Treatment for Chronic Hepatitis B

Treatment for Chronic Hepatitis B
Screening for Hepatocellular Carcinoma
Presentation by: Mindie H. Nguyen, MD, MAS

Assistant Professor of Medicine
Division of Gastroenterology & Hepatology
Liver Transplant Program
Stanford University Medical Center

Chronic Hepatitis B
HBV Disease Burden in Asian-Americans
Hepatitis B Prevalence
Etiology of HCC in Asians
Impact of HBV DNA and ALT Levels on Disease Outcomes
HBV DNA Levels,
Disease Progression and HCC Risk
Impact of Viral Load
HBV DNA Associated with Increased Risk of HCC
HBV DNA levels and Risk of Cirrhosis and HCC REVEAL-HBV Study
HBV DNA Levels Predict Risk of Developing Cirrhosis
HBV DNA Levels Predict Risk of Developing HCC
Dose-Response Relationship:
HBV DNA and HCC
REVEAL-HBV Study: HCC Analysis Conclusions
Impact of Treatment on Disease Progression
Primary Goal of Treatment
Rapid and sustained suppression of HBV to the lowest possible level1,2
Rapid and Profound HBV Suppression: an Important Therapeutic Goal
Lamivudine and Disease Progression and HCC incidence in Advanced HBV (stage III/IV)
HBV DNA Suppression Reduces HCC Incidence Rate
Screening for Hepatocellular Carcinoma
HCC: Screening Tests
HCC: Screening Strategies and Frequency
WHO Principles of Screening
Screening improves survival
HCC Screening: clinical studies
RCT for HCC Screening

Treatment for Chronic Hepatitis B

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Hepatitis C

Hepatitis C
Presentation by
Bruce Luxon, MD, PhD
James A. Clifton Chair in Gastroenterology
Professor of Internal Medicine
Director, Division of Gastroenterology and Hepatology
University of Iowa


The Silent Epidemic
DIAGNOSTIC APPROACH TO CHRONIC HEPATITIS
RISK FACTORS FOR HCV OR ELEVATED ALT LEVELS
ANTI-HCV (EIA) TESTING
REFER TO SPECIALIST FOR EVALUATION AND TREATMENT
NEGATIVE
POSITIVE
EIA=enzyme immunoassay.
Check HCV RNA (viral load) and HCV genotype

* Basic facts on diagnosing hepatitis C
o Who is at risk?
o How do I screen?
o Why should I screen?
* Basic facts on treating hepatitis C
o What are treatment options?
o What are the success rates?
* Mention new trials and treatment options
o What should I do if initial treatment fails?

Cure
Consensus Interferon (CIFN)
DIRECT Trial
Maintenance Therapy?
HALT-C Trial
Summary
What to Take Away from Today

Hepatitis C.ppt

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Natural Supplements in Gastroenterology

Natural Supplements in Gastroenterology—An overview
Presentation by: Victor S. Sierpina, MD

W.D. and Laura Nell Nicholson Professor of Integrative Medicine
Family Medicine Department
University of Texas Medical Branch

Learning Objectives

* Describe common categories and examples of natural products for gastroenterology
* Describe indications and rationale for use of probiotics in clinical care
* Outline integrative approaches to irritable bowel syndrome, inflammatory bowel syndrome, chronic hepatitis
* List reliable references for evidence in the use of natural supplements in gastroenterology

Categories of GI herbals with examples
Some popular Hispanic herbs for GI complaints

* Basil/Albahaca
* Chamomile/Manzanilla
* Cumin/Comino
* Rue/Ruda
* Sage/Chia
* Spearmint/Yerba buena



Probiotics/Prebiotics
* Lactobacillus GG
* Lactobacillus casei
* Lactobacillus acidophilus
* Lactobacillus planatarum
* Lactobacillus reuteri
* Bifidobacterium bifidum/longum
* Saccharomyces boulardii
* Streptococcus therpophlus

Mechanisms of Action of Probiotics
* Colonization resistance
* Production of antibacterial substances
* Competition for nutrients
* Competitive inhibition at bacterial adhesion sites
* Enhancement of the immune defense system

Roles and indications of probiotics

* Dysbiosis
* Diarrhea (anitbx, e.g. H. Pylori tx, viral, traveler’s, infantile, AIDS related)
* Lactose intolerance
* Immunomodulatory effects
* Altered gut permeability (leaky gut)
* Inflammatory disorders
* Colon cancer prevention
* Atopy/food allergy

How to prescribe probiotics

* Occur naturally in many foods: yogurt, milk, miso, tempeh, kefir, sauerkraut, some cheeses
* Even non-viable organisms may have benefit (block bacterial adherence)
* Take on an empty stomach
* Space 3-4 hrs after antibx (2 weeks post tx)
* At least 1 billion organisms per dose
* Length of intake uncertain for many conditions


Peppermint
Herbal approach to IBS--carminatives

* Enteric coated peppermint (Mentha piperita):1-2 capsules (0.2ml) tid between meals
* Ginger (Zingiber officinale): 0.25-1 g tid
* Fennel (Foeniculum vulgare): ½-1 tsp seeds pp, 0.03-0.2 ml oil qd, alcoholic extract 0.5-2 ml/d
* Chamomile (Matricaria recutita): tea/infusion with 2-3 g of flowers; 1-4 ml tincture (1:5) tid
* Caraway:1-2 tsp seeds in tea/infusion, or alcoholic extract

Fennel
Herbal approach to IBS—stool agents

Other options
Inflammatory bowel disease

Hepatitis

Anti-viral, anti-inflammatory, anti-fibrotic
Selected References—Hispanic Herbs


Natural Supplements in Gastroenterology

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