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How Would You Assess These Patients for Liver Fibrosis?

  • Authors: Rohit Loomba, MD, MHSc
  • CME Released: 2/28/2023
  • Valid for credit through: 2/28/2024
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  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    You Are Eligible For

    • Letter of Completion

Target Audience and Goal Statement

This activity is intended for gastroenterologists, diabetologists, and endocrinologists.

The goal of this activity is for learners to be better able to use appropriate NITs to assess patients for liver fibrosis.

Upon completion of this activity, participants will:

  • Have increased knowledge regarding the
    • Appropriate NITs to use in assessing a patient for liver fibrosis
    • Guideline recommendations for NAFLD screening in patients with diabetes
  • Have greater competence related to
    • Implementing NITs for disease stratification in clinical practice


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All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.


  • Rohit Loomba, MD, MHSc

    Professor of Medicine
    Director of Hepatology
    University of California at San Diego
    Director, NAFLD Research Center
    San Diego, California, United States


    Rohit Loomba, MD, MHSc, has the following relevant financial relationships:
    Consultant or advisor for: 89 Bio Inc; Aardvark Therapeutics; Altimmune; Amgen Inc.; Anylam/Regeneron; Arrowhead Pharmaceuticals, Inc.; AstraZeneca; Bristol Myers Squibb Company; CohBar; Eli Lilly and Company; Galmed Pharmaceuticals Ltd.; Gilead Sciences, Inc.; Glympse Bio; HighTide; INIPharma; Intercept Pharmaceuticals, Inc.; Inventiva; Ionis Pharmaceuticals; Janssen; Madrigal Pharmaceuticals, Inc.; Merck; Metacrine; NGM Biopharmaceuticals; Novartis; Novo Nordisk; Pfizer Inc.; Sagimet Biosciences; Terns Pharmaceuticals; Theratechnologies Inc.; Viking Therapeutics
    Research funding from: Arrowhead Pharmaceuticals, Inc.; AstraZeneca; Boehringer Ingelheim Pharmaceuticals, Inc.; Bristol Myers Squibb Company; Eli Lilly and Company; Galectin Therapeutics; Galmed Pharmaceuticals Ltd.; Gilead Sciences, Inc.; Hanmi Pharm. Co., Ltd.; Intercept Pharmaceuticals, Inc.; Inventiva; Ionis Pharmaceuticals; Janssen; Madrigal Pharmaceuticals, Inc.; Merck; NGM Biopharmaceuticals; Novo Nordisk; Pfizer Inc.; Sonic Incytes; Terns Pharmaceuticals
    Other: Co-founder of LipoNexus Inc.


  • Anne G. Le, PharmD

    Senior Medical Education Director, Medscape, LLC


    Anne G. Le, PharmD, has no relevant financial relationships.

  • Gina Montanero, PharmD, RPh

    Associate Medical Writer, Medscape, LLC


    Gina Montanero, PharmD, RPh, has no relevant financial relationships.

Compliance Reviewer

  • Yaisanet Oyola, MD

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Yaisanet Oyola, MD, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.

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In support of improving patient care, Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

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You may now view or print the certificate from your CME/CE Tracker. You may print the certificate, but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period, you can print out the tally as well as the certificates from the CME/CE Tracker.

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How Would You Assess These Patients for Liver Fibrosis?

Authors: Rohit Loomba, MD, MHScFaculty and Disclosures

CME Released: 2/28/2023

Valid for credit through: 2/28/2024



  1. Younossi ZM, et al. Role of noninvasive tests in clinical gastroenterology practices to identify patients with nonalcoholic steatohepatitis at high risk of adverse outcomes: expert panel recommendations. Am J Gastroenterol. 2020;116:254-262.
  2. Cusi K, et al. American Association of Clinical Endocrinology clinical practice guideline for the diagnosis and management of nonalcoholic fatty liver disease in primary care and endocrinology clinical settings: co-sponsored by the American Association for the Study of Liver Diseases (AASLD). Endocr Pract. 2022;28:528-562.
  3. Loomba R, et al. Mechanisms and disease consequences of nonalcoholic fatty liver disease. Cell. 2021;184:2537-2564.
  4. Chalasani N, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67:328-357.
  5. Caussy C, et al. The relationship between type 2 diabetes, NAFLD, and cardiovascular risk. Curr Diab Rep. 2021;21:15.
  6. Simon TG, et al. Cancer risk in patients with biopsy-confirmed nonalcoholic fatty liver disease: a population-based cohort study. Hepatology. 2021;74:2410-2423.
  7. Rinella ME, et al. AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023. doi: 10.1097/HEP.0000000000000323. [Epub ahead of print]
  8. Yoshitaka H, et al. Nonoverweight nonalcoholic fatty liver disease and incident cardiovascular disease: a post hoc analysis of a cohort study. Medicine (Baltimore). 2017;96:e6712.
  9. Dulai PS, et al. Increased risk of mortality by fibrosis stage in nonalcoholic fatty liver disease: systematic review and meta-analysis. Hepatology. 2017;65:1557-1565.
  10. Anstee QM, et al. Impact of non-invasive biomarkers on hepatology practice: past, present and future. J Hepatol. 2022;76:1362-1378.
  11. Llop E, et al. High liver stiffness values by transient elastography related to metabolic syndrome and harmful alcohol use in a large Spanish cohort. United European Gastroenterol J. 2021;9:892-902.
  12. Browning JD, et al. Prevalence of hepatic steatosis in an urban population in the United States: impact of ethnicity. Hepatology. 2004;40:1387-1395.
  13. Ajmera V, et al. A prospective study on the prevalence of NAFLD, advanced fibrosis, cirrhosis and hepatocellular carcinoma in people with type 2 diabetes. J Hepatol. 2022. doi: 10.1016/j.jhep.2022.11.010. [Epub ahead of print]
  14. Anstee QM, et al. Noninvasive tests accurately identify advanced fibrosis due to NASH: baseline data from the STELLAR trials. Hepatology. 2019;70:1521-1530.
  15. Shah AG, et al. Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol 2009;7:1104-1112.
  16. Srivastava A, et al. Prospective evaluation of a primary care referral pathway for patients with non-alcoholic fatty liver disease. J Hepatol. 2019;71:371-378.
  17. Mansour D, et al. Embedding assessment of liver fibrosis into routine diabetic review in primary care. JHEP Rep. 2021;3:100293.
  18. Younossi ZM et al. Algorithms using noninvasive tests can accurately identify patients with advanced fibrosis due to NASH: data from the STELLAR clinical trials. Presented at: American Association for the Study of Liver Diseases; November 9-13, 2018; San Francisco, California. Abstract LB-10.
  19. Davies MJ, et al. Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2022;45:2753-2786.
  20. Azoulay L, et al. The use of pioglitazone and the risk of bladder cancer in people with type 2 diabetes: nested case-control study. BMJ. 2012;344:e3645.
  21. Tamaki N, et al. Risk of advanced fibrosis in first-degree relatives of patients with nonalcoholic fatty liver disease. J Clin Invest. 2022;132:e162513.
  22. Caussy C, et al. Nonalcoholic fatty liver disease with cirrhosis increases familial risk for advanced fibrosis. J Clin Invest. 2017;127:2697-2704.
  23. Pavlides M, et al. Interobserver variability in histologic evaluation of liver fibrosis using categorical and quantitative scores. Am J Clin Pathol. 2017;147:364-369.
  24. Dufour JF, et al. Current therapies and new developments in NASH. Gut. 2022;71:2123-2134.
  25. Patton H, et al. AGA clinical practice update on bariatric surgery in cirrhosis: expert review. Clin Gastroenterol Hepatol. 2020;19:436-445.
  26. Loomba R, et al. Expert panel review to compare FDA and EMA guidance on drug development and endpoints in nonalcoholic steatohepatitis. Gastroenterology. 2021;162:680-688.
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