Controversies in Treating Chronic Hepatitis B virus
Controversial areas in chronic hepatitis B (CHB) are those where there is uncertainty, or differences of opinion in management, or where evidence may be insufficient. Areas of controversy include whether patients with high viral load but normal liver function tests should be treated to prevent hepatocellular carcinoma (HCC) or liver disease progression to cirrhosis. Another area is whether quantitative hepatitis B surface antigen (qHBsAg) can be used to better characterize phases of CHB and prognosticate. Finally, the utility of qHBsAg in the management of patients on antiviral therapy such as interferon and nucleoside ana...
Source: Clinics in Liver Disease - July 30, 2021 Category: Gastroenterology Authors: Daniel Q. Huang, Guan Sen Kew, Seng Gee Lim Source Type: research
Treatment of Chronic Hepatitis B Virus with Oral Anti-Viral Therapy
Nucleoside analogues are the drugs most commonly used in the treatment of chronic hepatitis B. They act by inhibiting viral replication and have minimal impact on HBsAg loss. Nucleoside analogues are indicated in patients with chronic hepatitis, cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, and in those with extrahepatic manifestations. Real-world experience has been ongoing for more than 10 years, and the efficacy and safety results obtained are similar to those reported in clinical trials. Prolonged use is needed to maintain suppression of viral replication, prevent the development of liver cirrhosis and ...
Source: Clinics in Liver Disease - July 28, 2021 Category: Gastroenterology Authors: Maria Buti, Mar Riveiro-Barciela, Rafael Esteban Source Type: research
Controversies in Treating Chronic HBV
Pegylated interferon-alpha therapy is one of the first-line chronic hepatitis B treatment. Finite treatment duration, absence of drug resistance, delayed response, and higher hepatitis B surface antigen loss than nucleos(t)ides analog therapy are the advantages of pegylated interferon-alpha treatment. Common side effects and subcutaneous injections requirement limit its use. Identifying patients likely to respond to pegylated interferon-alpha and optimizing treatment is reasonable. Motivating patients to complete the 48-week treatment is necessary. Treatment is stopped or switched to other treatment strategies in patients ...
Source: Clinics in Liver Disease - July 28, 2021 Category: Gastroenterology Authors: Phunchai Charatcharoenwitthaya, Apichat Kaewdech, Teerha Piratvisuth Source Type: research
Alcoholic Hepatitis
CLINICS IN LIVER DISEASE (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - July 4, 2021 Category: Gastroenterology Authors: Paul Y. Kwo Source Type: research
Copyright
Elsevier (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - July 4, 2021 Category: Gastroenterology Source Type: research
Contributors
NORMAN GITLIN, MD, FRCP (LONDON), FRCPE (EDINBURGH), FAASLD, FACP, FACG (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - July 4, 2021 Category: Gastroenterology Source Type: research
Contents
Paul Y. Kwo (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - July 4, 2021 Category: Gastroenterology Source Type: research
Forthcoming Issues
Challenging Issues in the Management of Chronic Hepatitis B Virus (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - July 4, 2021 Category: Gastroenterology Source Type: research
Genetic and Environmental Susceptibility to Alcoholic Hepatitis
Constitutional, environmental, and genetic risk factors influence the development of alcohol-related cirrhosis. The amount of alcohol consumed and whether excessive drinking continues after the identification of pre-cirrhotic liver damage are key risk factors. Female sex, ethnicity, obesity, coffee consumption, cigarette smoking, and exposure to other causes of liver injury also influence the risk of disease development. More recently several genetic loci have been robustly associated with the risk for developing significant alcohol-related liver disease. It remains unclear whether additional risk factors are involved in t...
Source: Clinics in Liver Disease - June 8, 2021 Category: Gastroenterology Authors: Marsha Y. Morgan, Moksh Sharma, Stephen R. Atkinson Source Type: research
Current Trends in Liver Transplantation for Alcoholic Hepatitis
Liver transplantation (LT) for alcohol-related or alcoholic hepatitis (AH) remains a controversial treatment option. However, recent studies have shown promising outcomes for LT in a subgroup of patients with AH. Considering these emerging data, LT as definitive therapy for severe AH refractory to medical management is gaining recognition. However, concerns of alcohol recidivism pose a significant barrier to perform LT for this indication. Predictive models can be utilized to develop a selection criterion to identify suitable candidates for LT. Hence, carefully selected patients with severe AH and low risk of alcohol relap...
Source: Clinics in Liver Disease - May 29, 2021 Category: Gastroenterology Authors: Sundus Bhatti, Donghee Kim, Aijaz Ahmed, George Cholankeril Source Type: research
Selection Criteria for Liver Transplantation for Acute Alcohol-Associated Hepatitis
Severe acute alcohol-associated hepatitis that is nonresponsive to medical therapy has an extremely high mortality. Liver transplantation is a feasible treatment option and available at certain transplant centers globally. Selection criteria for liver transplantation are not, uniform but there are important key criteria shared across protocols. Of equal importance to the management of liver disease is the treatment of alcohol use disorder. A thorough assessment of candidates involves input from an addiction specialist and psychiatrist. With careful selection practices, graft and patient survival among transplant recipients...
Source: Clinics in Liver Disease - May 27, 2021 Category: Gastroenterology Authors: Aparna Goel, Tami Daugherty Source Type: research
Moderate Alcoholic Hepatitis
The natural history of moderate alcoholic hepatitis (AH) is not well known. It is a frequent disease with a probable underestimated incidence compared with its severe form. Among the different prognostic scores predicting short-term mortality in AH, MELD seems to be the most accurate. The mortality of moderate AH is 3% to 7% in the short to medium term and 13% to 20% at 1 year, mainly because of liver-related complications, including severe infections. Long-term abstinence is the main goal of the treatment. There is still need for the development of new therapies for AH, including the less severe forms. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 27, 2021 Category: Gastroenterology Authors: Ana Clemente-S ánchez, Aline Oliveira-Mello, Ramón Bataller Source Type: research
Diagnosis of Alcohol-Associated Hepatitis
Alcohol-associated hepatitis (AH) is a unique clinical syndrome in patients with excessive and prolonged alcohol consumption, and negatively impacts the patient outcomes. Among patients with asymptomatic alcohol-associated liver disease with elevated liver enzymes and/or steatosis, liver biopsy is required to diagnose AH. Noninvasive assessment should be performed in these patients to determine risk of advanced fibrosis. In symptomatic patients with jaundice, liver biopsy is required when the clinical diagnosis is uncertain. Liver biopsy is not recommended to determine prognosis of patients with AH. Noninvasive biomarkers ...
Source: Clinics in Liver Disease - May 27, 2021 Category: Gastroenterology Authors: Juan Pablo Arab, Marco Arrese, Ashwani K. Singal Source Type: research
Emerging Therapies for Alcoholic Hepatitis
This article reviews novel therapies targeting various mechanisms in the pathogenesis of alcoholic hepatitis, such as the gut-liver axis, inflammatory cascade, oxidative stress, and hepatic regeneration. Current ongoing clinical trials for alcoholic hepatitis also are described. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 27, 2021 Category: Gastroenterology Authors: Ma Ai Thanda Han, Nikolaos Pyrsopoulos Source Type: research
Selection Criteria for Liver Transplantation for Acute Alcohol Associated Hepatitis
Severe acute alcohol-associated hepatitis that is nonresponsive to medical therapy has an extremely high mortality. Liver transplantation is a feasible treatment option and available at certain transplant centers globally. Selection criteria for liver transplantation are not, uniform but there are important key criteria shared across protocols. Of equal importance to the management of liver disease is the treatment of alcohol use disorder. A thorough assessment of candidates involves input from an addiction specialist and psychiatrist. With careful selection practices, graft and patient survival among transplant recipients...
Source: Clinics in Liver Disease - May 27, 2021 Category: Gastroenterology Authors: Aparna Goel, Tami Daugherty Source Type: research
