Foreword
Emmet B Keeffe, MD, is a Professor of Medicine Emeritus at Stanford University Medical Center and for the past three years has been Vice President and Chief Medical Officer at Romark Laboratories. He is Past President of the American Gastroenterological Association (AGA) and the American Society for Gastrointestinal Endoscopy (ASGE) and has been active in a number of professional organizations and foundations throughout his career. He is Editor in Chief of Digestive Diseases and Sciences and is a member of the editorial boards of several journals. Professor Keeffe has published more than 700 articles, book chapters, and miscellaneous publications that have focused on the treatment of chronic hepatitis B and C, hepatitis vaccination, and liver transplantation.
issue of US Gastroenterology & Hepatology Review includes an eclectic collection of articles reviewing the current status of the management of a number of disease conditions. There have been major advances in the treatment of inflammatory bowel disease (IBD), particularly the introduction and refinement in the use of biologic agents in adults. However, the manifestations of IBD are somewhat different in children, and the safety of a number of drugs has yet to be established. Current evidence on the use of probiotics in children is reviewed, and the conclusion is that existing data do not support their use for induction or maintenance therapy in pediatric IBD. Similarly, much has been learned recently in terms of the serious complication of small bowel adenocarcinoma in patients with Crohn’s disease, and the epidemiology, diagnosis, and treatment of this challenging disease is expertly reviewed. Probiotics are reviewed in their use in the management of Helicobacter pylori colonization and gastric inflammation, with existing data suggesting some benefit. Probiotics resist gastric pH, inhibit the growth of H. pylori and its adhesion to gastric epithelial cells, and exert antioxidant and anti-inflammatory effects in experimental animals. They also improve gastric mucosal barrier function in humans, and may increase the H. pylori eradication rates of antibiotic treatment.
T Many drugs are in the pipeline for the treatment of irritable bowel syndrome (IBS), although most of these candidates remain in the early
stages of development. A scholarly and thorough article addresses the safety and efficacy of a wide range of agents, including 5-HT4 agonists, 5-HT3 antagonists, inhibitors of serotonin synthesis, intestinal secretagogues, drugs that modulate bile acids, anti-inflammatory agents, visceral analgesics, and centrally acting agents that reduce colonic motility and visceral sensitivity. Several of these drugs are promising, and a better understanding of the pathophysiologic mechanisms of IBS will likely further increase the pipeline of new agents.
Currently approved therapeutic strategies for the management of chronic hepatitis C with peginterferon and ribavirin are nicely reviewed, with a focus on the evolving data supporting individualization of therapy. Some, although not all, data suggest that patients with chronic hepatitis C genotype 1 infection who are slow responders may achieve incremental benefit in the sustained virologic response (SVR) rate by prolonging therapy to 72 weeks. Conversely, patients with a rapid virologic response and undetectable virus after four weeks of therapy, particularly if the baseline viral load is low, may be able to have therapy shortened to 24 weeks without compromising the SVR rate. The standard treatment of patients with genotypes 2 and 3 is peginterferon plus ribavirin for 24 weeks, although some data suggest the possibility of a shorter course of therapy in those with a rapid virologic response. This article does not address the new era of treatment that will likely take center stage in the 2011, when a protease inhibitor, i.e. either telaprevir or boceprevir, will be added to the standard of care. In patients with genotype 1 infection, this exciting new triple-therapy regimen will increase the SVR rate from 40 to 50% to 65 to 75%, with many patients requiring only 24 weeks of therapy using a response-guided approach. The other important advance is the recent recognition and now commercial availability of testing for the IL28B gene, which is a dominant predictor of SVR. Patients with the IL28B CC genotype, versus the CT or TT genotypes, have a significantly greater chance of an SVR, and knowledge of genotype status will allow for future tailoring of clinical management based on host genotype. Finally, early studies using interferon-free regimens with multiple oral agents, with a protease inhibitor and a polymerase inhibitor as the backbone, have been initiated and hold promise for yet a further evolution in the therapy of chronic hepatitis C in four to six years.
I am sure you will enjoy US Gastroenterology & Hepatology Review and the diverse topics that are expertly reviewed. n
he gastroenterology and hepatology field continues to be exciting, with an improved understanding of the pathophysiology of numerous diseases, refinement of diagnostic tools and strategies, and advances in the treatment of many disorders. This
8
© TOUCH BRIEFINGS 2010
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100