From EASL 2026: What Hepatology Still Needs to Solve

Treating patients with metabolic dysfunction–associated steatohepatitis (MASH) cirrhosis, scaling population-level screening, and addressing chronically underfunded conditions top the list of hepatology's most pressing unmet needs, according to experts who presented at the 2026 European Association for the Study of the Liver (EASL) Congress.

Why MASH Cirrhosis Demands the Field's Immediate Attention

Urgency around MASH cirrhosis was a consistent theme. Naim Alkhouri, MD, FAASLD, chief medical officer at Summit Clinical Research and hepatologist at NorthShore Gastroenterology & Endoscopy Centers, framed the stakes clearly: patients with stage IV fibrosis face the highest rates of hepatocellular carcinoma, decompensating events, and liver transplantation. The goal, he argued, should be both stabilizing disease and reversing it.

"Finding treatment that can slow progression to decompensation is highly desirable, but even we want to take it a step further and potentially develop treatments that can lead to a reversal of MASH cirrhosis," said Alkhouri. He added that fibrosis reversal rates above 15% to 20% are achievable through more potent agents or combination regimens and could meaningfully reduce rates of liver cancer and hepatic complications.

Mazen Noureddin, MD, MHSc, professor of medicine and transplant hepatologist at Houston Methodist Hospital, drew on the hepatitis C cure as a model. Direct-acting antivirals effectively removed the disease as a leading transplant indication, and he argued the same potential exists for steatotic liver disease but will require more effective medications for cirrhotic patients and combination strategies to boost efficacy. He also flagged primary sclerosing cholangitis as a smaller but equally underserved population.

Screening Gaps, Alcohol Disease, and the Compounding Burden of Steatotic Liver Disease

Zobair M. Younossi, MD, chairman of The Global NASH/MASH Council, placed individual disease categories within a larger framework. Steatotic liver disease, which encompasses MASH, alcohol-associated liver disease, and metabolic and alcohol–related liver disease (metALD), is now the leading indication for liver transplantation in both Europe and the US. Beyond its standalone burden, steatotic liver disease acts as a compounding factor for patients with hepatitis B or hepatitis C, worsening outcomes across disease states regardless of region.

“These diseases [are] not only important by themselves, but also they're important because they aggravate any other liver disease that you have, so that the disease burden from a liver standpoint is going to be higher,” Younossi said.

Meena Bansal, MD, professor of medicine and system chief of the Division of Liver Diseases at the Icahn School of Medicine at Mount Sinai, pointed to a gap between knowledge and action: validated algorithms to screen at-risk populations for fibrosis already exist, but their deployment and impact at a population level remain largely unassessed.

Tarik Asselah, MD, PhD, professor of hepatology at Hôpital Beaujon and the University of Paris-Cité, highlighted alcohol-related liver disease and rare liver conditions as chronically underfunded areas and pointed to early-phase gene therapy research in hepatitis B as a technology worth watching.