Showing posts with label 2018 - Digestive Disease Week® (DDW). Show all posts
Showing posts with label 2018 - Digestive Disease Week® (DDW). Show all posts

Wednesday, June 6, 2018

DDW 2018: PPIs Are Taken Inappropriately by Patients With GERD

June 5, 2018—Washington, DC—In patients with gastroesophageal reflux disease, proton pump inhibitors are initiated at the appropriate dose as per American College of Gastroenterology guidelines.

Lifestyle modifications are seldom discussed by primary care providers, and the majority of patients continue to take proton pump inhibitors after 8 weeks.

This conclusion, based on results of a retrospective chart review, was presented at Digestive Disease Week (DDW) 2018, from June 2 – 5.

Proton pump inhibitors have been reported recently to be associated with multiple serious side effects including chronic kidney disease, dementia, infection, osteoporotic fracture, cardiovascular events, and increased mortality.
Continue reading...…..

Recommended Reading
Proton pump inhibitors (PPIs) are medicines that work by reducing the amount of stomach acid made by glands in the lining of your stomach.

Watch: Expert reviews clinical liver disease take-aways from DDW 2018

Expert reviews clinical liver disease take-aways from DDW 2018
June 5, 2018
WASHINGTON — In this exclusive video perspective from Digestive Disease Week 2018, Steven L. Flamm, MD, chief of the Liver Program at Northwestern University Feinberg School of Medicine in Illinois, reviews some of the important clinical presentations in liver disease from the meeting.

“As usual, there are presentations across the gamut of liver disease at DDW,” Flamm told Healio Gastroenterology and Liver Disease. “They include the topics of hepatitis B, hepatitis C, autoimmune hepatitis, liver cancer, liver transplantation and many other pertinent topics to your practice.”

Monday, June 4, 2018

DDW 2018 - Is an HCV cure rate of 100 percent realistic?

DDW News | Jun 4, 2018 | 2018, AASLD, DDW Daily News, Monday Issue 2018, Watch Videos

David E. Bernstein, MD, FAASLD, discusses the possibility of an HCV cure rate of 100%

Is an HCV cure rate of 100 percent realistic?
David E. Bernstein, MD, FAASLD, wants to break down the barriers preventing access to curative therapies for hepatitis C virus (HCV). Although antiviral therapy has led to a cure rate of more than 90 percent of HCV cases, Dr. Bernstein thinks more can be done to increase the cure rate.

In this DDW Daily News video exclusive, he discusses several obstacles preventing patients’ access to curative therapies, including cost concerns, public policy issues and insurance variations that have led to different state rules and regulations. Dr. Bernstein also addresses the benefits of HCV therapy and whether it’s possible to eradicate HCV and achieve 100 percent cure rate.

“It’s the only viral disease that we can actually cure, but from a public policy standpoint a significant portion of our population does not have access to these life-changing and curative therapies for unclear reasons,” says Dr. Bernstein, director of the Sandra Atlas Bass Center for Liver Diseases at the Zucker School of Medicine at Hofstra/Northwell, East Garden City, NY.
Video:
http://blog.ddw.org/is-an-hcv-cure-rate-of-100-percent-realistic/

Links
Digestive Disease Week® (DDW) 2018 June 2-5, 2018
Website - Digestive Disease Week® (DDW)
DDW Blog
DDW Daily News
On Twitter - #DDW18

DDW 2018 - Insurance coverage and mortality in patients with hepatitis C

HCV outcomes worse for patients with public insurance, Medicaid
WASHINGTON — In this exclusive video perspective from Digestive Disease Week 2018, Zobair M. Younossi, MD, chairman of the department of medicine at Inova Fairfax Hospital in Virginia, discusses insurance coverage and mortality in patients with hepatitis C in the U.S.
Video:https://www.healio.com/hepatology/hepatitis-c/news/online/%7B3714098b-f39c-4e99-86d1-e3a7e9bebb5d%7D/hcv-outcomes-worse-for-patients-with-public-insurance-Medicaid

MedPage Today
WASHINGTON -- Adults with hepatitis C virus (HCV) were more likely to die if they were on Medicaid than other insurance plans, while uninsured HCV-infected …

Digestive Disease Week® (DDW) 2018
Coverage @ Healio
Healio staff will report live on breaking news presented at the meeting and capture video interviews with experts to gain their perspectives on important presentations.

Links
Digestive Disease Week® (DDW) 2018
June 2-5, 2018
Website - Digestive Disease Week® (DDW)
DDW Blog
DDW Daily News
On Twitter - #DDW18

June Newsletters - Hepatitis C in Colorado & Liver Congress 2018 Coverage

June Hepatitis Newsletters
Welcome, we start with a few June publications, followed by events you may have missed last month. Next, sift through the June index of newsletters, and finish off with a list of well written blogs with extremely useful information on the topic of viral hepatitis.

June Updates
A Guide to Understanding Hepatitis C (HCV)
HCV Advocate: We have completely updated and given our most popular publication and a new look. To download, click here

Despite the availability of new DAA regimens and changes in restrictions of these therapies, absolute denials of DAA regimens by insurers have remained high and increased over time, regardless of insurance type.

Updated Guidelines - Hepatitis C testing recommended for Canadians born between 1945 and 1975
More than 250,000 Canadians are believed to be infected with hepatitis C, but 40 to 70 per cent are unaware they harbour the blood-borne virus. The Canadian Association for the Study of the Liver, a national group of health-care providers and researchers, published its guidelines on testing and treating hepatitis C in Monday’s edition of the Canadian Medical Association Journal.

When to Initiate HCV Therapy and Overview Of New Drugs
Sit back, grab your favorite beverage and review; Making a Decision on When to Initiate HCV Therapy, updated a few days ago, published by Hepatitis C Online.

What You Missed In May
Screening for Hepatitis C Climbs in Colorado

Each year, more Coloradans are contracting hepatitis C, the infectious liver disease spread by contact with infected blood. The state’s hep C death rate is heading higher as well. An analysis by the Colorado Health Institute of newly available information from the state’s All Payer Claims Database (APCD) reveals the rate of Coloradans getting screened for the hepatitis C virus nearly tripled between 2011 and 2016.

Key Takeaways:
The rate of screening for hepatitis C among Coloradans nearly tripled between 2011 and 2016, a Colorado Health Institute analysis of newly available data shows.

Baby boomers between ages 55 and 64 saw the largest increase in screening rates during that time; millennials between 25 and 34, had the highest screening rate each year.

Medical advances, federal and state policy changes and fallout from the opioid epidemic have contributed to the rise in screening.  
Download the report.

Full of Life: The Stories of People Affected by Hepatitis C
The Institute’s Hepatitis Policy Project has released a new report that features the stories of people affected by hepatitis C. The report was authored by Sonia Canzater and Jeffrey S. Crowley. “Full of Life: The Stories of People Affected by Hepatitis C,” underscores the impact of hepatitis C and the potential for improving the lives of those with the disease.

Real people make up the HCV epidemic, and their experiences and the full lives they lead offer motivation and resolve to work to eliminate HCV as a public health threat. But, as this report will show, the reality of what is happening to respond to HCV in the United States (US) falls short of the possibility of what we could make happen to save lives and strengthen communities, read it here....
This project is supported by a grant from Gilead Sciences.

AASLD online HCV guide update includes key at-risk populations

May 31, 2018
The American Association for the Study of Liver Diseases and the Infectious Diseases Society of America recently updated their hepatitis guideline website, HCVguidelines.org, to include several new testing and management recommendations for pregnant women, men who have sex with men, people who inject drugs and incarcerated individuals. Kristen M. Marks, MD, assistant professor of medicine at Weill Cornell Medical College in New York and HCV Guidance co-chair, discussed the new updates with HCV Next, read it here...

New Hepatitis C Virus Guidelines and Lyme Disease Prevention



Perspective - New England Journal Of Medicine 
The FDA and the Next Wave of Drug Abuse — Proactive Pharmacovigilance
In response to the opioid crisis, the Food and Drug Administration (FDA) has taken action on multiple fronts. We have approved better measures for treating opioid use disorder and preventing deaths from overdose, have launched efforts to inform more appropriate prescribing as a way to limit clinical exposure to opioids, have taken actions to reduce the excess opioids available for abuse, and are working to facilitate development of new therapeutics that can effectively and safely help patients suffering from pain. Going forward, the FDA needs to remain vigilant to recognize shifting trends in the addiction landscape. Taking a systematic approach to monitoring such trends should allow us to intervene promptly and appropriately and protect the public from associated risks, read the article here...…

Surrey develops hepatitis C model that could help improve treatment
The University of Surrey has created a new mathematical model that details how the hepatitis C (HCV) infection develops and behaves more accurately than previous models, read the press release, here.....

New strategy to cure chronic hepatitis B infection
Scientists from Karolinska Institutet and Hannover Medical School have published two studies that provide insights into how the immune system responds and helps to clear a hepatitis B infection after treatment interruption. The findings offer a framework for future tailored treatment strategies and are published in The Journal of Infectious Diseases and Journal of Hepatology, read it here....

Conditions Related To HCV
Listen - Hepatitis C: It’s About More than Liver Disease
The National Viral Hepatitis Roundtable is pleased to present a webinar to discuss the health effects of hepatitis C virus (HCV) infection that occur outside the liver. Learn more about how conditions such as kidney disease, depression, certain types of cancer, and diabetes are related to HCV infection. The webinar will feature clinician and patient perspectives to facilitate discussion about the importance of recognizing these conditions as part of HCV management and the implications for early HCV treatment.
This webinar is now archived. Click here for the slides. Click here for the recording. (Click the link and then enter the requested information to view the webinar).

Fatigue & Achieving SVR

Do fatigue and quality of life improve after hepatitis C is cured?
Patient-reported outcomes such as fatigue, vitality and mental health improve substantially in the two years following hepatitis C cure for people with cirrhosis, but people with cirrhosis are less likely than others to experience rapid resolution of severe fatigue after successful hepatitis C treatment, according to two studies from the Center for Outcomes Research in Liver Diseases reported last month at the 2018 International Liver Congress in Paris, read it here...

Fibrosis
Can anti-viral therapy reduce liver fibrosis and steatosis in patients with chronic hepatitis C virus?
In this study, changes in liver stiffness and steatosis as determined by MRI in patients with chronic HCV genotype 1 or 2 infection who received direct-acting anti-viral therapy and achieved SVR is investigated, read the article here....

Screening & Treating HCV
HCV From Screening to Cure
The following video presentation; "HCV From Screening to Cure: A Closer Look at Changing At-Risk Populations and an Evolving Treatment Landscape" with Ira M. Jacobson, MD., and provided by Medical Learning Institute, Inc. and PVI, PeerView Institute for Medical Education, will discuss screening strategies, stigma, patient-related barriers to treatment, hepatitis C testing for identifying current infection, and tests used to stage fibrosis. Also discussed is treatment for HCV patients with cirrhosis, as well as treatment adherence, duration, treatment according to HCV genotype, ending with "How Much Care Do The Cured Need?" Watch the video, here....

Supervised injection sites are coming closer to reality in several cities in the United States.
U.S. Cities Consider Supervised Injection Sites
Safe injection facilities can reduce overdoses, disease transmission, and public drug use.

Prospective Study: No psychiatric side effects with new IFN-free treatment for HCV 
Treatment of Hepatitis C virus (HCV) infection has evolved from interferon (IFN)-based treatments to direct-acting antivirals (DAAs). Patients with HCV have an elevated psychiatric morbidity (including substance abuse) and patients with such comorbidity have often been excluded from treatment with IFN. To date, little is known about psychiatric adverse effects of DAA-based regimens. We therefore aimed to study the psychiatric side effects of new IFN-free treatment for HCV (including depressive symptoms and sleep) in real world patients also including those with a history of psychiatric diagnosis, substance abuse or drug dependence, read the article here....

The Truth about Hepatitis C Treatment long term Side Effects
Karen Hoyt is devoted to offering support and accurate information to people coping with the effects of liver disease through a series of informative videos, topics include ascites, hepatic encephalopathy and other liver-related complications.
Here is the latest video: The Truth about Hepatitis C Treatment long term Side Effects.

AASLD Special Collection: Treating Liver Disease in 2018
Topics include: Hepatitis C virus reactivation in patients receiving cancer treatment, drug‐drug interactions in hepatitis C virus treatment and more. Start here...…

Fatty Liver
Journal of Gastroenterology and Hepatology
Special Issue: Burden of Nonalcoholic Fatty Liver Disease in Australia.
In this review, we present available data on the prevalence of NAFLD in Australia, its associated health burden in terms of hepatic and extrahepatic complications, common presentations, and evidence‐based therapeutic options. We also outline a research agenda highlighting gaps in knowledge that are needed to improve diagnosis and management of people with NAFLD specific to the Australian context. Full-text available here.....  

Behind The Headlines
Most multivitamins and supplements are a 'waste of money' 
The review found that taking the most widely used supplements – multivitamins, vitamin D, vitamin C and calcium – had no significant effect on the risk of heart-related illnesses. And some supplements, such as vitamin B3 (niacin) may do more harm than good, read it here.... 

HIV
A new edition of our 'Antiretroviral drugs chart' is now available online. This one-page reference guide lists all the anti-HIV drugs licensed for use in the European Union, with information on formulation, dosing, key side-effects and food restrictions, read it here ….

The Controversy 
Do direct acting antivirals cure chronic hepatitis C?
A controversial review by the Cochrane Collaboration published June 6, 2017/updated September 8 2017, cast doubt on the effectiveness of new hepatitis C treatments, on May 12, 2018, BMJ published; Do direct acting antivirals cure chronic hepatitis C ? by Cochrane author Janus Christian Jakobsen. BMJ talk medicine also aired a follow-up podcast with Jakobsen; New antivirals for Hepatitis C - what does the evidence prove? On May 16, 2018 experts weighed in on the program, read what they had say: Experts Respond To Latest BMJ Article: Do direct acting antivirals cure chronic hepatitis C?

June Newsletters
HCV Advocate
The HCV Advocate newsletter is a valuable resource designed to provide the hepatitis C community with monthly updates on events, clinical research, and education.
Newsletter
June Issue
We are continuing our conference coverage of the International Liver Congress 2018 and we have the following posters and presentations:
More of Lucinda’s Highlights from the 2018 International Liver Congress:
STUDY Abstract: THU-099 Lowering the upper limit of serum alanine aminotransferase levels may detect significant liver disease in the elderly – H. Schmilovitz-Weiss, et al.
STUDY Abstract: THU-100 Hepatitis C patients with HIV co-infection demonstrate unique liver-related complications and health behaviors compared to HCV mono-infected patients – M. Lu, et al.
STUDY Abstract: THU-399 Incidence and prevalence of extrahepatic manifestations of HCV – H. El-Serag, et al.
STUDY Abstract: THU-418 Lymphomas incidence in HIV/HCV coinfected versus HIV monoinfected patients over twenty-one years of follow up (1993–2014) – A.M. de Cea, et al.
STUDY Abstract: FRI-368 Long-term immunological and clinical impact of HCV eradication with directacting antivirals in patients with HCV-associated cryoglobulinemia vasculitis – M. Bonacci, et. al.
STUDY Abstract: THU-412 Among 1945–1965 birth cohort patients with at least one additional hepatitis C virus risk factor, one in eight were positive for HCV antibody: an underserved safety-net population experience – G. Hirode, et. al.
STUDY Abstract: THU-429 Strong increase of acute HCV infections in HIV-negative men having sex with men – L. Cotte, et. al.

More of Alan’s Highlights from the 2018 International Liver Congress:
STUDY Abstract: GS-018 Long-term follow-up of patients with chronic HCV infection and compensated or decompensated cirrhosis following treatment with sofosbuvir-based regimens – A. Mangia, et. al.
STUDY Abstract: LBO-008 A phase 3b, open-label, randomized, pragmatic study of glecaprevir/ pibrentasvir +/− ribavirin (RBV) for HCV genotype 1 subjects who previously failed an NS5A inhibitor + sofosbuvir (SOF) therapy – A. Lok, et. al.
STUDY Abstract: THU-121 Track, Trace & Treat: Results from a retrieval strategy to identify lost to follow-up chronic hepatitis c patients – I. Munsterman, et. al.
STUDY Abstract: LBP-0231 The percentage of patients with HCV infection in need of a liver transplant is rapidly declining while their survival after transplantation is improving: a study based on European Liver Transplant Registry – G. Perricone, et al.
STUDY Abstract: FRI-028 Liver transplant waitlist mortality, transplantation rates and post-liver transplant outcomes in Hispanics – P.J. Thuluvath, et al.
STUDY ABSTRACT: FRI-374 The impact of sustained virologic response on severe fatigue in patients with chronic hepatitis C: the role of HCV viremia and co-morbidities – Z. Younossi, et. al.
STUDY Abstract: THU-075 hepatitis C screening within the National Elimination Program in the country of Georgia – A. Gamkrelidze, et. al. 

BRIEFLY…
STUDY Abstract: THU-075 hepatitis C screening within the National Elimination Program in the country of Georgia – A. Gamkrelidze, et. al.
STUDY Abstract: THU-104 The first result from the general population hepatitis screening in Mongolia: 38% of 40– 65-year-olds screened and anti-HCV prevalence of 15.6% among 40– 65-year-olds – B. Dashtseren, et. al.
STUDY Abstract: PS-090 Direct-acting antiviral treatment in sub-Saharan Africa: A prospective trial of ledipasvir/ sofosbuvir for chronic hepatitis C infection in Rwanda (The SHARED Study) – N. Gupta, et. al.

Hepatitis Materials Available:

We have a limited supply of free materials available. They are pre-packaged in the following quantities:
A Box of 1,500 Palm cards
A box of 1,000 Palm cards, 500 Baby Boomer postcards, & 500 website cards.

Please email us at Rosanne1956@hotmail.com if you have a need for materials to distribute.

Pack Health
Don’t forget to check out Pack Health: a free resource to help patients navigate their HCV treatment journey from applying for treatment to cure.
Enter your contact info
Use promo code: HCV2017
Get 3 months of membership free! As easy as 1-2-3!

Questions? Call us at 885-255-2362 8am-5pm | Monday-Friday 
• Get a personal Health Advisor to coach you on your journey 
• Develop a personalized plan – you set the goals, we’ll help you get there 
• Find answers and accountability to get the results you want 
• Use the tools and guides we send you to track your progress.
View all newsletters here....

Hep - Your Guide to Hepatitis
Hep is an award-winning print and online brand for people living with and affected by viral hepatitis. Offering unparalleled editorial excellence since 2010, Hep and HepMag.com are the go-to source for educational and social support for people living with hepatitis.

June - Hep Summer Issue 2018
Alive and Kicking
A photographer helps his mom get cured of hep C after reading Hep magazine.

Mother and Child Reunion 
Connie Dewbre’s son convinced her to get cured of HCV again after visiting our Hep magazine website.
Read the news
Check out the talented people who blog at Hep.

The National Viral Hepatitis Roundtable
The National Viral Hepatitis Roundtable (NVHR) is national coalition working together to eliminate hepatitis B and C in the United States.

The New York City Hepatitis C Task Force
The New York City Hepatitis C Task Force is a city-wide network of service providers and advocates concerned with hepatitis C and related issues. The groups come together to learn, share information and resources, network, and identify hepatitis C related needs in the community. Committees form to work on projects in order to meet needs identified by the community.
View all: Hep Free NYC Newsletters

HCV Action
HCV Action brings together hepatitis C health professionals from across the patient pathway with the pharmaceutical industry and patient representatives to share expertise and good practice.
View recent newsletters

Healio: International Liver Congress 2018
HCV Next is a monthly publication offering patients the latest research, news and commentary on liver disease and viral hepatitis, published online at Healio.
Read a nice summary of the liver meeting in the May/June issue.

World Hepatitis Alliance
We run global campaigns, convene high-level policy events, build capacity and pioneer global movements, ensuring people living with viral hepatitis guide every aspect of our work.
Read all updates
Newsletters - World Hepatitis Alliance (WHA) presents hepVoice, a monthly magazine with updates on the latest projects, news from WHA members and key developments in the field of hepatitis.

GI & Hepatology News
Over 17,000 gastroenterologists and hepatologists rely on GI & Hepatology News every month to cover the world of medicine with breaking news, on-site medical meeting coverage, and expert perspectives both in print and online.
View all updates here....

Weekly Bull

HepCBC is a Canadian non-profit organization offering awareness with basic information about HCV and a weekly digest of news.
Read the highly successful Weekly Bull.

Pacific Hepatitis C Network (PHCN)

Welcome to the Pacific Hepatitis C Network (PHCN)‘s Hepatitis C News in Review Newsletter. This is where we review all of the major current issues and events around hepatitis C and hep C treatments. It is an email that includes links to our recent blog posts—including links to blog posts about Public Health Agency of Canada funding.
View all updates
Newsletter Sign Up

CATIE
CATIE strengthens Canada’s response to HIV and hepatitis C by bridging research and practice. We connect healthcare and community-based service providers with the latest science, and promote good practices for prevention and treatment programs.
Sign up for CATIE Email Newsletters
Updates - News

CanHepC - Canadian Network on Hepatitis C
CanHepC is a collaborative research network funded by the Canadian Institutes of Health Research (CIHR) and the Public Health Agency of Canada (PHAC) dedicated to translational research linking over 100 researchers, trainees, knowledge-users (community members, community-based organizations, policy and decision makers) in the field of Hepatitis C (HCV) from across Canada as well as international partners.
View all newsletters here.....

Hepatitis Victoria
Hepatitis Victoria is the peak not-for-profit community organisation working across the state for people affected by or at risk of viral hepatitis.
GOOD LIVER MAGAZINE is our quarterly newsletter, providing in-depth articles, interviews and reports, as well as detailing upcoming events, support groups, liver clinics, and other items likely to be of interest to our members. HepChat is our monthly electronic newsletter sharing news and information about hepatitis and the projects and activities we're working on, subscribe to HepChat. We also produced short podcasts interviewing health experts and practioners on topics related to viral hepatitis - come have a listen!

British Liver Trust
The British Liver Trust is the leading UK liver disease charity for adults – we provide information and support; increase awareness of how liver disease can be prevented and promote early diagnosis; fund and champion research and campaign for better services.
View all Newsletters here.

Hepatitis B Foundation
Hepatitis B Foundation is a national nonprofit dedicated to finding a cure and improving the quality of life for people affected by hepatitis B worldwide.
All newsletters, sign up
Blog & News

Hepatitis A - Voice of San Diego
Voice of San Diego is an award-winning nonprofit news organization based in San Diego, California.
The Hep A Fallout Continues: On this week’s San Diego Explained, Voice of San Diego’s Jesse Marx and NBC 7’s Monica Dean take a look back at San Diego’s response to last year’s hepatitis A outbreak, listen here.

National Institutes of Health
A monthly newsletter from the National Institutes of Health, part of the U.S. Department of Health and Human Services
June Newsletter
View all newsletters: https://newsinhealth.nih.gov/

Blogs
The Best Of The Best
HCV Advocate - Hepatitis C Blog - Daily Updates
HepatitisC.net - Updated with about 5 posts per week
Lucinda K. Porter - Updated about once a week
Hep - Updated with 5 or more posts per week
ADRLF (Al D. Rodriguez Liver Foundation) - Updated monthly
Hepatitis NSW Updated about twice or more per month
Life Beyond Hepatitis C - Updated with about 3 posts per week
I Help C - Updated about twice or more per month
CATIE Blog - Updated about twice or more per month
Canadian Liver Foundation - Updated about twice or more per month
AGA Journals - Updated once a week
Hepatitis B Foundation - Updated once a week or more.
HIV and ID Observations - Updated once a week
The Hepatitis C Mentor and Support Group - (News) Updated once a week or more

Wellness
Live Fit Liver Fit Get Fit (American Liver Foundation) - Monthly updates
Harvard Health Blog - Updated with about 3 posts per week
ACP Internist and American College of Physicians - Weekly & monthly updates
Healio Med Blog- Monthly updates

Conference 
Digestive Disease Week® (DDW) 2018
June 2-5, 2018
Website - Digestive Disease Week® (DDW)
DDW Blog
DDW Daily News
Topics at DDW:
AASLD’s annual Hepatology Update: The Year in Review session will feature recent advances in hepatitis C, hepatitis B, nonalcoholic fatty liver disease, and liver transplantation. Other sessions include Functional GI and Motility Disorders; Irritable Bowel Syndrome, Functional Dyspepsia.

Updates
On This Blog

Meeting Coverage
Healio 
Healio staff will report live on breaking news presented at the meeting and capture video interviews with experts to gain their perspectives on important presentations. 
Free registration may be required

Thanks for stopping by!
Tina

Tuesday, May 22, 2018

More patients with severe alcoholic hepatitis receiving liver transplants

More patients with severe alcoholic hepatitis receiving liver transplants
Medical centers willing to perform transplants without mandated six-month wait

Washington, DC (May 22, 2018) -- Increasingly, liver transplant centers are changing a long-standing practice of delaying potentially life-saving liver transplantation for patients with severe alcoholic hepatitis until after they stopped drinking alcohol for six months, according to a new study scheduled for presentation at Digestive Disease Week® (DDW) 2018.

Study implications
"Liver transplant for severe alcoholic hepatitis is being increasingly accepted, with positive outcomes, and the hope is that more and more patients will be evaluated for transplants," said Saroja Bangaru, MD, chief resident in internal medicine at the University of Texas Southwestern Medical Center, Dallas, and co-author of the study. "The hope is that survival rates are encouraging enough for centers, so that even more of them will reverse past practices."

Severe alcoholic hepatitis has an extremely high mortality rate. The primary treatment option has been the use of steroids, predominantly prednisolone. But, many patients do not respond to steroids, and a significant percentage of them will die within three months.

Historically, centers would not perform transplants until patients had stopped drinking for six months due to concerns about a return to drinking after transplant. Additionally, there was a perceived high risk that patient's continued drinking would cause them to miss medical appointments and failure to take their immunosuppressant medications, which prevent organ rejection, all of which could contribute to transplant failure.

Only in recent years have limited studies begun to show greater success for transplants for severe alcoholic hepatitis, Bangaru said. These studies have also shown that a variety of other factors -- aside from recent drinking -- influence whether a patient relapses. These include whether the patient has good social support, suffers from psychiatric ailments and accepts that they have an alcohol problem. "These studies suggest that predicting risk of relapse is much more complicated than just duration of abstinence," Bangaru said.

Study design and results
Researchers gathered data from 45 transplant centers, of which 23 said they were now performing such transplants. Among those, 17 centers reported that patients had a one-year survival rate of more than 90 percent, which is higher than that reported in several previous studies.

The survey found that centers have become more willing to perform transplants, as long as patients are carefully screened. Researchers reported that centers use highly selective criteria in approving candidates for transplant, assessing their medical history, social support system and whether they have additional health problems, particularly psychiatric disorders.

"If patients are selected well, according to these criteria, it allows for the excellent survival that we are seeing post-transplant," Bangaru said. Past policy has done a disservice to those patients who were previously unaware that they had liver disease. "Some patients come in for the first time with severe alcoholic hepatitis, and no one has ever told them to stop drinking. Because they are not eligible for transplant, they have a really high mortality rate."

The survey also concluded that most transplant centers had "inadequate" post-transplant support for patients. While most offered the services of social workers, only a limited number provided psychiatric or group therapy support that could be very important in helping patients avoid relapse and further medical problems.

Next steps
Dr. Bangaru said further study is needed to encourage more transplants, in particular a controlled clinical trial that follows survival rates over one, three and five years, along with an assessment of rates of alcoholic relapse.

DDW presentation details
Dr. Saroja Bangaru will present data from the study, "Increased use of liver transplantation as therapeutic option for severe alcoholic hepatitis," abstract Sa1457, on Saturday, June 2, at noon EDT. For more information about featured studies, as well as a schedule of availability for featured researchers, please visit http://www.ddw.org/press.

Digestive Disease Week® (DDW) is the largest international gathering of physicians, researchers and academics in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery. Jointly sponsored by the American Association for the Study of Liver Diseases (AASLD), the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy (ASGE) and the Society for Surgery of the Alimentary Tract (SSAT), DDW takes place June 2-5 at the Walter E. Washington Convention Center in Washington, DC. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. 
More information can be found at http://www.ddw.org.
https://www.eurekalert.org/pub_releases/2018-05/ddw-mpw051818.php