GI centers being hit with 'freight train of fatty liver disease': One physician's top concern

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The U.S. consistently ranks below other wealthy nations in measurements of lifestyle healthiness and preventive care. Ernest Ribera, MD, a gastroenterologist and medical director of the Burlingame, Calif.-based Mid Peninsula Endoscopy Center, said on "Becker's Ambulatory Surgery Centers Podcast" that he's seeing the effects of the trend firsthand.

This is an edited transcript. Download the full podcast episode here.

Question: What are the top three trends you're following in healthcare today?

Dr. Ernest Ribera: You know, from a gastroenterology standpoint, we're very well suited for televisits. So when the pandemic hit, we were able to convert ... to a couple of [online] platforms. And I don't think that's going to go away for our field, so telemedicine would be one of the trends for sure. 

Secondly, I think that the rising costs of healthcare — where you have joint or equity partner groups, you have large hospital systems, you have the medical device companies, you have the pharmaceutical companies, insurance companies — everybody wants a piece of that dollar, so the healthcare costs will continue to be a problem. I just saw in Becker's ASC Review this morning that CMS will be cutting reimbursement for colonoscopy going forward, or asking that the patients provide a copay when a polyp is removed. 

A third trend — and a big one — is the epidemic we're looking at: The freight train of fatty liver disease. So with transient elastography, we're able to identify patients that are at risk for cirrhosis with a diagnosis of [nonalcoholic steatohepatitis], although the precise diagnosis would require a liver biopsy. [Transient elastography] allows us to look at patients in a relatively cheap, noninvasive manner and identify those patients that either have NASH or are at high risk. And this population is continuing to grow as America becomes more and more overweight, so that's a definite trend in gastroenterology that we're seeing. 

Q: Is fatty liver disease a trend you're actively preparing your practice for?

ER: We're struggling with that because it's basically a lifestyle issue. America is eating more, exercising less, drinking more alcohol. And what it's done is the major labs have raised the normal liver enzyme level to 60 [units per liter], which is actually grossly abnormal. So the first thing we advise our [primary care physicians] to do is lower that threshold and send people that have [liver enzyme levels] over 35 for men, and over 25 for women, for that transient elastography. 

But in terms of [preparation], that's a toughie. We're trying to put together access to dietitians. There aren't enough of them. ... So, yeah, I think all of us are looking at ways to help people with their lifestyle, because obviously whether you have diabetes or fatty liver disease, the first thing to do is to lose weight.

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