Activity Details

Free CME
0.5 AMA PRA Category 1 Credit
Released: February 1, 2019
Expires: January 31, 2020
30 minutes to complete

Jointly Provided by

Postgraduate Institute for Medicine and Integritas Communications

Target Audience

Gastroenterology/hepatology MDs and specialist NP/PAs

Learning Objectives

  • Identify patients with or at risk for the development of nonalcoholic steatohepatitis (NASH) using current epidemiologic and demographic data
  • Select appropriate invasive biopsy and/or noninvasive assessment modalities for diagnosing, staging, and monitoring NASH
  • Describe late-stage emerging NASH therapies in terms of mechanisms of action, relationships with disease pathophysiology and fibrosis progression, and the most recent efficacy and safety clinical data

Activity Description

This activity presents a review of the pathophysiology of NASH, noninvasive and invasive diagnostic methods, existing management options, and investigational targeted therapies through innovative infographic panels, which allow the learner to, at his or her pace, delve into each concept presented in the multiple layers of the panel.

Statement of Educational Need

Nonalcoholic steatohepatitis (NASH), part of the nonalcoholic fatty liver disease (NAFLD) spectrum, is characterized by steatosis, lobular inflammation, hepatocyte ballooning, and varying degrees of fibrosis.1 Both obesity and diabetes play large roles in development and progression of NAFLD and NASH, and the growing prevalence of NAFLD and NASH parallel the rise in obesity and diabetes.2 In addition to obesity and diabetes, multiple comorbidities occur with NASH; the 2 comorbidities that are strongly tied to mortality are cardiovascular disease and malignancy.3,4 Liver biopsy, often impractical or unfeasible, is the gold standard for diagnosis.5 Recently, noninvasive modalities, particularly imaging, have been used as substitutes to identify patients at risk for disease progression; there are, however, deficits in knowledge and access to some noninvasive modalities. Though there is no US Food and Drug Administration (FDA)-approved treatment for NASH, fibrosis, along with other histopathologic markers of NASH, can be improved through lifestyle modification or off-label use of therapies.5 Recent clinical trial data have been encouraging, but management of patients with NASH still proves difficult, necessitating education about diagnosis and management.


  1. Buzzetti E, Pinzani M, Tsochatzis EA. The multiple-hit pathogenesis of non-alcoholic fatty liver disease (NAFLD). Metabolism. 2016;65(8):1038-1048.
  2. Lonardo A, Bellentani S, Argo CK, et al. Epidemiological modifiers of non-alcoholic fatty liver disease: focus on high-risk groups. Dig Liver Dis. 2015;47(12):997-1006.
  3. Calzadilla Bertot L, Adams LA. The natural course of non-alcoholic fatty liver disease. Int J Mol Sci. 2016;17(5):E774.
  4. Stepanova M, Rafiq N, Makhlouf H, et al. Predictors of all-cause mortality and liver-related mortality in patients with non-alcoholic fatty liver disease (NAFLD). Dig Dis Sci. 2013;58(10):3017-3023.
  5. Chalasani N, Younossi Z, Lavine JE, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018;67(1):328-357.


  1. How to Use
  2. Introduction
  3. Epidemiology
  4. Risk factors
  5. Comorbidities
  6. Pathophysiology
  7. Metabolism
    1. Cell stress
    2. Inflammation
    3. Cirrhosis
  8. Goals of Assessment
    1. NAFLD
    2. NASH
    3. Fibrosis
  9. Assessment Algorithm
  10. Management
    1. Lifestyle
    2. Pioglitazone
    3. Investigational Treatments
  11. Conclusions


Arun J. Sanyal, MBBS, MD, FAASLD
Professor of Medicine, Physiology and Molecular Pathology
Virginia Commonwealth University (VCU)
Richmond, Virginia

  • Consulting Fees: Ardelyx, Inc., Eli Lilly and Company, Gilead Sciences, Inc., HemoShear Therapeutics, LLC, Mallinckrodt Pharmaceuticals, Nimbus Therapeutics, LLC, Nitto Denko Technical Corporation, Pfizer Inc., Salix Pharmaceuticals, Sanyal Biotechnology
  • Contracted Research: Bristol-Myers Squibb, Conatus Pharmaceuticals Inc., Galectin Therapeutics, Inc., Gilead Sciences, Inc., Mallinckrodt Pharmaceuticals, Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Salix Pharmaceuticals, Sequana Medical AG
  • Salary: Sanyal Biotechnology
  • Ownership Interest: Akarna Therapeutics Ltd., GENFIT SA, Natural Shield, NewCo LLC, Tiziana Life Sciences plc

Conflict of Interest Policy/ Disclosure Statement

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COIs are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality activities and related materials that promote improvements or quality in health care and not a specific proprietary business interest of a commercial interest.

Planners and Managers
The PIM planners and managers have nothing to disclose. The Integritas Communication planners and managers have nothing to disclose.

Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and Integritas Communications. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the health care team.

Designation of Credit

The Postgraduate Institute for Medicine designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Instructions for Receiving Credit

In order to claim credit, participants must complete the following:

  1. Read the educational objectives, accreditation information, and faculty disclosures at the beginning of this activity.
  2. Complete the Preactivity Questions.
  3. Read or review the activity content.
  4. Complete the Postactivity Test Questions and Evaluation.
  5. Physicians must achieve a grade of 100% on the Postactivity Test Questions and complete the Evaluation to receive a CME Certificate.
  6. All other participants who achieve a grade of 100% on the Postactivity Test Questions and who complete the Evaluation will receive a Certificate of Participation.

Statement of Commercial Support

This activity is supported by an independent educational grant from Gilead Sciences, Inc.



Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. PIM and Integritas Communications do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.


Participants have an implied responsibility to use newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions, possible contraindications, dangers of use, review of applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Contact Information for Questions about the Activity

For information about the accreditation of this program, please contact PIM via email at

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