Sobia Laique, MD, is a gastroenterologist and transplant hepatologist at Cleveland Clinic.

Can Metabolic Surgery Reverse MASH Cirrhosis?

For decades, cirrhosis has been understood as an irreversible, fibrotic scar replacing functional liver tissue, largely viewed as an endpoint. However, emerging evidence is challenging that assumption, particularly in the setting of 

metabolic dysfunction-associated steatohepatitis (MASH)

New research presented by Sobia Laique, MD, a gastroenterologist and transplant hepatologist, Chair of the MASLD Task Force, and director of the Multidisciplinary MASLD Center at Cleveland Clinic, at Digestive Disease Week (DDW) 2026 in Chicago, IL, suggests that for select patients with compensated MASH cirrhosis, metabolic bariatric surgery may not only halt disease progression, but actually reverse it.

The research builds on previously published findings from the SPECIAL study, which demonstrated a 72% reduction in major adverse liver outcomes, including variceal hemorrhage, hepatic encephalopathy, liver cancer, need for transplant, and liver-related death, in patients with compensated MASH cirrhosis who underwent MBS.

"When we saw that, it begged the question: did we potentially also reverse the cirrhosis itself?" Laique told 

To explore that question, the team conducted a retrospective cohort study of 30 patients with biopsy-proven compensated MASH cirrhosis who underwent metabolic bariatric surgery between 2004 and 2024 at a single tertiary care center. All patients had F4 fibrosis on baseline biopsy, no prior decompensation or liver transplant, and a median biopsy interval of 6.2 years. The cohort was metabolically advanced, with a mean BMI of 43.7 kg/m² and 87% having diabetes, but carefully selected for compensated disease.

Laique noted that a key insight from the study was methodological: how cirrhosis regression is measured matters. Conventional staging systems, such as the NASH CRN scoring system, define regression as a transition from F4 to F3 or lower, capturing stage changes but potentially missing subtler architectural remodeling, such as thinning or fragmentation of fibrous septa that does not shift the overall stage. When the team applied more granular frameworks, including the Ishak and Beijing classifications, which specifically assess architectural changes within fibrotic tissue, regression rates were meaningfully higher.

Using conventional NASH CRN staging, approximately one-third of patients showed cirrhosis regression. With Ishak scoring, that figure rose to 40%, and with the Beijing classification, to 60%.

"Even if there's a 1-in-3 chance that I have the ability to reverse a patient's disease, that's something I would want to be able to offer them, let alone if that goes up to 40 or 60%," Laique said.

Beyond regression rates, the findings carry broader implications for clinical practice, according to Laique. First, metabolic bariatric surgery can now be positioned as a truly disease-modifying intervention for patients with compensated MASH cirrhosis, one capable of improving long-term outcomes and reversing underlying disease. Second, the field needs to reassess how it measures fibrosis regression, not only in the context of surgical intervention, but also as pharmacologic therapies continue to emerge.

Laique noted that next steps should include prospective studies comparing metabolic bariatric surgery with GLP-1 receptor agonists, as well as mechanistic investigations into what drives cirrhosis regression, work she says her team is actively pursuing at the Cleveland Clinic.

Editor's note: Laique reports no relevant disclosures.

 Long-term liver outcomes after metabolic surgery in compensated cirrhosis due to metabolic dysfunction-associated steatohepatitis. 

https://doi.org/10.1038/s41591-024-03480-y

Laique S, Hammad AF, Allende DS, et al. CAN METABOLIC SURGERY REGRESS MASH CIRRHOSIS? EVIDENCE FROM PAIRED BIOPSIES. Presented at Digestive Disease Week (DDW) 2026 in Chicago, IL, May 2-5, 2026.

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New paired biopsy data show histologic regression after metabolic bariatric surgery in compensated MASH patients, challenging the irreversibility of cirrhosis.

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MASH / MASLD

The HCPLive MASH & MASLD page is a comprehensive resource for clinical news and insights on metabolic dysfunction-associated steatotic liver disease and steatohepatitis. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for fatty liver disease, steatohepatitis, and more.

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Histologic Evidence of MASH Cirrhosis Regression After Metabolic Bariatric Surgery, With Sobia Laique, MD

Allison Wu, MD, MPH, is a general pediatric gastroenterologist at Boston Children’s Hospital and an assistant professor of pediatrics at Harvard Medical School.

How Food Access Shapes Childhood Obesity Risk

 remains one of the most pressing public health challenges in the United States, with growing recognition that its roots extend far beyond individual behavior. Increasing attention is being turned to the broader food environment, both at the neighborhood and household levels, as a key driver of long-term health outcomes.

0:00:13 – Defining food access vs food availability

0:01:0 – Study design and main findings

0:02:40 – Critical windows for intervention

0:04:05 – Role of gastroenterologists and team-based care

0:05:15 – Policy and “food is medicine” advocacy

New research presented by Allison Wu, MD, MPH, a general pediatric gastroenterologist at Boston Children’s Hospital and an assistant professor of pediatrics at Harvard Medical School​, at Digestive Disease Week (DDW) 2026 offers important insight into how these factors intersect to shape obesity risk over time.

In a large retrospective cohort study of nearly 14,000 children aged 2 to 11 years across Mass General Brigham-affiliated sites, she and colleagues examined how neighborhood food access and household food security influence body mass index (BMI) trajectories and obesity risk. Using geocoded residential data linked to the USDA Food Access Research Atlas, the study identified children living in low-income, low-vehicle (LILV) neighborhoods, areas where access to supermarkets is limited.

Over a 5-year follow-up period spanning 2019 to 2024, residence in these neighborhoods was associated with significantly higher BMI z-scores and an increased risk of obesity.

Of note, these effects were not immediate but emerged over time. Children living in LILV neighborhoods had a nearly 2-fold increased risk of obesity by age 10 compared to peers in areas with better food access, even after adjusting for insurance status. Parallel findings were observed at the household level, where children from food-insecure households also demonstrated higher BMI trajectories and elevated obesity risk, reinforcing the independent and additive roles of these exposures.

The study also underscores the importance of timing in intervention strategies. While differences in BMI were not apparent in early childhood, disparities became significant later, particularly in older children and adolescents. This suggests that early life remains a critical window for prevention, even before measurable differences emerge.

“I think of the critical windows for intervention as 2-fold. One is in early childhood thinking of obesity prevention. Even though we didn't see these effects at age 5, obesity prevention needs to be an area of focus, so intervening early on in life,” Wu said. “I think of the first 1000 days of life as being an important period to prevent obesity and promote optimal health, and then later on, early adolescence is another critical window for intervention.”

For gastroenterologists, these findings carry direct clinical relevance. Specialists often encounter the downstream effects of obesity, including 

metabolic dysfunction-associated steatotic liver disease

. This positions them as important touchpoints for screening and intervention. However, Wu stressed that addressing food access challenges requires a team-based approach.

“Working with primary care physicians, working with our dietitians, social work, other patient health navigators, is critical because it does not by any means rely on the gastroenterologist alone, and we have found a team-based approach is what's most productive and collaborative in helping navigate healthy food access, at least in terms of children and for families,” she explained.

Looking ahead, the findings support a multilevel strategy to combat childhood obesity that integrates clinical screening with community-based interventions and policy-level changes. Expanding access to nutrition support programs, including “food is medicine” initiatives and Medicaid-covered services, may play a critical role in bridging gaps.

Editors’ note: Wu reports no relevant disclosures.

US Centers for Disease Control and Prevention. Childhood Obesity Facts. April 2, 2024. Accessed May 2, 2026. 

https://www.cdc.gov/obesity/childhood-obesity-facts/childhood-obesity-facts.html

Wu A, Arris IM, Luo M, et al. MULTILEVEL ASSOCIATIONS OF THE FOOD ENVIRONMENT WITH CHILD BODY MASS INDEX AND OBESITY. Presented at Digestive Disease Week (DDW) 2026 in Chicago, IL, May 2-5, 2026.

Wu describes her research linking low food access and food insecurity to higher childhood obesity risk, highlighting the need for early, multilevel prevention strategies.

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, IBS and IBD, Crohn's disease, and more.

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Why Food Access Matters in Childhood Obesity Prevention, With Allison Wu, MD, MPH

Basile Njei, MD, PhD, MPH, is an assistant professor at Yale School of Medicine.

Optimizing MASLD Screening in the Era of Liver-Directed Therapy

metabolic dysfunction-associated steatotic liver disease (MASLD)

 solidifies its position as the leading cause of chronic liver disease in the United States, a critical gap remains: most patients with clinically significant fibrosis still go undiagnosed. With the recent emergence of liver-directed therapies, the stakes of early identification have never been higher.

New research presented by Basile Njei, MD, PhD, MPH, an assistant professor at Yale School of Medicine, at Digestive Disease Week (DDW) 2026 in Chicago, IL, explores whether widespread screening using noninvasive tests (NITs) is not only clinically beneficial, but also economically justified in this new treatment era.

March 14, 2024: Madrigal Pharmaceuticals’ 

, an oral, thyroid hormone receptor (THR)-β selective agonist, approved as the first MASH therapy in combination with diet and exercise

injection 2.4 mg, a GLP-1 receptor agonist, approved as the second MASH therapy, again in combination with diet and exercise

In the past, most of the noninvasive tests were not cost effective, because you identify a patient with fibrosis, but then you don't have a treatment for it,” Njei explained to 

. “You diagnose more patients without treating them, and so the cost goes up without an improvement in the quality of life.”

He noted that MASLD carries risks that extend far beyond the liver, with affected patients facing an increased likelihood of cardiovascular events, kidney disease, and cancer. Despite this, many individuals remain undiagnosed until later stages of disease, limiting opportunities for intervention.

Traditionally, clinicians have relied on simple, accessible tools such as the FIB-4 score to assess fibrosis risk, followed by confirmatory imaging like transient elastography (TE) to evaluate liver stiffness. While effective, the broader implementation of these strategies has been limited in part by questions regarding cost-effectiveness, especially in an era when treatment options were lacking.

Now, with 2 US Food and Drug Administration approved treatment options in the forms of resmetirom (Rezdiffra) and semaglutide (Wegovy), Njei and colleagues conducted a decision-analytic Markov model informed by nationally representative NHANES data from 2017 to 2020. The study evaluated multiple screening pathways over 5- and 10-year horizons from a US payer perspective, comparing FIB-4, SAFE, ALADDIN, and LRS each followed by TE, against TE-only screening and usual care. The model also incorporated a phenotype-guided treatment strategy, assigning semaglutide to patients with obesity or diabetes and resmetirom to others with confirmed F2–F3 fibrosis.

Findings showed that across both time horizons, all lab-based NIT strategies followed by TE were cost-effective at a willingness-to-pay threshold of $50,000 per quality-adjusted life year (QALY), while TE-only screening was not. Among the approaches, SAFE + TE consistently emerged as the most cost-effective strategy, with incremental cost-effectiveness ratios (ICERs) of $8405/QALY at 5 years and $6864/QALY at 10 years, along with the highest net monetary benefit.

Of note, the study also highlighted the added value of a hybrid treatment approach. Compared to single-agent strategies, combining semaglutide and resmetirom based on patient phenotype yielded the greatest population-level benefit, underscoring the importance of personalized care in MASLD management.

While the results provide compelling, policy-relevant evidence supporting population-level screening, Njei noted that further real-world data are needed to confirm long-term outcomes, including reductions in liver decompensation, hepatocellular carcinoma, and mortality.

“In management of these patients, we can easily diagnose them now with simple lab tests, we have treatments that can help in reversing liver disease to a certain extent, and so that what we need moving forward is to get more data in the long term and to see how screening impacts long term outcomes,” he said. “Right now, we're still projecting, we're estimating, and in our study, for example, we are simulating scenarios of care. What will be important is for us to look long term.”

Editors’ note: Njei reports no relevant disclosures.

Njei B, Lim JK. COST-EFFECTIVENESS OF NONINVASIVE TESTS FOR SCREENING MASLD-ASSOCIATED SIGNIFICANT LIVER FIBROSIS IN THE US POPULATION. Presented at Digestive Disease Week (DDW) 2026 in Chicago, IL, from May 2-5, 2026.

Brooks A. Resmetirom (Rezdiffra) Receives Historic FDA Approval for Noncirrhotic NASH. HCPLive. March 14, 2024. Accessed May 2, 2026. 

https://www.hcplive.com/view/resmetirom-rezdiffra-receives-historic-fda-approval-for-noncirrhotic-nash

Brooks A. FDA Approves Semaglutide (Wegovy) Injection 2.4 mg for Noncirrhotic MASH. HCPLive. August 15, 2025. Accessed May 2, 2026. 

https://www.hcplive.com/view/fda-approves-semaglutide-wegovy-injection-2-4-mg-for-noncirrhotic-mash

Njei explains the evolving treatment landscape for MASLD and how it impacts the cost-effectiveness of noninvasive tests for screening.

Optimizing MASLD Screening in the Era of Liver-Directed Therapy, With Basile Njei, MD, PhD, MPH

Welcome to The HCPFive, your go-to roundup for the latest healthcare news and breakthroughs, curated specifically for busy healthcare professionals.

Each week, we highlight 5 key developments or headlines from healthcare that you need to know—whether it's a cutting-edge treatment, regulatory updates, or innovations shaping the future of medicine. This week's top stories include the US Food and Drug Administration (FDA) approvals of anifrolumab-fnia (Saphnelo) for subcutaneous self-administration in systemic lupus erythematosus (SLE) and lumateperone (Caplyta) for schizophrenia, clearance of Tandem Diabetes Care’s Control-IQ+ automated insulin delivery technology for use during pregnancy complicated by type 1 diabetes, Priority Review and Breakthrough Therapy Designation for bepirovirsen in chronic hepatitis B, and approval of AstraZeneza’s budesonide/glycopyrrolate/formoterol fumarate (BGF; BREZTRI Aerosphere) as the first single-inhaler triple-combination maintenance therapy for asthma in adult and pediatric patients 12 years of age and older.

With The HCPFive, you'll get the essential takeaways to stay informed and ahead of the curve. Here’s your quick dive into the top stories for the week of April 26, 2026—let’s jump in!

Anifrolumab (Saphnelo) Wins FDA Approval for Subcutaneous Self-Administration in SLE

On April 27, 2026, the FDA approved anifrolumab-fnia (Saphnelo) for subcutaneous self-administration via a once-weekly 120 mg autoinjector, the Saphnelo Pen, for adult patients with moderate to severe SLE receiving standard therapy. The decision was based on results from the phase 3 TULIP-SC trial.

Lumateperone sNDA Approved with Relapse Prevention Data in Schizophrenia

On April 26, 2026, the FDA approved a supplemental New Drug Application (sNDA) for lumateperone (Caplyta) based on long-term data supporting the prevention of relapse in adults with schizophrenia. Specifically, a phase 3 randomized withdrawal trial demonstrating a 63% reduction in relapse risk versus placebo over a 26-week double-blind treatment period.

FDA Clears Control-IQ+ for Use in Pregnancy With Type 1 Diabetes

On April 27, 2026, the FDA cleared Tandem Diabetes Care’s Control-IQ+ automated insulin delivery technology for use during pregnancy complicated by type 1 diabetes, expanding the label for the company’s t:slim X2 and Tandem Mobi systems. According to the Company, this makes Control-IQ+ the first commercially available automated insulin delivery system in the US with a pregnancy indication.

FDA Grants Bepirovirsen Breakthrough Therapy Designation, Priority Review for Chronic Hepatitis B

On April 28, 2026, the FDA accepted for Priority Review the New Drug Application (NDA) for bepirovirsen, an investigational antisense oligonucleotide developed by GSK in partnership with Ionis Pharmaceuticals, for the treatment of adults with chronic hepatitis B. The Agency simultaneously granted bepirovirsen Breakthrough Therapy designation and established a PDUFA target action date of October 26, 2026.

If approved, bepirovirsen would represent the first therapy to achieve clinically meaningful functional cure rates in this population, addressing a significant gap in the current treatment landscape.

FDA Approves BGF Triple Therapy for Asthma in Patients 12 and Older

On April 28, 2026, the FDA approved AstraZeneza’s budesonide/glycopyrrolate/formoterol fumarate (BGF; BREZTRI Aerosphere) as the first single-inhaler triple-combination maintenance therapy for asthma in adult and pediatric patients 12 years of age and older. The decision marks the second approved indication for BGF, which received FDA clearance for chronic obstructive pulmonary disease in adults in 2020.

Articles

Multiple late-April 2026 FDA actions expanded access to therapies and devices across immunology, psychiatry, diabetes, virology, and pulmonary medicine. Anifrolumab gained a once-weekly subcutaneous autoinjector option for moderate-to-severe SLE based on phase 3 TULIP-SC. Lumateperone received an sNDA approval supported by phase 3 randomized withdrawal data showing reduced schizophrenia relapse risk. Tandem’s Control-IQ+ was cleared for type 1 diabetes in pregnancy. Bepirovirsen received Priority Review and Breakthrough Therapy designation in chronic hepatitis B, and BGF triple therapy was approved for asthma ages ≥12.

Stay updated with the latest healthcare breakthroughs, including notable FDA approvals and filings, in this week’s essential news roundup.

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The HCPFive: Top News for Healthcare Providers from the Week of 04/26

Jignesh Shah, MD, is a gastroenterologist at Gastroenterology Consultants, PA.

New Tools, New Questions: Portable Gluten Sensors for Celiac Disease

As the management of celiac disease continues to rely almost entirely on strict dietary avoidance, emerging technologies are beginning to reshape how patients navigate daily life. Portable gluten detection sensors are generating both excitement and skepticism within the celiac community as new devices continue to enter the market.

, Jignesh Shah, MD, emphasized that while diagnosis remains the most challenging step in celiac disease management, the long-term burden often shifts to education and lifestyle adaptation. He noted that once confirmed, care transitions toward helping patients and families navigate dietary restrictions, behavioral modifications, and ongoing monitoring. This is where new tools, including portable gluten sensors, may offer meaningful support.

These devices, such as the NIMA sensor, rely on immunoassay-based technology similar to rapid antigen tests. A small sample of food is inserted into a disposable cartridge, which is then analyzed for gluten content. Results are displayed in a simple, user-friendly format, indicating whether the food is safe to consume.

According to Shah, this type of accessibility is key: “Easy interpretation and that kind of technology is what we need for consumers. Sometimes, we have to provide some reassurance. So devices like this are really, really needed as a tool for patients out there.”

In January 2026, Nima announced its next generation of the NIMA™ Gluten Sensor, branding it as the first handheld gluten detection device reengineered for faster, more dependable results. As described in a press release from the Company, it is the only portable solution capable of identifying all major gluten sources, including wheat, barley, and rye, down to 10 ppm with 99% accuracy, as confirmed through independent third-party laboratory testing.

“Once that diagnosis is done, essentially, what am I going to do as a gastroenterologist? I can just reassure, reassure, reassure, but when you start having devices like that, I can provide some objectivity, I can provide a resource, I can provide a tool,” he said.

However, Shah cautioned that it is still early in the adoption curve and stressed that these sensors should be viewed as adjunctive tools rather than definitive diagnostic instruments.

Clinically, he described particular value in targeted, situational use. For example, patients navigating social settings, such as dining out, may benefit from having an on-the-spot method to assess uncertain foods. He described the case of a college student newly diagnosed with celiac disease who wanted to maintain a normal social life. Rather than restricting her activities, Shah recommended selective use of the device in moments of doubt.

Additionally, these sensors may help address unexplained symptoms or persistently elevated serologic markers despite reported adherence to a gluten-free diet. In such cases, the device could help identify hidden sources of cross-contamination, offering both patients and clinicians greater insight into real-world exposures.

Looking ahead, Shah anticipates that adoption of these technologies will grow, though incorporation into formal guidelines may take time and require robust clinical data. For now, he believes the value lies in their ability to fill a gap in patient support.

Rubio-Tapia A, Hill ID, Semrad C, et al. American College of Gastroenterology Guidelines Update: Diagnosis and Management of Celiac Disease. The American Journal of Gastroenterology 118(1):p 59-76, January 2023. doi:10.14309/ajg.0000000000002075

Nima. NIMA Partners Introduces the Next-Generation NIMA Gluten Sensor with 99% Accuracy Across All Major Gluten Sources. January 12, 2026. Accessed May 2, 2026. 

https://www.globenewswire.com/news-release/2026/01/12/3216836/0/en/nima-partners-introduces-the-next-generation-nima-gluten-sensor-with-99-accuracy-across-all-major-gluten-sources.html

Shah describes the science and real-world use of gluten sensors, with insights on how these tools may support patients with celiac disease without replacing standard care.

The Emerging Role of Gluten Detection Sensors in Celiac Disease Care, With Jignesh Shah, MD

Tim Smith joined the MJH Life Sciences team in 2022 and is currently an associate editor for HCPLive. He is also the executive producer of two podcasts: Skin of Color Savvy and The Medical Sisterhood. Previously, he was the producer of the Lungcast podcast. He graduated from UC Berkeley and worked in multimedia journalism as a staff writer prior to joining MJH. You can contact him at tsmith@mjhlifesciences.com.

This iteration of the ‘Month in Review’ series highlights top headlines covered in April in dermatology news, including FDA decisions.

Dermatology

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Plaque Psoriasis

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7 Dermatology Headlines You Missed in April 2026

Elizabeth Kiracofe, MD, speaks in this segment of her recent The Medical Sisterhood podcast about her career and other community initiatives.

Getting Involved in the Community as a Dermatologist, With Elizabeth Kiracofe, MD

Rachael Sood, NP, is a diabetes nurse practitioner and Owner and CEO of The Diabetes Collective.

Sood shares her thoughts on the recent announcement by the FDA, limiting pharmacies’ ability to compound semaglutide, tirzepatide, and liraglutide from bulk substances.

FDA News

Type 2 Diabetes

FDA Proposes Exclusion of Multiple GLP-1 RAs from Bulks List, With Raechel Sood, NP

Pranav Garimella, MBBS, MPH, is chief medical officer of the American Kidney Fund.

APOL1 research is driving precision nephrology, but prediction gaps and equity challenges still limit clinical impact.

Nephrology

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APOL1-Mediated Kidney Disease: From Genetic Discovery to the Edge of Precision Medicine

Physician and CEO, Chicago Allergy Center, and board director at American Lung Association

The first single-inhaler ICS/LABA/LAMA combination for asthma adds a mechanistically distinct bronchodilator to a well-established inhaled backbone.

BGF Triple Therapy FDA Approval Expands Asthma Options for Underserved Patients, With Juanita Mora, MD

Chelsie Derman is an associate editor for 

who covers allergy and  psychiatry. She joined MJH Life Sciences in September 2023 after graduating from The College of New Jersey with a bachelor’s degree in journalism and professional writing. In her free time, she enjoys creative writing and reading.

FDA expands lumateperone for relapse prevention in schizophrenia, White House boosts psychedelics research, and AI reshapes psychiatry care debates in April 2026.

Major Depressive Disorder

Major Depressive Disorder condition center page, resources on the topics of medical news and expert insight into depression can be found. Content includes articles, interviews, videos, podcasts, and breaking news on MDD research, treatment, and drug development.

5 Psychiatry Headlines You Missed in April 2026

Victoria Johnson joined MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and is now an assistant managing editor for HCPLive and RheumatologyLive. She doesn’t have enough time for her numerous hobbies. You can reach her at vjohnson@mjhlifesciences.com.

April 2026 saw new data from pivotal clinical trials and a new approval in asthma.

Asthma

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COPD

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5 Pulmonology Headlines You Missed in April 2026

Experts debate when to start growth hormone after cancer, share pediatric vs adult wait times, and offer tips on long‑acting GH dosing.

Growth Hormone Deficiency in Cancer Survivors

Insurance barriers and missing records complicate adult growth hormone therapy, as experts urge better documentation, transition clinics, and patient-centered care to improve outcomes.

Navigating Barriers in Adult GHD Management

How to keep growth hormone deficiency patients on track when moving to adult care—cutting waitlists, dropouts, and insurance delays.

Latest News

Histologic Evidence of MASH Cirrhosis Regression After Metabolic Bariatric Surgery, With Sobia Laique, MD

Why Food Access Matters in Childhood Obesity Prevention, With Allison Wu, MD, MPH

Optimizing MASLD Screening in the Era of Liver-Directed Therapy, With Basile Njei, MD, PhD, MPH

The HCPFive: Top News for Healthcare Providers from the Week of 04/26

The Emerging Role of Gluten Detection Sensors in Celiac Disease Care, With Jignesh Shah, MD