#211  Breaking Down MASLD vs. MASH and the MAESTRO-NASH & ESSENCE Trials: Beyond Journal Club Segment

#211 Breaking Down MASLD vs. MASH and the MAESTRO-NASH & ESSENCE Trials: Beyond Journal Club Segment

Author: Core IM Team June 29, 2026 Duration: 33:40

MASLD affects nearly one in three adults worldwide, yet many patients remain undiagnosed until advanced fibrosis or cirrhosis develops. So, which patients should clinicians actually be screening? When is a FIB-4 enough, and when should we move to elastography or hepatology referral? And are we finally entering an era where we can meaningfully treat MASH?

In this Beyond Journal Club episode, we unpack the evolving language of steatotic liver disease and take a close look at two major trials: MAESTRO-NASH studying resmetirom, the first FDA-approved liver-directed therapy for MASH, and ESSENCE, evaluating semaglutide in biopsy-confirmed disease.

Along the way, we explore what these biopsy-based histologic endpoints really mean, why placebo responses were surprisingly high, and whether improvements in steatohepatitis and fibrosis will ultimately translate into better clinical outcomes for patients.

This episode is for clinicians trying to understand where the field is headed, which patients deserve closer attention, and how metabolic liver disease is increasingly becoming part of everyday primary care and hospital medicine.


🔹Sponsor: Oakstone CME

Use the code "CORE25" for 25% off: https://www.coreimpodcast.com/MKSAP 


🔹Transcript and Shownotes:  

01:57 | Understanding MASLD as a Systemic Disease 

05:45 | MASLD vs MASH vs Met-ALD: Spectrum Steatotic Liver Disease 

08:55 | How to Screen for Fibrosis (FIB-4 & FibroScan) 

16:15 | Lifestyle Treatment & Weight Loss Targets 

19:00 | ESSENCE Trial: Semaglutide for MASH 

21:58 | MAESTRO-NASH Trial: Resmetirom 

27:27 | Future Treatments for MASH 

30:51 | Key Takeaways for Clinicians 


Tags: CoreIM, Internal Medicine, Medical Education, Hepatology, Fatty Liver Disease, Metabolic Dysfunction Associated Steatohepatitis, Nonalcoholic Fatty Liver Disease, Liver Fibrosis



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Ever find yourself in the middle of a busy day, wondering about the 'why' behind a common treatment or needing a clear way to think through a complex diagnosis? That's the space where Core IM | Internal Medicine Podcast lives. Created by the Core IM Team, this isn't just a lecture series; it's a practical companion for clinicians, students, and anyone curious about the inner workings of medical practice. Each episode is structured into distinct segments that tackle different facets of the clinical world. You'll hear "5 Pearls" for concise, immediately useful takeaways, and "Mind the Gap" explores the evidence and reasoning behind our everyday decisions. When management gets tricky, "Gray Matters" steps in to untangle the thought process, while "Hoofbeats" focuses on sharpening diagnostic acumen. Finally, "At the Bedside" brings it all together, addressing the real and often nuanced challenges faced in patient care. The conversation throughout this podcast is grounded, thoughtful, and driven by a genuine desire to deepen understanding beyond the textbook. It’s about connecting the dots between knowledge and application, making the intricate landscape of internal medicine a bit more navigable, one discussion at a time.
Author: Language: English Episodes: 50

Core IM | Internal Medicine Podcast
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