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Recently diagnosed with metabolic dysfunction-associated steatohepatitis (MASH)? This condition, formerly known as NASH, is a serious liver disease that takes a team of medical specialists to properly diagnose and manage. Since MASH can lead to liver cirrhosis or even failure, having the right people involved in your care is a must. Most people are initially seen in the Office or Urgent Care by their Primary Care Provider when the diagnosis is first suspected. Internal Medicine Physicians, Family Medicine Physicians and Advanced Practitioners including Nurse Practitioners and Physician’s Assistants are generally seen initially. The patient is generally referred to medical specialists with significant additional training in both Gastroenterology and Liver (Hepatology) Disease for more comprehensive management of MASH.
Internists: Internal Medicine Physicians
An Internist is a physician who specializes in the prevention, diagnosis, and treatment of adult diseases. They provide comprehensive, long-term care in both the office and hospital settings. Internists are skilled in managing patients with complex, chronic conditions as well as acute illnesses. Training includes four years of medical school followed by a three-year internal medicine residency. Many internists pursue additional fellowships to subspecialize in areas such as cardiology, gastroenterology, or infectious disease.
Family Medicine Physicians
A Family Practitioner is a physician trained to provide comprehensive healthcare for individuals of all ages, from newborns to the elderly. They treat a wide range of acute and chronic conditions and emphasize preventive care and health education. Family doctors often care for entire families, building long-term relationships across generations. Training includes four years of medical school followed by a three-year residency in family medicine. Their broad scope includes pediatrics, internal medicine, geriatrics, and minor procedures.
Advanced Practitioners: Physician Assistants and Nurse Practitioners
Physician assistants (PAs) and nurse practitioners (NPs) provide care alongside physicians. These healthcare providers have advanced training and can do many of the same tasks as doctors, making them key members of the team managing MASH.
What Do PAs and NPs Do?
Both PAs and NPs are trained to diagnose and treat a range of conditions, including liver diseases like MASH. They do patient evaluations and order tests, look at lab results and images to check your liver health, and give counseling on diet, exercise, and medication use. You may hear from an NP or PA when it comes to follow-up to check your disease progression. Both providers work closely with your primary care doctor, hepatologist, and gastroenterologist on treatment plans.
Differences Between PAs and NPs
While PAs and NPs have similar jobs, there are some differences. Nurse practitioners follow a nursing-based approach to care and often work independently in states that allow them to. They may specialize in areas like family medicine, internal medicine, or gastroenterology. Physician assistants on the other hand are trained in a medical model similar to physicians and work under the supervision of a doctor. They are trained in general medicine and can specialize in gastroenterology, hepatology, or primary care.
When Might You See a PA or NP?
In all likelihood through your treatment you will see either a PA or an NP. These providers help in every area of care, from monitoring to counseling to adjusting treatment plans. Often, these providers are also more accessible than certain specialists. While it may take a number of weeks or even months to find time with a hepatologist or gastroenterologist, PAs and NPs reduce wait times and make sure you get support between visits with your doctors.
Gastroenterologists: Digestive Health Experts
A gastroenterologist, or GI doctor, is a specialist in digestive diseases. This includes anything affecting the stomach, intestines, pancreas, gallbladder, and liver. They may be the first specialist that you see and diagnoses you with MASH. While hepatologists focus on liver diseases, gastroenterologists treat a wider range of digestive disorders, including MASH.
What Does a Gastroenterologist Do?
Gastroenterologists diagnose and treat conditions affecting the entire digestive system. MASH is connected with metabolic issues like obesity, diabetes, and high cholesterol. Therefore a GI doctor may work with you to improve your overall digestive health. Their primary job is to accurately diagnose and treat any issue with the GI tract. This is done through blood tests, imaging, and non-invasive procedures. In the case of MASH, a GI doctor may also do a procedure called a FibroScan to get a better sense of your liver's health and stiffness. This test uses ultrasounds to scan the liver and look for scarring. A GI doctor will also recommend certain changes to diet and lifestyle to help with your liver's health. If you have any digestive issues related to MASH, like acid reflux or IBS, a GI doctor will help treat those as well.
When Should You See a Gastroenterologist?
Generally a gastroenterologist helps manage early-stage MASH. They can assist with diagnosis and monitoring, as well as help manage any digestive symptoms that are linked to liver disease. Because MASH is closely tied to obesity and metabolic syndrome, there may be other issues they need to keep an eye on related to your digestive tract.
Hepatologists: Liver Disease Specialists
A hepatologist is a gastroenterologist who specializes in diagnosing and treating liver diseases. They have completed postgraduate training after medical school in internal medicine, gastroenterology and hepatology. They are going to have a lot of input in how MASH is treated, especially for people with advanced fibrosis or cirrhosis.
What Does a Hepatologist Do?
Hepatologists focus on diseases of the liver and the surrounding biliary system. This system includes the gallbladder, bile ducts, and pancreas. Because the liver plays such a key role in digestion and detoxification, hepatologists have to have a deep understanding of how liver diseases affect the entire body.
The primary responsibility of a hepatologist is to diagnose liver diseases using blood tests, imaging, and liver biopsies. If you were diagnosed with MASH, you likely had some or all of these tests done. They will also determine how severe MASH is and figure out whether there is any fibrosis or cirrhosis of the liver. You will see a hepatologist regularly to monitor how your MASH is progressing. A hepatologist will also recommend certain lifestyle changes and medications to help slow down or even reverse the damage to your liver. If needed, they will help patients eligible for a liver transplant. While this type of doctor does not do the transplant themselves, a hepatologist will certainly be involved in making that decision.
When Should You See a Hepatologist?
You will likely be referred to a hepatologist by your primary care doctor. This usually happens when MASH starts to progress towards advanced fibrosis or cirrhosis. It can also be because of concerning results from a liver test or a need for specialized liver imaging or a biopsy. If you develop certain complications, like fluid build up in the abdomen or signs of liver failure, you will see a hepatologist.
Treating MASH takes a team. While a gastroenterologist may be the first specialist to diagnose MASH, a hepatologist will step in once the disease is advanced enough. PAs and NPs help along the way with education, monitoring, and care. Having access to the right doctors can slow down the progression of MASH and improve your quality of life! Patients with MASH should work closely with their healthcare team to stay informed and proactive about their liver health.
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