . Thanks for listening!
/episode/index/show/b260931e-bd3b-44ea-8194-57c71cf0c9fd/id/34112721
info_outline
When to Order a Gamma-Glutamyl Transferase (GGT)
11/07/2024
When to Order a Gamma-Glutamyl Transferase (GGT)
In this episode, Dr. Robert Gish, a renowned expert in hepatology, examines the critical role of the Gamma-Glutamyl Transferase (GGT) test in assessing liver health. Dr. Gish explains why GGT is an essential part of the liver enzyme panel and how it provides vital insights into a patient's inflammatory status, especially when alkaline phosphatase (ALP) alone may not be sufficient due to its limited sensitivity and specificity. Tips for Providers: When ordering a liver enzyme panel, remember the "4 pillars" for a comprehensive evaluation of a patient's liver health, and always include GGT. Very high GGT values, when used in conjunction with PEth (Phosphatidylethanol) testing, can be an effective tool in identifying alcohol use disorder and alcohol-related liver disease. Disparate GGT and ALP levels can identify genetic diseases such as PFIC and other cholestatic variants. Keep in mind that high alkaline phosphatase levels can sometimes be misleading, as they may be caused by conditions like hyperparathyroidism or vitamin D deficiency, rather than liver disease. Join Dr. Gish as he shares practical tips, clinical insights, and expert advice for better interpreting these vital lab tests to improve patient outcomes. Whether you're a seasoned clinician or just starting out, this episode is packed with valuable takeaways for anyone involved in liver care. Please send any questions to Dr. Gish via email or via his website . Thanks for listening!
/episode/index/show/b260931e-bd3b-44ea-8194-57c71cf0c9fd/id/33822282
info_outline
Thromboelastography (TEG)
10/24/2024
Thromboelastography (TEG)
In this latest episode of "Everything Liver," Dr. Robert Gish delves into the intricacies of thromboelastography (TEG) and its pivotal role in patient care. Join Dr. Gish as he breaks down how to interpret TEG test results, emphasizing its importance in the clinical setting. With an engaging analogy, he compares TEG to the cutting-edge F-35 jet, showcasing its precision and versatility, while likening the traditional INR test to a Model T—valuable but limited in scope. Discover why understanding TEG is essential for optimizing treatment plans and improving patient outcomes in liver health. Tune in for insights that could revolutionize your approach to coagulation testing! Be sure to send any questions to Dr. Gish via email or via his website . Thank you for listening!
/episode/index/show/b260931e-bd3b-44ea-8194-57c71cf0c9fd/id/33572922
info_outline
Hepatitis B Virus - Treat All Approach
10/10/2024
Hepatitis B Virus - Treat All Approach
Join Dr. Gish, a leading expert in infectious diseases, as he delves into the complexities of Hepatitis B Virus (HBV) and the innovative "Treat All" approach. In this episode, Dr. Gish explores the 10 important reasons why we propose to treat all patient with HBV who are HBV DNA+ HBV DNA+ correlates with risk: risk of HCC, cirrhosis, liver transplant and death Treatment decreases risk: 70% less HCC and 90% decrease in cirrhosis and liver transplant Decrease Risk of Transmission U=U Treatment to prevent infection Reduce Stigma Improve QOL Reduce HBV related extrahepatic disease Decrease other HBV related cancers (bile duct cancer is an example) Reduce Discrimination Partner with Patients who request treatment Listeners will gain insights into the importance of early diagnosis, the benefits of universal treatment, and the impact of Hepatitis B on global health. Whether you're a healthcare professional, a patient, or simply curious about liver health, this podcast offers valuable information and expert perspectives to empower and inform. Tune in to learn how we can work together to eliminate Hepatitis B! As always, please share your comments or questions with Dr. Gish via email or via his website Thank you for listening!
/episode/index/show/b260931e-bd3b-44ea-8194-57c71cf0c9fd/id/33406842
info_outline
When and how do you use phosphatidylethanol (PETH) testing in your clinical practice
09/26/2024
When and how do you use phosphatidylethanol (PETH) testing in your clinical practice
In this episode, Dr. Gish delves into the crucial role of phosphatidylethanol (PETH) testing in detecting alcohol use among patients in your general clinic, for those who have undergone liver transplants or individuals being evaluated for liver transplantation. Understanding alcohol consumption quantity is vital for patient safety and optimal outcomes, and PETH serves as an invaluable tool in this process. Join us as we discuss: What PETH is and how it works, its significance in general practice and for liver transplant evaluations, and best practices for interpreting results. Please share any comments or questions on social media, message Dr. Gish via his website or email at Thanks for tuning in!
/episode/index/show/b260931e-bd3b-44ea-8194-57c71cf0c9fd/id/33190137
info_outline
Progressive familial intrahepatic cholestasis (PFIC) and genetic testing for cholestatic liver disease
09/12/2024
Progressive familial intrahepatic cholestasis (PFIC) and genetic testing for cholestatic liver disease
Welcome back to Dr. Robert Gish's podcast series! In this episode, he's diving deep into the world of Cholestasis with a focus on Progressive Familial Intrahepatic Cholestasis, or PFIC. Dr. Gish will unravel the complexities of this rare and challenging liver condition, exploring its genetic underpinnings and the latest advancements in genetic testing for many other forms of cholestasis as well. PFIC is a group of genetic disorders that impair bile flow, leading to progressive liver damage. Understanding its genetic basis is crucial for accurate diagnosis, prognosis, and treatment planning. There are 77 mutations that can now be detected using the Prevention Genetics Panel that have or may have a link to various forms of cholestasis. Dr. Gish will shed light on the latest developments in genetic testing for cholestatic liver diseases, discussing how these advancements can improve patient outcomes and tailor personalized treatment strategies. Whether you're a healthcare professional, a patient, or simply curious about liver health, this episode promises valuable insights and perspectives. Don’t miss it as we continue our journey into the cutting-edge world of liver disease research and treatment with one of the leading experts in the field. Please let us know your thoughts - you can send Dr. Gish a message through his website , on Facebook or via email [email protected].
/episode/index/show/b260931e-bd3b-44ea-8194-57c71cf0c9fd/id/32989867
info_outline
HCC Screening And Surveillance Risk Biomarkers
08/29/2024
HCC Screening And Surveillance Risk Biomarkers
In his first podcast, Dr. Robert Gish discusses Hepatocellular carcinoma (HCC) Screening And Surveillance Risk Biomarkers, how to use and what to order. Learn more about Dr. Gish at his website and send any questions or feedback to him at Dr. Gish will be releasing new podcasts every other week so tune in for more. Thank you for listening!
/episode/index/show/b260931e-bd3b-44ea-8194-57c71cf0c9fd/id/32421847