DAY 1: Are Primary Care Providers Equipped to Screen and Manage Patients with Metabolic Dysfunction-Associated Steatotic Liver Disease?

Addressing provider confidence and simplifying risk stratification are two critical steps in the process of integrating the management of metabolic dysfunction-associated steatotic liver disease (MASLD) into primary care clinics, according to survey findings presented at the 2026 Annual Scientific Meeting of the American College of Gastroenterology in Nashville, Tennessee.

With the increasing global prevalence of MASLD, primary care providers play an essential role in the early detection, risk stratification, and initial management of this disease spectrum, as these providers often reach patients before they receive specialty care. Nevertheless, screening and management patterns vary widely among primary care practices, as do providers’ levels of confidence in managing MASLD.

“MASLD has a massive global burden of disease, [affecting] up to 38% of the adult population worldwide” said presenting author Rahul Sandella, MD, chief resident in internal medicine at the University of Chicago Medical Center. “In our prior investigations, we noted that MASLD was being insufficiently screened [in] outpatient [settings], especially within the primary care setting.”

Sandella and colleagues conducted a survey of primary care providers affiliated with the University of Chicago health system to assess MASLD screening and management patterns in this setting in order to identify areas for potential targeted interventions. Survey respondents included trainees, advanced practice providers, and attending physicians. The 32 multiple choice questions were designed to address demographic characteristics of survey participants, as well as practice patterns and levels of comfort with the management of MASLD.

The respondents were largely women and more commonly internal medicine attending physicians who had been practicing for less than 5 years. Nearly one-third of respondents said they were not comfortable or were only slightly comfortable diagnosing and managing MASLD. Nevertheless, most respondents (72%) felt that screening for MASLD fell entirely within the purview of primary care providers, whereas lower proportions of respondents believed that primary care providers were responsible for diagnosing (47%) or managing (23%) MASLD. The survey also showed that primary care providers are largely familiar with the first-line, noninvasive screening test FIB-4 but are less familiar with vibration-controlled transient elastography (VCTE), magnetic resonance elastography (MRE), or even noninvasive biomarker-based tests such as the Enhanced Liver Fibrosis (ELF) test.

“The findings suggest that, when providers do suspect MASLD in the primary care setting, they often defer to imaging tests like abdominal ultrasound and are less likely to utilize noninvasive fibrosis testing,” Sandella remarked. When it comes to treatment, Sandella added, “primary care providers take ownership of the treatment of MASLD through options like lifestyle interventions, cardiometabolic management, and [the use of] glucagon-like peptide-1 (GLP-1) receptor agonists, but do regularly defer treatment to hepatology.” The survey showed that 84% of the respondents had never prescribed resmetirom, and nearly 40% were unaware of the recently-approved therapies targeting MASLD.

“Overall, our data suggest that there is an underlying discomfort [surrounding] MASLD management in the primary care setting and infrequent utilization of guideline-recommended noninvasive tests,” Sandella concluded. “Primary care providers are largely interested in improving their management of MASLD through targeted interventions, including electronic health record flags and pathways.” The author noted that breaking down institutional silos between primary care providers, hepatologists, and other subspecialty care providers is key to identifying individuals at risk for MASLD before irreversible liver damage occurs.