Integrating Non-Invasive Tests into Primary Care: A Practical Approach to Early Detection of Advanced Fibrosis in Metabolic Dysfunction–Associated Steatohepatitis (MASH)

Authors

Polina Manesis, University of LynchburgFollow

Specialty

GI/Hepatology

Advisor

James Kilgore, DMSc, PA-C

Abstract

ABSTRACT

Metabolic dysfunction-associated steatohepatitis (MASH), formerly known as nonalcoholic steatohepatitis (NASH), is a liver disease that is progressive over time. Populations with past medical history of obesity, type 2 diabetes mellitus or have other aspects of metabolic syndrome have an increased risk of MASH. MASH is a major cause of liver-related morbidity and mortality, and it is also a major cause of progressive liver fibrosis. Despite its growing prevalence, MASH remains underdiagnosed and underprioritized. This is especially true in primary care settings, where high-risk individuals are often treated. The biggest setback with diagnosis of MASH is the need of proper diagnostic tools. While historically the gold standard, liver biopsy is invasive, costly, and impractical for broad population screening. Due to the issue of proper diagnosis, it is rather difficult to discover patients who would benefit from early intervention and specialized care and treatment. This study evaluates whether non-invasive tests (NITs) can replace biopsy-based screening for patients at risk of advanced fibrosis. The Fibrosis-4 (FIB-4) index is the primary tool that is being evaluated in this paper. It focuses on how well it works as a diagnostic tool, how effective it is in the clinic, and how it is used in the real world. The review also evaluates how vibration-controlled transient elastography (VCTE) can help sort patients with moderate or high-risk FIB-4 scores into groups based on their risk stratification. Sequential application of these tools offers a real-world, evidence-based, and practical approach to early identification and risk stratification, minimizing unnecessary referrals and invasive procedures. The findings support a scalable model for integrating NITs into primary care workflows, emphasizing training, EMR integration, and standardized protocols. Adopting this approach aligns with current clinical guidelines and facilitates a proactive, population health-based strategy to address MASH-related liver disease. This article provides primary care providers with evidence-based strategies for identifying and managing patients at risk of MASH complications.

Recommended Citation

Manesis P. Integrating Non-Invasive Tests into Primary Care: A Practical Approach to Early Detection of Advanced Fibrosis in Metabolic Dysfunction–Associated Steatohepatitis (MASH). University of Lynchburg DMSc Doctoral Project Assignment Repository. 2025; 7(3).