Outpatient Medicine Update-GI Update - MASLD, Colorectal Cancer Screening

Video Transcription

Video Summary

This gastroenterology update reviews metabolic-associated steatotic liver disease (MASLD), GERD and proton pump inhibitors (PPIs), and colorectal cancer screening.<br /><br />For MASLD, 2026 consensus guidance recommends screening higher-risk patients—particularly those with type 2 diabetes, obesity, metabolic risk factors, or elevated liver enzymes—using the FIB-4 score. If risk is not low, follow-up testing with liver stiffness measurement or the ELF blood test can help determine whether specialist referral or treatment is needed, potentially avoiding liver biopsy. Weight loss, a Mediterranean-style diet, and aerobic and resistance exercise are central. Semaglutide and resmetirom are FDA-approved for specific patients with MASH and fibrosis; bariatric surgery also showed substantial benefit. Statins are not contraindicated, and SGLT2 inhibitors may help.<br /><br />For GERD, lifestyle measures and correctly timed, lowest-effective-dose PPIs are emphasized. Endoscopy is appropriate for alarm symptoms or persistent or recurrent symptoms. PPIs should be periodically reviewed and deprescribed when there is no ongoing indication; observational studies link unnecessary continuation with several adverse outcomes, though they cannot establish causation.<br /><br />For colorectal cancer screening, organizations differ on whether to begin at age 45 or 50. Colonoscopy and stool-based tests are options, but a positive noninvasive test requires follow-up colonoscopy. Screening decisions should consider health, life expectancy, and increasing procedural risks after age 75. Evidence supports FIT screening in reducing colorectal cancer deaths, while newer tests have less long-term outcome evidence. Risk factors—including excess weight, alcohol, meat intake, and family history—can inform prevention and screening discussions.

Keywords

MASLD

metabolic-associated steatotic liver disease

FIB-4

GERD

proton pump inhibitors

colorectal cancer screening

colonoscopy

FIT test

MASH fibrosis

statins