The 2026

Middle East School of Hepatology
School of Steatotic Liver Disease

“MASLD, a part of the new definition of steatotic liver disease, has become the most common chronic liver disease, and its prevalence will likely continue to rise. Therefore, MASLD needs to be addressed by medical societies and policymakers.” EASL CPG on management of MASLD.

The Middle East School of Hepatology (MESH) was established in 2004 as a teaching and mentoring venue that teaches liver disease to early- and mid-career hepatologists and gastroenterologists from different Middle East countries.
The MESH covers a teaching and training course in liver disease and liver cancer through one-week-modules each covering one topic (HCV, HBV, SLD, HCC, cirrhosis, portal hypertension, ascites, encephalopathy, liver transplantation).
Trainees attend lectures and discussions, and experience hands-on training in hospitals and hepatology clinics and centers. Teaching and hands-on-training modules are given in different venues in the Middle East (mainly in Egypt and UAE so far).
Five MESH rounds (each including 8 modules) were given over the past 10 years, with each round including between 25 and 50 attendees. Attendees are given a certificate of attendance for each module and a certificate of training completion for those who attend all modules. Costs are arranged to be grants from pharmaceutical companies or societies (no payment on part of the attendees).
With the rapid changes in the area of steatotic liver disease (from changing nomenclature to rapid change in knowledge of global epidemiology, complications and management options) the MESH is updating and modifying the SLD module to be delivered in 2026 to prepare the required experts for a region with one of the highest burdens of liver disease in general and SLD in particular.

Aims & learning objectives of the course

At the end of this course, attendees (postgraduate students) will be able to:

  • Accurately define steatotic liver disease, its nomenclature and the diseases it encompasses, and know who to include under this definition.
  • Accurately identify the metabolic syndrome, its individual components and cardio-reno- metabolic risk factors in general.
  • Identify who to screen and know how to screen for and diagnose hepatic steatosis and fibrosis due to MASLD in the general and in special populations; and be able to set-up/design screening programs in different settings.
  • Know the basics of performing abdominal ultrasound and liver stiffness measurement to diagnose steatotic liver, stage its severity and screen for HCC.
  • Correctly interpret results of several non-invasive tests, imaging and liver elastography results, including Fibroscan® and MR elastography.
  • Put forward the indications for advanced technical investigations, including liver biopsy, with an understanding of its added value and risks/limitations, and have a good understanding of the basic histological lesions and their clinical relevance.
  • Have an adequate understanding of disease pathophysiology and, building on that, on mode of action, indications and expected results of the different management methods and treatments available for MASLD, be confident in using them, choose between them, and deal with their possible complications.
  • Be familiar with latest published research on steatotic liver disease and its management, and know how to evaluate and critically interpret research manuscripts.
  • Position him/herself in a multidisciplinary/cross-disciplinary approach to MASLD patients and establish appropriate collaborations.
  • Assist in awareness campaigns and preventive actions regarding liver health in the context of general metabolic health.

The course will be held physically over 33.5 hours divided into 3 modules.

Attendance will be in person for the trainees and most speakers, and the sessions will be interactive, allowing extensive discussion and exchange between speakers and attendees.

Top experts in each field will give the talks and training sessions.

Module 1
7 & 8 May, 2026
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Module 2
16 & 17 July, 2026
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Module 3
17 & 18 September, 2026
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Curriculum

Introduction
1. New SLD Nomenclature
    • Rationale behind the new nomenclature.
    • Inclusive/overarching definition that can include:
      • HCV-infected patients,
      • Alcohol-related liver disease patients,
      • Patients with cardiorenometabolic risk factors.
    • Debate about MetALD entity.
    • Overlap/co-existence between SLD and other liver diseases, e.g., AIH, HBV and implications for management.
    • Summary of physiological whole body energy metabolism (including the role of gut-adipose tissue-pancreas-liver-muscle-brain).
    • Summary of the concepts of dysfunctional adiposity, insulin resistance, sarcopenic obesity.
    •  Addressing the pathophysiology of MASLD (including the adipose-tissue-liver and gut-liver axis) and bridging this to the potential targets for therapy.
    • Genetic predisposition and it’s clinical impact.
    • Pathophysiology of the extrahepatic consequences of MASLD, including cardiovascular and cognitive disorders. 
    • Brief summary of relevant pathophysiological interference of alcohol with metabolism/direct liver toxicity/CVD.
    • Summary of the data on the interaction/synergism between MASLD and other diseases (accelerated disease progression).
    • Metabolic syndrome globally and specifically in Egypt and Middle East.
    • Summary of the epidemiology of viral hepatitis, alcohol-related liver disease, MASLD, metabolic-viral liver disease and MetALD.
1. Who to Screen
    • Risk factors & associated diseases.
    • Categories of patients that should be screened:
        • All with elevated transaminases.
        • All with dysfunctional adiposity, obesity, HTN, DM & dyslipidaemia.
        • OSAS, PCO patients.
    • Goal of screening terminology: significant vs. advanced liver fibrosis clinically significant portal hypertension.
    • Available noninvasive tests for screening, their interpretation and appropriate use, and their limitations.
    • Validated screening algorithm according to the EASL CPG for SLD.
    • Importance of and correct measurement of BMI and Waist circumference.
    • Minimal lab set for liver and cardiorenometabolic screen.
  • Liver Biopsy
    • Reference standard:
      • Conventional read, staging systems.
      • Potential use of advanced techniques/AI
    • Limitations, risks, technical requirements.
    • Indications to perform a liver biopsy.
  • Noninvasive Techniques

  1. Transient Elastography (VCTE)
    • Correct interpretation of liver stiffness values in different contexts of use:
      • As a surrogate for fibrosis
      • As a prognostic marker
      • As a monitoring tool
      • As a treatment assessment tool
    • Technical challenges and limitations, especially in specific groups, g., obese patients, & how to overcome.
    • Summary of other ultrasound-based liver-stiffness measurement techniques.
    • Elements of availability and affordability.

  2. Direct Blood Markers

  • Non-proprietary and proprietary markers, their context(s) of use and correct interpretation.
  • Elements of availability and affordability.

  1. MR Elastography

  • Role as a non-invasive test in liver fibrosis confirmation compared to other imaging techniques.
  • Limitations, availability and affordability.

  1. Summary of a Suggested Pathway for screening & diagnosis of liver fibrosis.
    • The specifics of portal hypertension and the appropriateness of the thresholds for defining CSPH in MASLD.
    • Diagnostic modalities for CSPH in MASLD.
    • Tests to monitor disease over time, their correct interpretation.
    • Prognostication.
    • Indications
      • Does the occurrence of HCC in non-cirrhotic MASLD justify a different policy compared to other etiologies of chronic liver disease?
      • Risk stratification of patients for prioritizing HCC screening.
    • Best methods to use and specific challenges in MASLD.
    • Ultrasound (Steatosis, HCC, signs of portal hypertension).
    • Fibroscan® (CAPTM, LSM by VCTE).
    • MRI (PDFF, Elastography).
    • Liver biopsy interpretation.
1. Goals of management
    • Current global concepts regarding hard clinical outcomes vs. surrogates vs. QoL.
    • Current definitions that are the basis of the recommendations.
    • Mapping of cardiorenometabolic risk factors/components of the metabolic syndrome.
      • Tests to do in patients diagnosed with MASLD (whether as a result of screening or because of an incidental finding of steatosis and/or elevated liver tests).
    • Testing for subclinical cardiovascular disease:
      • Indications?
      • What to do?
    • Dysfunctional adiposity/Obesity introduction and relation to MASLD
      • Definitions and Measurements.
      • Mechanisms and Relation to Liver Disease.
      • Sense/Nonsense of differentially considering lean non-lean MASLD patients?
    • OSAS.
    • Obesity assessment and risk evaluation.
    • Goals: weight loss and beyond.
      • Thresholds for weight loss and their rationale,
      • Weight loss-independent benefits.
    • Food pattern and food composition:
      • Different diets preferred in MASLD patients,
      • Preferred time/pattern of eating (dietary circadian rhythm),
      • Unhealthy dietary habits to avoid.
    • Efficacy on liver steatosis, fibrosis, and related outcomes.
    • Weight loss-dependent and weight-loss independent benefits,
    • Nature of physical activity & exercise to be recommended for MASLD patients,
    • Efficacy on liver steatosis, fibrosis, and related outcomes.
    • Coffee,
    • Circadian rhythm,
    • Smoking,
    • Alcohol.
    • Learn patients to accept their shapes and at the same time cope with diet, and lifestyle modifications.
    • Behavioural motivation.
    • Empowerment.
  1. Anti-DM (Diabetes Mellitus) drugs
      • GLP-1R agonist,
      • SGLT-2 inhibitors,
      • Pioglitazone,
      • Metformin,
      • Insulin,
      • Dual and triple agonist.
    • Uses in MASLD patients in different categories (obese vs. lean, DM non-DM patients).
    • Side effects and precautions.
    • Efficacy on liver steatosis, fibrosis, and related outcomes.
  2. Statins and aspirin.
    • Indications.
    • Beneficial effects.
  3. Non-incretin-based weight loss drugs.
    • e.g., orlistat, naltrexone, bupropion.
    • Potential benefits in MASLD patients.
  1. Other medications
    • e.g.,
      • Vitamin E,
      • Omega 3,
      • UDCA,
      • Obeticholic acid.
    • When to recommend for MASLD patients?
  1. Resmetirom and other thyroid hormone receptor agonists.
    • Indications.
    • Efficacy & side Effects.
  1. Drugs in the pipeline.
  2. Endoscopic management of obesity.
  1.  

     8. Bariatric surgery

    • Indications.
    • Types of surgery.
    • Efficacy.
      • General,
      • Liver-specific.
    • Liver-specific safety considerations and risk of adverse liver outcomes.
  1. Management of MASH & MASH cirrhosis
    1. Goals and general considerations
      • Brief reminder of the concepts of ACLD and cirrhosis.
      • Specific aspects of MASLD cirrhosis compared to other aetiologies.
      • Differences in disease drivers and therapeutic targets and goals in cirrhosis/ACLD compared to earlier stages.
    2. Lifestyle changes in liver cirrhosis patients.
      • Goals,
      • Safety issues,
      • Specific recommendations regarding modifications in diet, exercise, and lifestyle.
    3. Assessing and managing malnutrition and osteosarcopenia.
    4. MASH-targeted pharmacological therapies
      • Which can be used safely in compensated/decompensated cirrhotic patients?
      • Specific precautions.
    5. Bariatric surgery in MASH & MASH cirrhosis.
      • Indications, contra-indications and precautions.
      • Recommended technique(s).
      • Timing.
      • Importance of portal hypertension.
    6. Liver transplantation.
      • Indications, contra-indications.
      • Timing and related considerations.
      • Risk of steatotic liver disease development after liver transplantation.

         7. Management of portal hypertension

      • Beta blockers, carvedilol.
      • Role of statins.
      • Surveillance and role of upper GI endoscopy.
  1. Management of associated cardiovascular & renal diseases
    • Brief and schematic overview of the different items the hepatologist should think of what the hepatologist can/should do and when and to whom the hepatologist should provide adequate referral.
  1. Vaccinations and cancer screening among SLD patients.
  1. SLD in special groups
    • PCO.
    • PLHIV.
    • IBD.
    • Paediatrics.
  1. Multidisciplinary management of MASLD/MASH patients
    • Highlight the overlap between different lines of MASLD management in the same patient and the need for a patient-centred rather than a disease-centred approach and hence for a personalized management plan for each patient.
    • Concepts of multidisciplinary clinics and community health approaches and what the role of the hepatologist could/should be.
  1. Preventive hepatology
    • Brief introduction to public health and the role of the hepatologist.