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Metabolic-associated steatotic liver disease—which we shorten to call MASLD—was previously known as non-alcoholic fatty liver disease.
And what that is, is: it’s very common. It’s patients who have fat in their liver and inflammation. And over time, this can cause an elevation in their liver enzymes. And then a small proportion of people go on to develop scar tissue in their liver—and it’s actually a very common reason that people can develop cirrhosis in their liver.
So if we identify those patients early—the ones that have fat and inflammation in their liver—and really try to manage the comorbidities that go along with it, like diabetes, high cholesterol, hypertension, obesity—that is your best bet to decrease the risk that you will form cirrhosis from MASLD.
And we now have a medication that was FDA-approved about a year ago.
Once you develop cirrhosis from MASLD, it’s very unlikely that it’ll be reversed. But up until that point, things like weight loss, control of your diabetes, starting on a medication can absolutely kind of put the brakes on it and cause a little regression of the scar tissue in your liver.
We see a lot of liver disease from alcohol use disorder. I think it’s very, very prevalent. And so we recommend that anyone who has a known form of liver disease—formal recommendations are not to drink any alcohol.
A lot of liver disease—once you truly develop signs and symptoms that prompt medical care—that usually means that you have late-stage disease. So things that usually bring people to the hospital or the doctor is if they develop yellow jaundice, if they start throwing up blood, if they develop a confusion called hepatic encephalopathy that goes along with liver disease—those things usually indicate that you have decompensated liver disease, and you’re pretty late-stage.
So liver disease can be very sneaky. It can smolder along for years and years without a lot of signs or symptoms.
And so what we try to do is: patients who have classic metabolic-associated steatotic liver disease, or have alcohol use disorder—which you may not know unless you really do a detailed history of their alcohol use—in clinic, we have something called a FibroScan, which is a machine. And it’s kind of like an ultrasound, but it assesses how much inflammation they have in their liver and also approximates how much scar tissue they have in their liver.
And so with those two pieces of information, it can really help us guide treatment and management. And it can also be a good thing to show the patient and say, “Yes, you know, I know you’ve been told you had fatty liver disease for years and years and years, but this is some objective evidence that it’s either getting worse or it’s getting better now that you’ve controlled your diabetes and lost weight,” and that type of thing.
So there’s a lot of stigma attached to alcohol use disorder, but in our hepatology clinic, we try to treat it just like we would any other medical issue.
