Contents
Mitchell L. Shiffman (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - September 28, 2021 Category: Gastroenterology Source Type: research
Forthcoming Issues
The Evolving Role of Therapeutic Endoscopy in Patients with Chronic Liver Diseases (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - September 28, 2021 Category: Gastroenterology Source Type: research
Endoscopic Treatment of Esophageal Varices
Acute variceal bleeding is a complication of portal hypertension, usually due to cirrhosis, with high morbidity and mortality. There are 3 scenarios for endoscopic treatment of esophageal varices: prevention of first variceal bleed, treatment of active variceal bleed, and prevention of rebleeding. Patients with cirrhosis should be screened for esophageal varices. Recommended endoscopic therapy for acute variceal bleeding is endoscopic variceal banding. Although banding is the first-choice treatment, sclerotherapy may have a role. Treatment with Sengstaken-Blakemore tube or self-expanding covered metallic esophageal stent c...
Source: Clinics in Liver Disease - September 25, 2021 Category: Gastroenterology Authors: Marc J. Zuckerman, Sherif Elhanafi, Antonio Mendoza Ladd Source Type: research
Management of Thrombocytopenia and Coagulopathy in Patients with Chronic Liver Disease Undergoing Therapeutic Endoscopic Interventions
Management of coagulopathy in patients with advanced liver disease undergoing therapeutic endoscopic procedures is complex. Improvements in the understanding of hemostasis at a physiologic level have highlighted the inaccuracy of currently available clinical tests, like platelet count and prothrombin time, in estimating hemostasis in patients with cirrhosis. With identification of novel factors that contribute to bleeding risk in patients with cirrhosis, there is a dearth of clinical trial data that account for all potentially relevant factors and that examine interventions to reduce bleeding risk. Precise recommendations ...
Source: Clinics in Liver Disease - September 16, 2021 Category: Gastroenterology Authors: Jay Luther, Lawrence S. Friedman Source Type: research
Endoscopic Bariatric Interventions in Patients with Chronic Liver Disease
Obesity and its associated comorbidities are rapidly increasing in the US population. Therefore, metabolic associated fatty liver disease (MAFLD), previously known as nonalcoholic fatty liver disease (NAFLD), has become a leading indication for liver transplantation. Lifestyle modifications as a sole therapy have been insufficient to reduce the burden of chronic liver disease secondary to MAFLD. Endoscopic bariatric interventions (EBI) appear to be safe and effective therapies for obesity and chronic liver disease secondary to MAFLD. Gastric EBI include endoscopic sleeve gastroplasty (ESG) and intragastric balloons (IGB). ...
Source: Clinics in Liver Disease - September 16, 2021 Category: Gastroenterology Authors: Marco A. Bustamante-Bernal, Luis O. Chavez, Marc J. Zuckerman Source Type: research
Hepatitis B and Health Care Workers
Owing to standard precautions and initiatives for universal hepatitis B virus (HBV) vaccination in the general population and health care workers, risk of transmission of HBV infection from the patient to a health care worker (and vice versa) is very low. The need for mandatory HBV screening and vaccination in health care workers is less clear than in the past. Health care workers with chronic HBV infection neither require restrictions on professional practice nor disclosure of infection status to a patient. Further study is required to develop effective revaccination strategies to manage health care workers who are vaccin...
Source: Clinics in Liver Disease - September 10, 2021 Category: Gastroenterology Authors: Stephen C. Pappas Source Type: research
Interpretation of HBV Serologies
Hepatitis B was discovered by researchers who were investigating jaundice associated with blood transfusions as well as parenterally administered medications. Through trial and error, the HBV was identified. There are specific tests that detect HBV infection, whether it is a previous exposure or active infection. The various HBV serologies are reviewed in this work as well. Hepatitis B surface antigen has emerged as a tool in defining treatment endpoint and its significance is reviewed. HBV genotypes are distributed uniquely throughout the world, in particular, genotype C is associated with higher rates of hepatocellular c...
Source: Clinics in Liver Disease - September 10, 2021 Category: Gastroenterology Authors: Philippe J. Zamor, Ashley M. Lane Source Type: research
The Changing Demographics of Hepatitis B Virus Infection
Hepatitis B virus infection remains a global public health problem with changing epidemiology due to several factors including vaccination policies and migration. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - September 9, 2021 Category: Gastroenterology Authors: Issam Tout, Dimitri Loureiro, Tarik Asselah Source Type: research
Treatment and Prevention of Acute Hepatitis B Virus
This article reviews the incidence of acute hepatitis B virus (HBV) infection, its clinical course, strategies to prevent acute HBV infection in susceptible individuals, and the management of patients with acute HBV. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - September 9, 2021 Category: Gastroenterology Authors: Simone E. Dekker, Ellen W. Green, Joseph Ahn Source Type: research
Controversies in the Management of Hepatitis B
Hepatitis B is the leading cause of hepatocellular cancer (HCC) worldwide. Untreated, annual HCC incidence rates in chronic hepatitis B subjects are 0.4% in noncirrhotics and 2% to 3% in cirrhotics. Surveillance with ultrasound with/without α-fetoprotein at 6-month intervals is recommended in at-risk persons including children. Antiviral therapy in chronic hepatitis B with entecavir or tenofovir significantly lowers the risk of HCC across all stages of liver disease, and lowers the risk of HCC recurrence following curative therapy. Th ere are insufficient data to recommend use of tenofovir over entecavir in the prevention...
Source: Clinics in Liver Disease - September 9, 2021 Category: Gastroenterology Authors: Stuart K. Roberts, Ammar Majeed, William Kemp Source Type: research
Preface
Chronic hepatitis B virus (HBV) is the most common cause of chronic viral liver disease throughout the world. Despite there being an effective vaccine for over 50 years, chronic HBV remains a primary cause of hepatocellular carcinoma (HCC), a common cause of cirrhosis, and leads to an estimated 880,000 deaths annually. Given the worldwide magnitude, health implications, and constant advances made in our understanding and treatment of HBV, this virus has been a recurring topic of Clinics in Liver Disease. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - September 3, 2021 Category: Gastroenterology Authors: Mitchell L. Shiffman Source Type: research
Chronic Hepatitis B Virus in Patients with Chronic Hepatitis C Virus
Many patients with hepatitis C virus (HCV) have also been exposed to hepatitis B virus (HBV). The 2 viruses interact and in most cases HCV suppresses HBV. When HCV is treated with direct antiviral agents, this suppressive effect is removed, HBV replication may increase, and a flare in liver enzymes with liver injury may occur. All patients with chronic HCV should therefore be checked for serologic evidence of HBV. Patients with hepatitis B surface antigen are at the highest risk for reactivation, and these patients should receive prophylactic treatment of HBV during and for 6 months after HCV treatment. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - August 24, 2021 Category: Gastroenterology Authors: Nelson E. Airewele, Mitchell L. Shiffman Source Type: research
New Treatments for Chronic Hepatitis B Virus/Hepatitis D Virus Infection
Chronic hepatitis D virus (HDV) infection is the most severe form of viral hepatitis with high rates of end-stage liver disease and hepatocellular carcinoma. Therefore, effective antiviral treatment strategies are needed desperately. Until recently, antiviral treatment was limited to pegylated interferon-alpha. With the conditional approval of the entry inhibitor bulevirtide by the European Medicines Agency, new treatment options are now available. In addition, multiple other antiviral compounds are currently tested in clinical phase II and III trials and represent promising agents for the treatment of chronic HDV infectio...
Source: Clinics in Liver Disease - August 7, 2021 Category: Gastroenterology Authors: Lisa Sandmann, Heiner Wedemeyer Source Type: research
Controversies in Treating Chronic Hepatitis B Virus Infection
Despite effective vaccines and approved therapeutic agents, hepatitis B virus (HBV) remains a prevalent global health problem. Current guidelines rely on a combination of serologic, virological, and biochemical markers to identify the phase in the natural history of chronic HBV infection. Discordant serologic results can occur, which may lead to misclassification. Commonly encountered results that differ from the typical profiles seen in chronic HBV infection are described. For each scenario, the frequency of occurrence, possible explanations, and recommendations for clinical management are discussed. Recognition of discor...
Source: Clinics in Liver Disease - August 5, 2021 Category: Gastroenterology Authors: Arif Sarowar, Grishma Hirode, Harry L.A. Janssen, Jordan J. Feld Source Type: research
Use of Hepatitis B Virus –Positive Organs in Organ Transplantation
The significant morbidity and mortality of people with end-stage renal, liver, heart, and lung diseases in need of transplantation provides rationale for use of organs from donors who are hepatitis B positive. The recipient ’s hepatitis B status plays a key role in defining the prophylactic strategy. The availability of safe and effective therapies (hepatitis B antivirals and hepatitis B immune globulin) has contributed to the safety of using hepatitis B–positive donors. The outcomes in both liver and nonliver soli d organ transplant recipients given hepatitis B–positive organs have been excellent if appropriate prop...
Source: Clinics in Liver Disease - August 5, 2021 Category: Gastroenterology Authors: Saro Khemichian, Jeffrey Kahn, Norah A. Terrault Source Type: research
