Gastroenterology & Hepatology

September 2023 - Volume 19, Issue 9

Letter From the Editor: Shifting Our Focus From NASH to MASH 

Gary R. Lichtenstein, MD, AGAF, FACP, FACG

This month’s issue of Gastroenterology & Hepatology features our newly titled MASH in Focus column, formerly NASH in Focus. This name change reflects the new liver disease nomenclature recently developed by multinational liver societies, including the American Association for the Study of Liver Diseases, to avoid the use of exclusionary confounder terms and potentially stigmatizing language. MASH, metabolic dysfunction-associated steatohepatitis, replaces NASH, or nonalcoholic steatohepatitis. Likewise, MASLD, metabolic dysfunction-associated steatotic liver disease, replaces NAFLD, or nonalcoholic fatty liver disease. Our first MASH in Focus column features an interview with Dr Mazen Noureddin on the use of various noninvasive tests for the diagnosis of at-risk MASH.

One of our review articles this month highlights the latest research on bile acid diarrhea. Drs Michael Camilleri and Joelle BouSaba examine bile acid synthesis and enterohepatic circulation, pathophysiologic mechanisms of bile acid diarrhea, and clinical characteristics of the 3 types of bile acid diarrhea. The authors also review the advantages and disadvantages of different diagnostic tests, including the selenium-75 homocholic acid taurine test and 48-hour fecal total bile acid test. Lastly, the authors discuss treatment for the condition, including novel interventions such as obeticholic acid and tropifexor.

Our other review article focuses on hepatorenal syndrome–acute kidney injury (HRS-AKI) and is authored by Drs Michelle Loftus, Robert S. Brown Jr, Neveen S. El-Farra, Emily J. Owen, Nancy Reau, Hani M. Wadei, and David Bernstein. The authors review the condition and its new definition as well as how to apply updated guidance recommendations to clinical practice. They also examine the available data on terlipressin, the first drug approved for HRS-AKI in the United States, and present a sample order set. 

Our Advances in Hepatology column centers on social media in the field of hepatology. Dr Julius M. Wilder discusses how social media can affect physician collaboration and networking, clinical education, and patient education. He also reflects on the problem of misinformation on social media platforms, offers advice for hepatologists interested in engaging in social media, and shares his thoughts on the future of social media in hepatology, along with other issues.

The Rome Foundation Global Epidemiology Study is the focus of our Advances in IBS column, which is authored by Dr Ami D. Sperber. He reviews the study’s goals and important findings about irritable bowel syndrome and other disorders of gut-brain interaction, including the global burden and consistency of the findings across the countries surveyed. Among other issues, he also examines how the study findings affect our understanding of these diseases.

In our Advances in IBD column, Dr Marla Dubinsky provides a comprehensive overview of the evolution of anticytokine therapy for inflammatory bowel disease, from the targeting of tumor necrosis factor to the blocking of both interleukin (IL)-12 and IL-23 or only the latter. She also reviews the blocking of cytokine pathways, targeting of lymphocyte trafficking, and inhibition of lymphocytes. Other topics of discussion include the risks and benefits of different treatment approaches and the ultimate goal of being able to choose the right target for a patient.

Natural orifice transluminal endoscopic surgery (NOTES) is the focus of our Advances in Endoscopy column. Dr Michael L. Kochman’s discussion includes how the concept of NOTES first came about, its opportunities and challenges, how it has evolved over nearly 20 years, and what has limited its growth and adoption. He also discusses how the experience with NOTES may impact future endoscopic development, along with related topics. 

Finally, the next installment of our quarterly content partnership with the Crohn’s & Colitis Foundation focuses on diet and nutrition in inflammatory bowel disease. Readers can scan the resource link on page 545 for recipes and meal planning help for patients with inflammatory bowel disease and other helpful nutritional information for this patient population.

I hope that you enjoy these articles and find them interesting and clinically useful.


Gary R. Lichtenstein, MD, AGAF, FACP, FACG

Millennium Medical Publishing, Inc