CLDF Podcast

In this episode, Dr. Robert Wong from Stanford University School of Medicine discusses the importance of patient-centered care and the role of patient-reported outcomes in the comprehensive management of chronic hepatitis B. Dr. Wong explains how PROs capture patients’ perspectives on their physical, mental, and social well-being—critical yet often underrecognized components of care. He highlights three validated tools that can be easily integrated into clinical practice: the Short Form-36 (SF-36), the Chronic Liver Disease Questionnaire (CLDQ), and the Work Productivity and Activity Impairment (WPAI) Instrument. These measures help clinicians better understand how hepatitis B impacts patients’ daily lives, guide individualized treatment decisions, and strengthen multidisciplinary care involving hepatologists, mental health professionals, nutritionists, and other specialists. By incorporating PROs into pre-visit checklists and ongoing follow-up, providers can identify barriers to treatment, improve communication, and deliver more meaningful, patient-centered outcomes.

In this episode, Dr. Robert Wong from the Division of Gastroenterology and Hepatology at Stanford University School of Medicine discusses the value of patient-centric care and patient-reported outcomes in managing Primary Biliary Cholangitis (PBC). While traditional care often focuses on liver function tests and biochemical markers like alkaline phosphatase, Dr. Wong emphasizes the equal importance of understanding how PBC impacts a patient’s daily life, mental health, and overall quality of life. He highlights the PBC-40 questionnaire, a validated tool that captures six key domains—fatigue, emotional well-being, social and cognitive function, general symptoms, and itch (pruritus)—making it an essential instrument for comprehensive symptom assessment. Incorporating the PBC-40 into pre-visit questionnaires or waiting-room checklists allows clinicians to efficiently identify and address the most distressing symptoms before and during patient visits. Dr. Wong explains how integrating PROs enhances shared decision-making, helps manage challenging symptoms such as pruritus, and fosters multidisciplinary collaboration with specialists in dermatology, mental health, nutrition, and rheumatology. This holistic, patient-centered approach not only improves symptom management but also strengthens engagement, satisfaction, and outcomes for individuals living with PBC.

In this expert discussion, Dr. Paul Kwo, hepatologist at Stanford University, explores the critical importance of patient adherence to treatment for chronic hepatitis B. Hepatitis B remains a global public health challenge and a leading cause of liver cancer—and yet in the U.S., many individuals remain undiagnosed or untreated. Dr. Kwo outlines how to assess disease stage, when to initiate antiviral therapy, and how to communicate effectively with patients—especially foreign-born individuals—about the safety, effectiveness, and accessibility of approved treatments. He explains how these once-daily therapies improve outcomes, reduce the risk of liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC), and why long-term follow-up is essential even for those not immediately eligible for treatment. Dr. Kwo also addresses cultural considerations, cost concerns, and common misconceptions around alternative therapies. This presentation emphasizes that hepatitis B is not only manageable—it is a condition where proactive care leads to meaningful, life-extending results.

Join Dr. Ira Jacobson, Professor of Medicine at NYU Langone Health, for an in-depth exploration of the complex pathophysiology of chronic hepatitis B. In this expert lecture, Dr. Jacobson reviews the virologic and immunologic mechanisms that underpin HBV infection, from viral entry into hepatocytes and the formation of covalently closed circular DNA (cccDNA), to the integration of viral DNA and its implications for hepatocellular carcinoma. He also examines the immune system’s multifaceted role in disease progression, including T-cell exhaustion, checkpoint inhibition, and the contributions of humoral immunity. The discussion extends to cutting-edge therapeutic strategies aimed at achieving functional cure, including siRNAs, antisense oligonucleotides, therapeutic vaccines, monoclonal antibodies, and T-cell receptor therapies. Whether you're a hepatology provider, researcher, or student, this comprehensive overview sheds light on where we are in the fight against HBV—and where promising advances may take us next.

In this expert video, Dr. Robert Gish—renowned hepatologist and Medical Director of the Hepatitis B Foundation—discusses the critical role of quantitative hepatitis B surface antigen (HBsAg) testing in the management and long-term monitoring of chronic hepatitis B. With over a decade of experience using quantitative HBsAg in clinical practice, Dr. Gish explains how this highly sensitive test complements HBV DNA and e-antigen testing to assess disease phase, track treatment response, and evaluate a patient's candidacy for functional cure. He breaks down how low surface antigen levels can signal improved outcomes, including reduced liver cancer risk and lower infectivity, and how this data supports decision-making around nucleos(t)ide analogue (NUC) therapy continuation or cessation. Dr. Gish also discusses emerging therapies, including interferon combinations, antisense oligonucleotides (ASOs), capsid assembly modulators (CPAMs), and therapeutic vaccines—highlighting the future potential of viral silencing strategies aimed at complete hepatitis B control. For clinicians and researchers, this session underscores why quantitative HBsAg is a foundational biomarker for baseline assessment, longitudinal follow-up, and treatment strategy optimization in chronic HBV.

In this expert highlight, Dr. Robert Wong shares essential tips for monitoring and managing patients with Primary Biliary Cholangitis (PBC). He outlines key goals after diagnosis, including evaluating liver disease severity through imaging and lab-based non-invasive testing, and assessing treatment eligibility. Dr. Wong explains the importance of monitoring alkaline phosphatase (ALP) levels—not only to guide treatment initiation but also to measure treatment response, with normalization signaling a complete response. Beyond labs, he emphasizes the need to assess patient-reported outcomes such as fatigue and pruritus, which directly impact quality of life. He also discusses the challenges of interpreting non-invasive fibrosis tools in PBC, highlighting the importance of longitudinal monitoring to track disease direction over time. Finally, Dr. Wong stresses patient engagement—using consistent follow-up, clear education, and linking lab results with symptom improvements to keep patients motivated in their care journey. This practical overview offers valuable insights for clinicians and patients aiming to optimize outcomes in PBC management.

Join Dr. Alan Bonder, Associate Professor of Medicine at Harvard Medical School and Medical Director of Liver Transplantation, for an expert overview on the latest AASLD guideline updates for Primary Biliary Cholangitis (PBC). This in-depth session highlights key diagnostic criteria—such as AMA positivity, elevated alkaline phosphatase, and histologic confirmation—and walks through evidence-based treatment pathways for managing PBC. Dr. Bonder discusses the pivotal role of ursodeoxycholic acid (UDCA) as first-line therapy and emphasizes the importance of risk stratification using tools like FibroScan and biochemical markers to identify non-responders.He outlines thresholds for therapeutic response and reviews the FDA-approved second-line therapies, including obeticholic acid and the three new agents approved in summer 2024, while addressing safety concerns and boxed warnings. Dr. Bonder also underscores the need to address quality of life, managing symptoms like fatigue, pruritus, and abdominal pain—often overlooked but impactful for patients with PBC. With clinical pearls on when to escalate care or refer for liver transplantation, this session offers a comprehensive, practical roadmap for optimizing PBC outcomes today and in the future.

Thank you Gilead Sciences, Inc. for your support on this FAQ Video Module.In this practical and patient-focused video, Dr. Nadege Gunn, a hepatologist based in Waco, Texas, shares essential diet and lifestyle strategies for individuals living with Primary Biliary Cholangitis (PBC). Addressing a common question—“What can I eat or do to feel better?”—Dr. Gunn highlights the benefits of a balanced, Mediterranean-style diet rich in fruits, vegetables, nuts, seeds, fish, and olive oil. She emphasizes bone health as a key concern for PBC patients, recommending adequate intake of vitamin D and calcium, resistance-based exercises, and regular weight-bearing activity. The video also stresses the importance of monitoring fat-soluble vitamin levels (A, D, E, and K), avoiding alcohol, and supplementing with a multivitamin if needed. Dr. Gunn further underscores the role of maintaining a healthy weight, staying active, avoiding smoking, and ensuring hepatitis A and B vaccinations to prevent additional liver complications. Whether you're a provider looking to guide patients or someone living with PBC seeking actionable advice, this video offers valuable lifestyle recommendations to help manage the disease and improve overall liver health.

Thank you Gilead Sciences, Inc. for your support on this FAQ Video Module.In this thoughtful discussion, Dr. Nancy Reau from RUSH University Medical Center explores the often-overlooked psychological impact of Primary Biliary Cholangitis (PBC). While managing the physical symptoms of PBC is critical, addressing the emotional and mental health challenges faced by patients is equally important. Dr. Reau highlights how the lifelong nature of PBC, its familial implications, unpredictable progression, and extrahepatic symptoms like fatigue and pruritus can contribute to significant stress, anxiety, and emotional strain. Many patients may appear physically healthy yet suffer from symptoms that disrupt their daily lives and relationships—leading to frustration, isolation, and misunderstood expectations from others. Even those in biochemical remission can experience mental health burdens, especially if they’ve seen loved ones struggle with the disease. Dr. Reau emphasizes the need for providers to initiate open conversations about these psychological effects to validate patient experiences and support overall wellness. If you're a clinician or caregiver seeking a more holistic approach to PBC management, or a patient navigating the emotional side of liver disease, this video offers compassionate, practical guidance.

Thank you Gilead Sciences, Inc. for your support on this FAQ Video Module. In this insightful discussion, Dr. Tatyana Kushner, hepatologist and associate professor at Weill Cornell Medicine, explores the critical issue of medication adherence in patients living with Primary Biliary Cholangitis (PBC). While ursodeoxycholic acid (ursodiol) remains the cornerstone of first-line therapy for PBC, up to half of patients express uncertainty or reluctance about taking it consistently. Dr. Kushner delves into the complex barriers affecting adherence, including lack of symptom relief, fear of side effects, misunderstanding of long-term benefits, pill burden from multiple daily doses, and socioeconomic challenges such as medication costs and insurance coverage. She also addresses the impact of extrahepatic symptoms—like pruritus, fatigue, and depression—which can further discourage regular medication use. Importantly, certain subgroups, such as younger patients and males, have been shown to be at higher risk for non-adherence and may require additional support. If you're a healthcare provider managing PBC or a patient navigating treatment, this video offers valuable insights into improving adherence and outcomes.

Thank you Gilead Sciences, Inc. for your support on this FAQ Video Module.In this engaging update from the Allied Digestive Health Annual Conference, Dr. Sonal Kumar, hepatologist at Weill Cornell Medicine, shares the latest advancements in diagnosing and managing Primary Biliary Cholangitis (PBC). Dr. Kumar emphasizes the importance of early assessment and intervention—highlighting the limitations of outdated treatment algorithms that delay evaluation for second-line therapy. Instead, clinicians are now encouraged to assess patients as early as 6 months after starting ursodeoxycholic acid (UDCA), especially those with elevated alkaline phosphatase (ALP), advanced fibrosis, or younger age. The discussion also explores the evolving treatment goals in PBC, including a shift toward normalization of ALP and bilirubin levels as key biomarkers of disease activity and prognosis. Dr. Kumar highlights exciting data from the ELATIVE and RESPONSE trials, which led to the approval of two new PPAR agonists—elafibranor and seladelpar—offering improved ALP normalization rates and even symptom relief for pruritus. This marks a significant turning point in how hepatologists approach symptom management in PBC, with fatigue and pruritus now recognized as critical components of care. Learn more about this evolving treatment landscape and how these advancements are shaping a more personalized, proactive approach for patients living with PBC.

Thank you Gilead Sciences, Inc. for your support on this FAQ Video Module. In this comprehensive discussion, Hetal Karsan, Chair of Medical Education at United Digestive, explores how to manage complications of Primary Biliary Cholangitis (PBC) and their impact on patient quality of life. PBC is a chronic autoimmune cholestatic liver disease that primarily affects women—but is increasingly diagnosed in men. Dr. Karsan breaks down the progression from inflammation to fibrosis and cirrhosis, and emphasizes how early diagnosis and adherence to treatment with ursodeoxycholic acid (UDCA) can dramatically improve outcomes.Learn practical strategies to monitor liver function, prevent and manage complications such as variceal hemorrhage, ascites, hepatic carcinoma, and osteoporosis. Discover the importance of normalizing alkaline phosphatase and bilirubin, supporting nutrition and vitamin levels, and reducing risk through lifestyle changes. Dr. Karsan also highlights how fatigue and pruritus impact daily life for patients with PBC and discusses both pharmacologic and non-pharmacologic ways to help. From screening recommendations to emotional support and patient education, this video is a vital guide for healthcare providers treating PBC.

Thank you Gilead Sciences, Inc. for your support on this FAQ Video Module. Discover the evolving landscape of Primary Biliary Cholangitis (PBC) treatment with Dr. Huiming Sooki Hon from United Digestive. In this expert-led discussion, Dr. Sooki Hon reviews both established and emerging therapies for PBC, beginning with first-line treatment using ursodeoxycholic acid (UDCA) and the importance of early diagnosis and biochemical monitoring. Learn why normalization—not just reduction—of alkaline phosphatase is becoming a new treatment goal, and why up to 40% of patients may require second-line therapy. Dr. Sooki Hon outlines the latest FDA-approved options, including obeticholic acid, elafibranor, and seladelpar, highlighting their mechanisms of action, efficacy, and key safety considerations. This video also explores promising investigational therapies and combination strategies aimed at slowing disease progression and improving symptom control. Whether you're a healthcare professional or a patient seeking updated information on PBC management, this comprehensive overview provides valuable insights into current standards and future directions.

In this expert spotlight, Dr. Nancy Reau of RUSH University Medical Center addresses two of the most pressing challenges in the management of Primary Biliary Cholangitis (PBC): delayed diagnosis and delayed treatment escalation. Drawing from clinical insights and institutional data, Dr. Reau discusses how symptoms such as fatigue, pruritus, and elevated alkaline phosphatase often go unrecognized for years—resulting in delayed initiation of therapy. She highlights the importance of earlier testing with antimitochondrial and PBC-specific antinuclear antibodies to improve time to diagnosis. Dr. Reau also examines the hesitancy among clinicians to escalate therapy beyond ursodeoxycholic acid (UDCA), despite new FDA-approved second-line treatments such as obeticholic acid and PPAR agonists. With clear benchmarks like alkaline phosphatase normalization and bilirubin control now guiding treatment response, she calls for timely intervention to improve prognosis, transplant-free survival, and quality of life in patients with PBC.

In this expert-led video, Dr. Nadege Gunn, a gastroenterologist and hepatologist based in Waco, Texas, offers a practical and up-to-date overview of primary biliary cholangitis (PBC)—a chronic autoimmune liver disease that primarily affects women and can progress to cirrhosis if not treated early. Dr. Gunn breaks down the key steps in diagnosing PBC using simple blood tests, including alkaline phosphatase and antimitochondrial antibody levels, and highlights the importance of non-invasive fibrosis assessment tools like elastography. She discusses first-line treatment with ursodeoxycholic acid (UDCA) and reviews second-line therapies such as obeticholic acid and newer agents with PPAR mechanisms that are emerging in 2024 to address both biochemical response and symptom control, including pruritus. With a focus on early diagnosis, personalized care, and integrating evolving therapies, Dr. Gunn emphasizes the need to proactively manage PBC to prevent progression and improve long-term outcomes. This video is a must-watch for healthcare professionals seeking a concise yet comprehensive clinical approach to PBC.

In this video, Dr. Sonal Kumar, hepatologist at Weill Cornell Medical College in New York City, discusses the complex and often debilitating symptoms associated with Primary Biliary Cholangitis (PBC)—a chronic autoimmune liver disease. Dr. Kumar provides expert insight into symptom identification and management strategies for pruritus (itching), fatigue, jaundice, dry eyes and mouth (Sjögren's overlap), and brain fog. She emphasizes that symptom burden in PBC does not always align with disease severity, meaning even patients with early-stage or well-controlled liver disease may experience significant quality-of-life disruptions. The video explores first-line and second-line treatments for pruritus, techniques to manage fatigue, and supportive therapies for brain fog and dryness. Dr. Kumar also highlights the importance of multidisciplinary care and addressing coexisting mental health concerns to optimize outcomes. For healthcare providers managing patients with PBC, this presentation reinforces the need for a personalized, symptom-focused approach to care.

In this expert-led video, Dr. Jeff Kahn, hepatologist at the University of Southern California, explores the often-overlooked topic of symptom control and quality of life in primary biliary cholangitis (PBC). Although PBC is a chronic liver disease, symptoms like fatigue and pruritus (itching) can appear early and significantly impact patients’ daily functioning, mental health, and sleep—often independent of liver disease severity. Dr. Kahn offers practical strategies for managing these symptoms, including first-line and second-line treatments for itching, approaches to improving sleep hygiene, and the importance of addressing vitamin deficiencies (A, D, and K) to reduce the risk of osteoporosis. He also highlights the role of advanced practice providers (APPs) in building trust with patients and navigating sensitive topics. The video closes with a discussion on when to consider liver transplantation and how long-term outcomes for patients with PBC are often favorable. For more insights and resources, visit GHAPP.org or download the GHAPP ACE App.

In this episode, Marcelo Kugelmas, MD, and Steven Flamm, MD, discuss strategies to prevent clinical decompensation in patients with cirrhosis and clinically significant portal hypertension. They explore the importance of identifying overlapping liver disease etiologies—such as MASLD/metALD and alcohol-related liver disease—and emphasize a thorough diagnostic approach using non-invasive fibrosis staging tools like transient elastography, ELF, FibroSure, and Fib-4. The conversation highlights the role of liver stiffness measurements and platelet count in diagnosing clinically significant portal hypertension, referencing the latest AASLD guidelines and the “Rule of Fives.” The speakers also review the use of carvedilol as a first-line non-selective beta blocker to reduce the risk of variceal bleeding and improve survival—even in the absence of large varices. They offer clinical insights on when endoscopic variceal banding may still be appropriate and how evolving practices are shaping the future of portal hypertension management. This episode is a must-listen for hepatologists, gastroenterologists, and providers managing patients with advanced chronic liver disease.

Thank you Madrigal for your support on this podcast episode. Join Dr. Steven Flamm, Rush University Medical School, and Dr. Naim Alkhouri, Arizona Liver Health, for an in-depth discussion on Resmetirom — the first FDA-approved treatment for adults with MASH (Metabolic Dysfunction-Associated Steatohepatitis) and moderate to advanced fibrosis. In this expert-led podcast, the panel explores the groundbreaking clinical data behind Resmetirom, including findings from the MAESTRO-NASH trial, which demonstrated fibrosis regression and NASH resolution after just one year of treatment. Drs. Flamm and Alkhouri review real-world patient experiences, optimal use of non-invasive tests (like FibroScan, ELF, and MRI-PDFF), practical monitoring strategies, and common questions on dosing, side effects, and access.This conversation also addresses treatment selection, synergistic use of Resmetirom with GLP-1 receptor agonists, and how to approach medication continuation or discontinuation in responders. For liver care providers managing patients with MASLD and MASH, this podcast offers valuable guidance on how to incorporate this landmark therapy into practice.

Thank you Madrigal for your support on this Medication Review Video Module. Dr. Reed Hogan, a practicing gastroenterologist in Jackson, Mississippi, shares his clinical experience and insights on Resmetirom, the first FDA-approved therapy for MASH (Metabolic Dysfunction-Associated Steatohepatitis). With over 6,000 patients screened annually in his metabolic and fatty liver clinics, Dr. Hogan highlights the urgent need for effective treatment options in fibrotic liver disease and how Resmetirom is filling that gap. He explains the drug’s novel mechanism of action as a thyroid hormone receptor beta (THR-β) agonist, its ability to reduce triglycerides within liver cells, and its impact on reducing inflammation and fibrosis. Drawing from real-world experience with over 100 patients on therapy, Dr. Hogan discusses the favorable safety profile—primarily mild and self-limited GI side effects—and emphasizes why every liver care provider should be considering Resmetirom as a frontline option beyond lifestyle interventions. Tune in for a practical, expert-led update on one of the most significant advancements in liver disease management in decades.