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WHO:

Dr. Gish is a Hepatologist specializing in all forms of liver disease, liver cancer and liver transplant. Dr. Gish has partnered with TeleMed2U to provide telemedicine consultative services for patients with liver disease.

WHAT:

TeleMed2U is a telemedicine-based multi-specialty clinical practice increasing access to specialist providers providing, “healthcare anywhere and everywhere.” The telemedicine consultation will be conducted through our HIPAA and HITECH compliant platform. Connectivity testing will be done in advance to ensure you can connect via our telemedicine platform. Following the consultation, a clinical note will be provided including a summary of your liver consultation with Dr. Gish and his consultative recommendations.

COST:

Payment will be processed through an online secure transaction portal. The fees for consultative services are:

Initial 60 minute consultation per patient: $500.00
Follow Up 30 minute consultation per patient: $300.00

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If you’d like to continue, please click Next to complete the form and we will contact you to schedule connectivity testing. During the test you will have the opportunity to determine the method of providing medical records, discuss appointment availability as well as discuss any additional questions that you have. If you are a healthcare facility interested in services, please complete the form and we can discuss the options that are right for you and your patients.

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NAFLD and Dietary Patterns

Dec 3, 2020

Geographic regions with high prevalence of nonalcoholic steatohepatitis-related hepatic fibrosis are also observed to demonstrate high prevalence of metabolic disease risk factors and low consumption of fruits and vegetables

Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease globally. We aim to evaluate prevalence and predictors of hepatic fibrosis among NAFLD patients, focusing on metabolic co-morbidities and dietary patterns.

Methods:
Quest Diagnostics laboratory data from 2017 to 2018 were used to identify NAFLD patients using a stepwise algorithm based on laboratory data and ICD-9/10 codes. Prevalence of fibrosis was assessed using a step-wise AST to platelet ratio index (APRI) algorithm. Multivariate logistic regression evaluated predictors of F2 fibrosis or cirrhosis. Prevalence of fibrosis was stratified by U.S. Department of Health and Human Services geographic regions and compared with region-specific data on metabolic diseases and dietary patterns (fruit and vegetable intake) using 2017 Behavioral Risk Factor Surveillance System.

Results:
Among NAFLD patients, proportion of patients with APRI >2.0 was 1.58%, increasing to 3.05% (APRI > 1.5), 6.81% (APRI > 1.0), 12.67% (APRI > 0.7), and 21.87% with APRI >0.5. Increasing metabolic co-morbidities was associated with higher odds of fibrosis. Compared to patients with no metabolic co-morbidities, odds of >F2 fibrosis was OR 2.61 (95% CI 2.57e2.65, p < 0.01) and odds of cirrhosis was OR 1.76 (95% CI 1.70e1.82, p < 0.01) in patients with three metabolic co-morbidities. We observed that geographic regions with low fruit and vegetable intake and high prevalence of concurrent metabolic abnormalities to have the highest prevalence of NAFLD hepatic fibrosis.

Conclusion:
Increasing number of metabolic co-morbidities is associated with incremental increasing risk of hepatic fibrosis in NAFLD patients. We also observed patterns of low fruit and vegetable intake in regions with high prevalence of hepatic fibrosis.

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