Hepatitis News; Adult Stem Cells Take Root In Livers And Repair Damage

Adult Stem Cells Take Root In Livers And Repair Damage

Johns Hopkins researchers have demonstrated that human liver cells derived from adult cells coaxed into an embryonic state can engraft and begin regenerating liver tissue in mice with chronic liver damage.

The work, published in the May 11 issue of the journal Science Translational Medicine, suggests that liver cells derived from so-called "induced-pluripotent stem cells (iPSCs)" could one day be used as an alternative to liver transplant in patients with serious liver diseases, bypassing long waiting lists for organs and concerns about immune system rejection of donated tissue.

"Our findings provide a foundation for producing functional liver cells for patients who suffer liver diseases and are in need of transplantation," says Yoon-Young Jang, M.D., Ph.D., assistant professor of oncology at the Johns Hopkins Kimmel Cancer Center. "iPSC-derived liver cells not only can be generated in large amounts, but also can be tailored to each patient, preventing immune-rejection problems associated with liver transplants from unmatched donors or embryonic stem cells."

iPSCs are made from adult cells that have been genetically reprogrammed to revert to an embryonic stem cell-like state, with the ability to transform into different cell types. Human iPSCs can be generated from various tissues, including skin, blood and liver cells.

Although the liver can regenerate in the body, end-stage liver failure caused by diseases like cirrhosis and cancers eventually destroy the liver's regenerative ability, Jang says. Currently, the only option for those patients is to receive a liver organ or liver cell transplant, a supply problem given the severe shortage of donor liver tissue for transplantation. In addition, mature liver cells and adult liver stem cells are difficult to isolate or grow in the laboratory, she says. By contrast, iPSCs can be made from a tiny amount of many kinds of tissue; and the embryonic stem-like iPSCs can grow in laboratory cultures indefinitely.

For the study, Jang and colleagues generated human iPSCs from a variety of adult human cells, including liver cells, fibroblasts (connective tissue cells), bone marrow stem cells and skin cells. They found that though the iPSCs overall were molecularly similar to each other and to embryonic stem cells, they retained a distinct molecular "signature" inherited from the cell of origin.

Next, they chemically induced the iPSCs to differentiate first into immature and then more mature liver cell types. Regardless of their origin, the different iPSC lines all showed the same ability to develop into liver cells.

Using mice with humanlike liver cirrhosis, the researchers then injected the animals with either 2 million human iPSC-derived liver cells or with normal human liver cells. They discovered that the iPSC-derived liver cells engrafted to the mouse liver with an efficiency of eight to 15 percent, a rate similar to the engraftment rate for adult human liver cells at 11 percent.

Researchers also found the engrafted iPSCs worked well. The scientists detected proteins normally secreted by adult human liver cells, including albumin, alpha-1-antitrypsin, transferrin and fibrinogen, in the blood of mice transplanted with human iPSC-derived liver cells.

Additional studies will need to be completed before clinical trials can begin, Jang says. One concern has been the potential for embryonic stem cells or iPSCs to cause tumors, though no tumors formed in any of the transplanted mice during the seven months they were studied (equating to more than 30 years in a human life). The scientists also plan to evaluate the impact of molecular memory that may linger in iPSCs for other type of cellular fate changes.

Source: Johns Hopkins Medicine

DDW

Lower Risk And Reduced Infection Offered By Pharmaceutical Advances

11 May 2011

Research presented at Digestive Disease Week® (DDW) shows that patients taking a blood thinner (clopidogrel) after having polyps removed during colonoscopy were at relatively low risk of bleeding...
.

Could Hep C screening changes prevent liver disease?

Liver disease could be prevented or treated by changing the way in which screening for Hepatitis C is conducted. 

According to a group of research projects being presented at Digestive Disease Week, screening for the virus purely on an age basis rather than the current risk-based programme could help catch more incidences earlier on.

Adrian Di Bisceglie, chairman of the department of internal medicine at Saint Louis University, explained: "These studies suggest that innovative detection practices, as well as different methods of screening, can go a very long way in preventing liver-related diseases and can stave off premature death due to liver disease."

Hepatitis C is an infectious disease that affects the liver and, once established, it can progress to cirrhosis of the liver and even liver cancer.

One of the problems with the condition is the fact that there are very few, if any, symptoms present after the initial infection, yet the virus will persist in the liver among the majority of those infected.

This makes screening for the initial condition particularly important when looking to prevent or treat liver disease.

© Adfero Ltd

Private liver treatment news: 11 May 2011

May News Letter;

Read the hepc.bull -
our online monthly newsletter (.pdf)

May 2011

In This Issue

Hep C Treatment 4 Dummies

That Fully-Loaded “Cure” Word

Affected by Pharmaceutical Shortages?

Hep C & Me: That “Cure” Word


Veteran's colonoscopy suit runs into trouble in court
Veterans suing the federal government after receiving colonoscopies with potentially contaminated equipment have been dealt a setback in federal court.
Todd J. Campbell, chief judge of the U.S. District Court in Nashville, dismissed one of the veterans’ cases in an order Friday. The judge said the lawsuit failed to meet the requirements for the filing of a medical malpractice lawsuit in Tennessee.


FDA urged to certify medicines more quickly

Health activists have urged the Food and Drug Administration to speed up certification of drugs for fighting Aids.

About 100 patients representing a network of Aids, cancer, kidney disease and mental health patients yesterday rallied at the agency asking for clarification from FDA executives.
The group said drug approvals by the agency were moving too slowly, which was holding back access to life-saving medicines.
They had checked with the Government Pharmaceutical Organisation (GPO) about three generic regimens, Efavirenz, Tenofovir and GPO-VIR S7, and found essential scientific documents needed for FDA approval had been submitted years ago.
"This is a matter of life and death for thousands of us, particularly children," she said.
Normally, the FDA spends up to 110 days examining documents, shortened to 70 days for fast-track examinations needed as part of the approval process. However, the approval process for GPO-VIR S7 for HIV-positive children had so far taken years, and still there were no results, said Supatra Nakapew, from the Thai NGO Coalition on Aids.
The group asked how many generic drugs were still pending approval, and whether a certain person hired to check documents for approval might have a conflict of interest with drug companies.
FDA secretary-general Pipat Yingseree said the agency could not certify any drug unless essential scientific documents were sent to support the regimen.
In some cases, the documents sent to support the safety of the drugs were insufficient.
But Dr Pipat said he would ask if a retired FDA official who checks documents as part of the certification process really had a conflict of interest as claimed.
Meanwhile, the Thai Network of People Living with HIV/Aids says more action is needed to stop drug companies renewing patents on life-saving drugs on spurious grounds.
It has sought an assurance from the Commerce Ministry that so-called "evergreen" patents on medicines will be banned, says network president Aphiwat Kwangkaew.
He asked Yanyong Phuangrach, the ministry's permanent secretary who is also chairman of the Patent Committee, to ensure that patents are not renewed in perpetuity if the drug companies owning the patent have not added anything new to medicines.
When patents expire, manufacturers can make cheap copies, called generics. Mr Aphiwat said drug manufacturers which seek an extension to their patents often claim to have added some new ingredients or developed the original drug further, which enables them to secure an extension, blocking rival manufacturers from making cheaper versions.

Mr Aphiwat said some multinational pharmaceutical firms adjust only a little of the drug formula and apply for new patent protection for another 20 years, creating obstacles for the development of cheaper medicines

N.J., N.Y. doctors to appear in court on charges of supplying oxycodone to drug network

TRENTON — Authorities have charged 22 people with trafficking millions of dollars worth of oxycodone tablets and selling the drugs to customers across the state, U.S. Attorney Paul Fishman announced today. Among those arrested were two doctors -- one from New Jersey and another from New York.

Fishman said 16 of the 22 suspects were arrested this morning, including the alleged ringleader, Christopher Erwin, 47, of Fair Haven, and added that one person was already in custody.



What’s That Smell? Another Johnson & Johnson Recall

Nearly a month has passed without a recall from Johnson & Johnson. This may cause recall withdrawal - pun intended - among those closely tracking the plethora of goods the health care giant has yanked over the past year; over-the-counter meds, hip replacement devices, contact lenses, prescription drugs and surgical sutures.

DDW: Rifaximin Cuts Peritonitis in Cirrhosis

By John Gever, Senior Editor, MedPage Today
Published: May 12, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

CHICAGO -- The nonabsorbable antibiotic rifaximin appeared to reduce the incidence of bacterial peritonitis in patients with advanced liver cirrhosis, according to a study presented here.

In a retrospective analysis of 404 patients at risk for spontaneous bacterial peritonitis, only 10% of patients treated with rifaximin developed the condition compared with 31% of those receiving no antibiotic prophylaxis (P=0.001), reported Ibrahim Hanouneh, MD, of the Cleveland Clinic.
Assuming that the drug therapy was responsible, these outcomes meant that treating five patients with rifaximin prevented one case of bacterial peritonitis, Hanouneh told attendees at Digestive Disease Week.
Rifaximin is not approved for or routinely used off-label for peritonitis prevention, but is given regularly for hepatic encephalopathy, Hanouneh explained at a press briefing on the study.
However, published guidelines have recommended other antibiotic regimens for prophylaxis against spontaneous bacterial peritonitis in cirrhosis patients with ascites, which occurs in an estimated 8% to 25% of such patients.
The condition is very serious -- inhospital mortality ranges from 10% to 30% -- Hanouneh said, and most of those who survive have another episode within a year.
He said rifaximin would appear to be a nearly ideal prophylactic drug for the condition. Its systemic absorption is very poor, it covers a broad range of bacterial species (including Gram-negative and Gram-positive organisms), and it does not appear to promote emergence of resistance.
Because some patients with advanced cirrhosis had received rifaximin for other reasons at the Cleveland Clinic, Hanouneh and colleagues thought it would be worthwhile to see whether they developed bacterial peritonitis.
They pulled records of all patients with cirrhosis marked by ascites seen in the liver transplant clinic from 2003 to 2007. After excluding those with previous episodes of spontaneous bacterial peritonitis, prophylaxis with other antibiotics, transplant recipients, and those with GI bleeding, they were left with 404 records for analysis.
Of those, 49 had received rifaximin, mainly for hepatic encephalopathy, 355 had not.
The groups were similar in terms of age, gender and racial balance, ascitic protein levels, serum albumin, bilirubin, creatinine, MELD score, and international normalized ratio.
The major difference was that all of the patients receiving rifaximin had hepatic encephalopathy compared with only 32% of the control group.
The analysis period began when paracentesis was conducted. Median follow-up was 4.2 months, although 49 patients (seven rifaximin, 42 control) had follow-up through 30 months.
A Kaplan-Meier curve indicated that the benefit of rifaximin was apparent immediately. About 10% of the control group developed bacterial peritonitis within the first few weeks, compared with only one patient receiving rifaximin.
In multivariate analysis, only one factor other than rifaximin treatment was significantly associated with the risk of peritonitis – MELD score – and it was relatively weak, with a hazard ratio of 1.06 (95% CI 1.03 to 1.10).
In contrast, the presence of rifaximin therapy was a powerful predictor, with a hazard ratio of 0.28 (95% CI 0.11 to 0.71).
Rifaximin was also associated with significantly improved transplant-free survival. Some 72% of patients taking the drug survived with their native livers, compared with 57% of the control group (P=0.04).
In multivariate analysis, the hazard ratio for transplant or death with rifaximin was 0.54 (95% CI 0.30 to 0.97), Hanouneh reported.
Ascitic fluid cultures were negative in the five rifaximin-treated patients who developed bacterial peritonitis. In the control group, cultures were positive in 36%, evenly divided between Gram-negative and Gram-positive species.
"Intestinal decontamination with rifaximin is an effective measure to prevent [spontaneous bacterial peritonitis] and improve transplant-free survival in cirrhotic patients with ascites," Hanouneh told attendees.
At the press briefing, he acknowledged that it was possible that the indications for rifaximin therapy in these patients, or some other factor associated with the treatment, were actually responsible for the study findings.
Consequently, he said, a randomized trial should be conducted before the drug could be recommended for peritonitis prophylaxis in this population.
"I realize this is retrospective data, but it does look promising in improving transplant-free survival," commented Nicholas Talley, MD, of the University of Newcastle in Australia, who moderated the press briefing.
"We need a randomized study," he added. "We really shouldn't believe it till then, but it is intriguing information."

The study had no commercial funding.
Hanouneh declared he had no relevant financial interests. One co-author reported relationships with Vertex, Roche, Centocor, and Schering-Plough.
Talley reported relationships with ARYx Therapeutics, AstraZeneca, Boehringer Ingelheim, Falk Pharma, Focus Medical Communications, Forest, Ironwood Pharmaceuticals, Janssen-Cilag, MD Evidence, Meritage Pharmaceuticals, Procter & Gamble, and Zeria.

Complete DDW Coverage »

,

Hepatitis C.Telaprevir Ups Response Rates Across IL28B Genotypes

CHICAGO – The addition of telaprevir to standard hepatitis C treatment substantially improved sustained virologic response rates across all IL28B genotypes in an unplanned post hoc analysis of the phase III ADVANCE trial.

The sustained virologic response (SVR) rate doubled and even tripled in patients with the CT or TT allele, and those with the CC allele also experienced an increase in SVR when telaprevir (Incivek) was included in the regimen, lead investigator Dr. Ira M. Jacobson reported in a late-breaking abstract session at the annual Digestive Disease Week.

Single nucleotide polymorphisms in the region of the IL28B gene have been strongly associated with response to standard treatment with pegylated interferon and ribavirin in patients infected with genotype 1 hepatitis C virus (HCV).

The current findings will change the physician dialogue with patients disheartened by early IL28B findings indicating that patients with the CC allele achieved much better responses than those with the CT or TT alleles, session cochair Dr. Andrew J. Muir said in an interview.

"From a clinical standpoint, some of my patients who did not know if they were CC or TT were very concerned," he said. "This changes that discussion a lot. All those patients can see they all get a benefit from this treatment. The CC [patients] still do better, but the fact that the TT and CT do very well is what the important message is for those patients."

The other benefit is that a shorter course of hepatitis C treatment might be possible for patients with the CC allele, said Dr. Muir, clinical director of hepatology at Duke University, Durham, N.C.

At press time, U.S. Food and Drug Administration approval of the protease inhibitors telaprevir and boceprevir was considered imminent, after the two drugs garnered unanimous support in late April from an FDA advisory committee. Pivotal data from the ADVANCE trial in patients with untreated HCV infection showed SVR rates of 75% for patients on a 12-week regimen of telaprevir plus standard treatment with pegylated interferon and ribavirin (PR) followed by 12 or 36 weeks of PR alone; 69% for those on 8 weeks of telaprevir plus PR followed by 4 weeks of placebo plus PR, followed by 12 or 36 weeks of PR alone; and just 44% for those on PR for 48 weeks (with placebo for telaprevir during the first 12 weeks).

The dosages used were: telaprevir, 750 mg every 8 hours; peginterferon alfa-2a, 180 mcg/week; and ribavirin, 1,000 or 1,200 mg/day.

The researchers conducted the genotype analysis during evaluation of an exploratory diagnostic assay that characterizes genetic polymorphisms near the IL28B gene. Using leftover, deidentified samples, test results were available for 454 (42%) of the 1,088 HCV genotype 1 patients at ADVANCE sites in the United States. Only white patients were genotyped for IL28B because of the small number of patients of other races.

The allele distribution was consistent with previous reports about treatment-naive patients, with 49% of patients having the CT allele, 33% the CC allele, and 18% the TT allele, said Dr. Jacobson, chief of the division of gastroenterology and hepatology at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York.

SVR rates among patients with the CC allele were 90% with 12-week telaprevir plus PR, 84% with 8-week telaprevir plus PR, and 64% with PR alone.

The largest improvements in response, however, were observed in patients with the CT and TT alleles – the addition of telaprevir doubled and even tripled SVR rates, Dr. Jacobson said. SVR rates in the CT group reached 71% with 12-week telaprevir plus PR, 57% with 8-week telaprevir plus PR, and 25% with PR alone. SVR rates in the TT group were 73%, 59% and 23%, respectively.

"The impact of 12- and 8-week telaprevir appear to be greater in patients with a T allele than with a CC allele," he said.

Rapid virologic response (RVR) rate, defined as undetectable HCV RNA at week 4, and eRVR, defined as undetectable HCV RNA at weeks 4 and 12, were improved with the telaprevir-based regimens across all IL-28B genotypes, compared to PR alone.

The RVR rates in patients with the CC allele were 84% with the 12-week telaprevir regimen plus PR vs. 71% with 8-week telaprevir plus PR and 16% for PR alone. Corresponding data for the CT allele were 60%, 62%, and 2%, and for the TT allele were 59%, 50%, and 0%.

Most eRVR patients achieved SVR to telaprevir with PR in all allele groups: CC at 95%, CT at 92%, and TT at 80%, Dr. Jacobson said. Patients with the CT and TT alleles who did not achieve eRVR had lower SVR rates than CC patients.

Further research, including studies on nonwhites, is needed to confirm these findings, Dr. Jacobson said.

Dr. Jacobson disclosed numerous financial relationships with industry including grant support and other financial benefits from Tibotec and Vertex Pharmaceuticals, which are developing telaprevir together. Several coauthors also disclosed financial relationships including employment with Vertex.

Source

DDW: video New HCV Drugs Expected to Be 'Breakthrough'

By John Gever, Senior Editor, MedPage Today
Published: May 11, 2011

Click here for video

CHICAGO -- With two hepatitis C virus (HCV) protease inhibitors expected to win FDA approval later this month, the hepatology community is looking at a genuine breakthrough in treating HCV infections, a well-known researcher said in this exclusive MedPage Today Infocus video report.

Telaprevir and boceprevir both won unanimous endorsements from an FDA advisory committee in April and final approval is believed to be imminent. Andrew Muir, MD, director of GI/hepatology research at Duke University, told MedPage Today Senior Editor John Gever that these drugs offer the promise of nearly doubling response rates compared with the current standard of care.

But he warned that clinicians need to be careful with the new agents -- they should never be given as monotherapy, but must be given along with pegylated interferon and ribavirin. Nor should physicians simply substitute the other drug in patients who don't respond adequately to the first one tried, Muir emphasized.

News; Interferon Treatment Raises Hepatitis C Cure Rate and DDW Update

DDW  Screening Baby Boomers for HCV Would Triple Diagnosis Rate May 9, 2011 (Chicago, Illinois) — Age-based screening for hepatitis C virus (HCV) infection, especially targeting baby boomers, would lead to fewer cases of advanced liver disease and related deaths than the current risk-based screening practice, researchers have demonstrated using a Markov model. They presented their findings here at Digestive Disease Week 2011. "Current risk-based HCV screening practices are often limited to people who have symptoms of liver disease or who are considered high risk," said Lisa McGarry, MPH, lead author and director of health economics and outcomes research at Ingenix Life Sciences — a health, technology, and consultant service headquartered in Somerset, New Jersey. "A shortcoming of this approach is that symptoms of HCV infection might not appear for 20 years or more, which is one reason for the high percentage of undiagnosed cases of HCV," she noted. The US Preventive Services Task Force currently does not recommend screening the general population, but advocates screening for HCV risk factors in primary care and testing people at high risk. However, approximately three quarters of HCV-infected people in the United States are unaware of their condition, the Institute of Medicine has determined, according to Ms. McGarry. "Considering the particularly high HCV infection rates among baby boomers, it was important to explore the implications of a targeted age-based birth-cohort screening approach," she said, noting that risk-based screening "has not been very successful." Epidemiologically Based Mathematical Model Revealed Projections A Markov model of the natural history of HCV and subsequent liver disease was developed to determine the distribution of undiagnosed people with HCV infection and their disease progression in 2010. The investigators then ran the model forward to produce a lifetime estimate of HCV-related outcomes under each screening scenario. This included the number of people screened, diagnosed, treated, and achieving sustained viral response, and the number of cases of liver disease and death resulting from advanced liver disease. The model was very detailed, Ms. McGarry noted. For example, it accounted for faster disease progression in males, in patients older at baseline, and in patients older at diagnosis. The researchers then compared the implications of targeted screening of adults born between 1946 and 1970 with the current practice of risk-based screening. The model suggested the following: Among the 102 million people 40 to 64 years of age, some 1.3 million are infected with HCV but remain undiagnosed. Of these, 35% of will have stage F3 to F4 fibrosis, reflecting the long duration of infection in the population. With birth-cohort screening, 78.7 million people would (ideally) be tested; with risk-based screening, 8 million would be tested. Of these, 1.3 million people would be diagnosed with HCV with birth-cohort screening, compared with 427,000 with risk-based screening, and 742,000 would be treated, compared with 235,000. Birth-cohort screening could prevent 113,000 cases of compensated cirrhosis, 53,000 cases of decompensated cirrhosis, 28,000 cases of hepatocellular carcinoma, 6,000 liver transplants, and 48,000 HCV-related deaths. When the investigators expanded birth-cohort screening to those born from 1946 to 1970 (40 to 65 years of age in 2010), the model estimated that wider screening would prevent an additional 24,000 cases of compensated cirrhosis, 11,000 cases of decompensated cirrhosis, 6,000 cases of hepatocellular carcinoma, 1300 liver transplants, and 11,000 deaths. Age-based screening would lead to higher overall costs nationally ($45.1 billion vs. $32 billion), Ms. McGarry acknowledged, but would yield lower costs related to advanced liver disease ($21.7 billion vs. $25.8 billion). The cost of extending the lives of the affected individuals would be $25,279 per quality-adjusted life-year gained (QALY), she said. "This approach appears to provide good value for the money, in addition to preventing advanced clinical outcomes," she suggested. Commenting on the findings, Zobair M. Younossi, MD, MPH, director of the Center for Liver Diseases at Inova Fairfax Hospital in Falls Church, Virginia, noted that the study, the first to examine birth-cohort screening outcomes for HCV, "provides compelling evidence for putting age-based screening guidelines into practice." "The cost of just over $25,000 per QALY gained through earlier detection and treatment is below the [American] willingness-to-pay thresholds and compares favorably with the economics of screening for many other serious diseases." He added that the findings are especially encouraging, given the potential impact of new antiviral treatments for HCV, "which were not even considered in the study." Adrian Di Bisceglie, MD, from St. Louis University School of Medicine, in Missouri, moderated a press briefing on the topic, and noted that the US Department of Health and Human Services will soon release an action plan for viral hepatitis. "Last year, the Institute of Medicine issued a report on screening, so the government has been thinking about this topic and is poised to announce an action plan. I think this study will be important in that context. Healthcare providers and third-party payers will need to be looking at strategies such as this one," he said. "Screening this birth cohort makes sense. There is no approach that will allow us to capture every infected person, unless we screen everyone, but this would allow the highest probability of capturing the greatest proportion of affected persons, and it's doable." Support for the study was provided by Vertex Pharmaceuticals. Ms. McGarry, Dr. Younossi, and Dr. Di Bisceglie have disclosed no relevant financial relationships. Digestive Disease Week (DDW) 2011: Abstract 477. Presented May 8, 2011. Authors and Disclosures Journalist Caroline Helwick Liver Disease: Identifying and Improving Screening and Treatment CHICAGO -- This exclusive broadcast focuses on screening for hepatitis C based on age instead of conventional risk factors and the rate of vaccination against viral hepatitis in patients with chronic liver disease and type 2. From HIV and Hepatitis: Longer Interferon Treatment Raises Hepatitis C Cure Rate Meta-analysis finds that extending pegylated interferon plus ribavirin to 72 weeks may improve sustained response rates for late-responder genotype 1 hepatitis C patients. Treatment of Hepatitis C in HIV Outpatient Study Only about 1 in 5 HIV/HCV coinfected participants in the HOPS cohort received hepatitis C treatment, though the proportion increased over time. Viral Hepatitis: Cutting Edge Update. Action Needed to Reach Out to Silent Sufferers of Hepatitis Red Orbit — Health and Medical Writers Invited to Attend Viral Hepatitis Workshop to Help Inform Silent Sufferers of Hepatitis Washington, D.C. (PRWEB) May 09, 2011 Join the Hepatitis Foundation International as they discuss current issues in viral hepatitis, including forthcoming therapies, shortcomings and improvements to existing treatment and prevention initiatives, and the need to identify the missing millions... Hepatitis B Routine Antenatal Screening For Hepatitis B In An Urban NYC Population 11 May 2011 According to new research at Columbia Presbyterian Medical Center, high rates of chronic hepatitis B infection (HBV) are found in pregnant minority and immigrant women in the New York City area, and most of them do not... From NATAP; Managing hepatitis B/HIV co-infected: adding entecavir to truvada (tenofovir disoproxil/emtricitabine) experienced patients Virological breakthrough and resistance in patients with chronic hepatitis B receiving nucleos(t)ide analogs in clinical practice - pdf attached

Characterizing hepatitis B stigma in Chinese immigrants
S. J. Cotler1, S. Cotler2, H. Xie3, B. J. Luc1, T. J. Layden1, S. S. Wong1Article first published online: 4 MAY 2011

DOI: 10.1111/j.1365-2893.2011.01462.x
© 2011 Blackwell Publishing Ltd
Issue

Journal of Viral Hepatitis

Early View (Online Version of Record published before inclusion in an issue)

Summary. 

Health-related stigma is a cause of stress, alienation and discrimination that can serve as a barrier to prevention and care for infectious diseases such as HIV. Hepatitis B virus (HBV)-related stigma is common in Asian immigrants, but has not been formally evaluated. The aim of this study was to develop and validate the first HBV stigma instrument and to begin to evaluate HBV stigma in Chinese immigrants. The HBV stigma instrument was developed based on constructs from validated HIV stigma scales and organized into five domains. A written survey was compiled to include demographic data, HBV knowledge questions and stigma items. The survey was pilot tested in English and Chinese and then finalized. Data were obtained from 201 patients seen in an urban Chinatown Internal Medicine practice. The stigma items showed a high degree of reliability when assessed in aggregate (α = 0.85) as well as within individual domains. Stigma was greatest in the Fear of Contagion domain. Knowledge questions showed a corresponding deficit in understanding of modes of HBV transmission. An inverse relationship between stigma scores and familiarity with HBV provided evidence of construct validity. In multivariable analysis, having a family member with HBV and higher HBV knowledge subset scores were associated with lower degrees of stigma. In conclusion, the hepatitis B stigma instrument showed reliability and construct validity. The relationship identified between familiarity and knowledge regarding HBV with lower stigma scores provides the basis for the development of interventions to reduce HBV stigma.

State health officials say living kidney donor passed Hepatitis C virus to UPMC organ patient

PITTSBURGH — The Pennsylvania Department of Health is investigating a living kidney donor who had Hepatitis C that was passed on to a transplant recipient at the University of Pittsburgh Medical Center.

The Pittsburgh Tribune-Review says UPMC is citing federal privacy laws in declining to discuss the case reported Wednesday, a day after the newspaper first reported that UPMC had voluntarily and temporarily shut down its living donor transplant program.

Health Department spokeswoman Yasmin Coleman says an investigation is ongoing concerning the transplant case, but says she can't provide more details.

UPMC spokeswoman Jennifer Yates say the hospital network still expects to reopen its living donor program soon, though she could not provide a specific time frame.

UPMC surgeons performed 62 adult living-donor transplants and 90 using kidneys from deceased donors in 2010.

__Information from: Pittsburgh Tribune-Review, http://pghtrib.com/

Healthy You

Tylenol poses a risk of cancer, study indicates

Wednesday, May 11, 2011

By Pohla Smith, Pittsburgh Post-Gazette

If you can find some other way of dealing with that annoying headache besides reaching for your favorite over-the-counter painkiller, use it.

That's one lesson people might take from a new study that suggests frequent users of acetaminophen are at slightly higher risk of developing certain blood cancers, said blood specialists John Lister of the West Penn Allegheny Health System and David Claxton of the Penn State Hershey Cancer Institute.

Acetaminophen is sold under the brand name Tylenol.

Read more: http://www.post-gazette.com/pg/11131/1145635-114.stm#ixzz1M2yH8GEW

Complementary Medicine / Alternative Medicine

Ohm: Americans Doing Doctor Reco Yoga, Meditating For Treatment
10 May 2011

Ohm. Did you know that more than a third of Americans use some form of complementary and alternative medicine (CAM) and that number continues to rise attributed mostly to increases in the use of mind-body therapies (MBT)...

From Scope;

Meditate and call me in the morning: Study looks at doctors' referrals for mind-body therapies

By Michelle Brandt

Are physicians becoming more open to complementary and alternative therapies, including meditation and yoga? Perhaps so, as reported by the Daily Dose's Deborah Kotz:

A study published yesterday in the Archives of Internal Medicine found that some three percent of Americans, who responded to a government health survey, were practicing some sort of mind-body therapy as a result of a physician referral.

That's still far less than the more than 15 percent of respondents surveyed who said they initiated these therapies on their own. But, hey, it's a start, considering how resistant doctors have been to adopting alternative remedies that veer away from mainstream medicine.

"To me this indicates that the use of mind-body therapies in the conventional medical setting is becoming more widely accepted -- absolutely," says study author Dr. Aditi Nerurkar, a fellow in integrative medicine at Beth Israel Deaconess Medical Center.

Nerurkar's research can be found here.

Previously: Americans' use of complementary medicine on the rise
Photo by Sergiu Alistar

Off The Cuff

Investigation into infected surgeon

Full story: Boston Today

A GYNAECOLOGIST from Boston's Pilgrim Hospital is 'devastated' after it emerged an investigation is under way into his practices.

Hepatitis News: New Hepatitis C Drugs Approaching Finish Line/Also DDW

New Hepatitis C Drugs Approaching Finish Line
RTTNews) - Hepatitis C, an infection of the liver, is caused by the deadly hepatitis C virus. This contagious liver disease can be either acute or chronic. Currently there is no vaccine to prevent hepatitis C. But there are approved anti-viral medications to treat hepatitis C.

The current standard treatment is a combination of pegylated interferon-alpha-2a or pegylated interferon-alpha-2b (brand names: Pegasys or PEG-Intron) given as a shot and antiviral drug ribavirin ( brand names: Copegus, Rebetol, Ribasphere, Vilona and Virazole) given in pill form, for a period of 24 or 48 weeks, depending on the hepatitis C virus genotype.

DDW

Video Report: Digestive Disease Week 2011

Here is a roundup of the latest news presented Sunday, May 8, at Digestive Disease Week 2011. Heidi Splete reports.



University of North Carolina School of Medicine
UNC research highlights at 2011 Digestive Disease Week

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, the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract, DDW takes place May 7-10, at McCormick Place in Chicago, Ill. The meeting showcases approximately 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology.
The following are a selection of oral presentations given at this year's DDW by University of North Carolina at Chapel Hill School of Medicine researchers.

1. Meditation offers relief for people with irritable bowel syndrome
This first-ever randomized controlled trial of the effect of mindfulness meditation training on irritable bowel syndrome found that the behavioral technique could significantly reduce the severity of symptoms. Dr. Olafur Palsson, associate professor of medicine, division of gastroenterology and hepatology, and UNC co-investigators also found that over time mindfulness training also reduced psychological distress associated with IBS. The study was led by Susan Gaylord, PhD, director of the University of North Carolina Program on Integrative Medicine.

2. Tough economic times affect colonoscopy screening rates even among the insuredThis study sought to determine if the recent economic recession had an impact on the use of screening colonoscopy among people with health insurance. Dr. Spencer D. Dorn, assistant professor of medicine and co-investigators in the division of gastroenterology and hepatology at UNC found that it did. Colonoscopy rates decreased among insured Americans during the recession, with high out-of-pocket costs a major factor. The findings support policies aimed at reducing costs for the procedure.

3. Diets high in fiber won't protect against diverticulosisPeople whose diets are low in fiber are thought to be at greater risk for developing the diverticular disease of the large intestine than those who eat high-fiber diets. The disease, in which pouches develop in the colon wall, affects about one-third of adults over age 60 and often occurs without symptoms. But complications can be severe and resultant U.S. health expenditures very high, an estimated $2.5 billion per year. A study of more than 2,000 people reported by Anne Peery, MD, fellow in the gastroenterology and hepatology division at UNC, could change dietary recommendations regarding the problem. Rather than a decrease, Peery and co-investigators found an increased risk of diverticulosis in people whose diets are high in fiber and who have more frequent bowel movements.



Off The Cuff

A glimpse into the future of mobile-social computing

Healthy You

Even Short-Term NSAID Use Raises Death/Recurrent MI Risk

By: ELIZABETH MECHCATIE, Internal Medicine News Digital Network

For patients with a history of myocardial infarction, any length of treatment with nonsteroidal anti-inflammatory drugs poses an unacceptably high risk for death or recurrent heart attack, based on findings from a Danish study using hospital and pharmacy registry data and published online May 9 in Circulation.

The risk elevation began during the first week of therapy and continued throughout the course of treatment, with some differences in the magnitude of risk between NSAIDs.

"These results challenge the view that NSAIDs are not harmful during short-term [1-week] treatment and indicate that a revision of current recommendations regarding NSAID treatment in patients with established cardiovascular disease is required," concluded Anne-Marie Schjerning of the department of cardiology, Copenhagen University Hospital in Gentofte, Denmark, and her coauthors. (Circulation 2011 May 9 [doi: 0.1161/CIRCULATIONAHA.110.004671]).

The significant increase in death and recurrent myocardial infarction associated with the use of NSAIDs in a study of people with a history of myocardial infarction indicates that current recommendations regarding NSAID use in patients with cardiovascular disease need to be revised, the study authors concluded.

Although international guidelines state that NSAID use should be discouraged in people with established cardiovascular disease, they say that if such use is unavoidable, the duration of NSAID treatment "should be as short as possible," the authors pointed out.

The investigators conducted the study to address the paucity of information on the association between the duration of treatment with NSAIDs and the risk of cardiovascular disease, in this population of patients. Of the 83,675 people aged 30 years and older who had had their first MI from 1997 through 2006 identified in the national registries (mean age, 68 years), 42% had received NSAIDs.

Overall, treatment with NSAIDs was associated with a 45% greater risk of death/recurrent MI during the first 7 days of treatment, which persisted and was increased by 65% over a 30- to 90-day period of treatment.

The greatest risk identified was with diclofenac (hazard ratio, 3.26; 95% confidence interval, 2.57-3.86 for death/MI at day 1-7 of treatment). Diclofenac is available over the counter in many countries, the authors noted.

A significant increase in risk was seen after 1 week of treatment with ibuprofen, in the first week of treatment with rofecoxib (which has been withdrawn from the market), and after 14-30 days with celecoxib. The risk associated with ibuprofen was lower than the risk associated with the two cyclo-oxygenase-2 (COX-2) selective inhibitors, rofecoxib and celecoxib, and it was lower than the risk associated with the use of diclofenac. There was no increased risk of death or recurrent MI associated with naproxen for the entire treatment duration, which exceeded 90 days in some cases. However, naproxen has been associated with an increased risk of GI bleeding, compared with rofecoxib, in one study, the authors noted.

The results of the study "challenge" American Heart Association recommendations regarding NSAID treatment in patients with established cardiovascular disease "because we demonstrate that even short-term NSAID treatment is associated with increased cardiovascular risk in patients with prior MI," the authors stressed.

Despite some limitations of the study, namely the observational design and the possible effects of information bias, and the need for randomized clinical studies, the investigators added: "The accumulating evidence suggests that we must limit NSAID use to the absolute minimum in patients with established cardiovascular disease."

The authors said they had no relevant financial disclosures.

DDW; New Hope For Some Hepatitis C Patients

New Hope For Some Hepatitis C Patients

(Ivanhoe Newswire) --Screening for hepatitis C based on age instead of conventional risk factors may help improve detection rates and prevent liver disease. New research shows that new detection practices are improving screening and treatment for liver diseases.
According to new research from the Inova Fairfax Hospital, vaccination rates against viral hepatitis in patients with chronic liver disease and type 2 diabetes is relatively low. This is significant because these patients are at increased risk of severe liver injury once infected with hepatitis. Individuals with chronic liver disease are more prone to develop severe liver disease, but when they develop additional liver problems the injury can worsen and result in liver failure or even death

These studies suggest that innovative detection practices, as well as different methods of screening, can go a very long way in preventing liver-related diseases and can stave off premature death due to liver disease," Adrian Di Bisceglie, M.D., chairman, department of internal medicine at Saint Louis University was quoted as saying.

Nearly four million Americans are infected with hepatitis C, and more than two million are in what investigators call the "Baby Boomer Plus" group (a category that includes individuals born between 1945 and 1970). Lisa McGarry, MPH, director of health economics and outcomes research at Innovus, part of Ingenix Life Sciences, in Medford, MA and her colleagues wanted to study this specific group because the current risk-based screening practices have had limited success. In fact, current estimates suggest less than three percent of infected individuals are screened each year.

For the study, researchers collected data from 662 patients with hepatitis C genotype 1, which is especially hard to treat. Researchers found that treating hepatitis C with a drug regimen that combines telaprevir to the standard therapy of pegylated interferon alfa-2a and ribavirin is more effective, both for patients who have not responded to usual therapy and those who relapsed after treatment.
To Receive Med Alerts all year click here. 


Source: Digestive Disease Week, May 8, 2011

DDW: Diet affects gastrointestinal illnesses, such as gallstones and celiac disease

Digestive Disease Week

Dietary research offers new explanations and treatments approaches for gastrointestinal disorders

Health outcomes explored at DDW 2011

CHICAGO, IL (May 8, 2011) — Research being presented at Digestive Disease Week® (DDW) offers further evidence that diet affects gastrointestinal illnesses, such as gallstones and celiac disease, and that some patients who think their digestive problems are caused by lactose intolerance are actually reacting to a psychological disorder. DDW is the largest international gathering of physicians and researchers in the field of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.

"New research is providing critically important, evidence-based results on the effect of diet on gastrointestinal disorders, and this is changing the way we detect and treat a number of digestive diseases," said Mark DeLegge, MD, AGAF, professor of medicine at Medical University of South Carolina. "It is important that patients understand what they eat has an effect on the way their digestive system works and that diet plays an important part in maintaining good health."

Carbohydrate Intake: A Risk Factor for Biliary Sludge and Stones During Pregnancy (Abstract #322)
High consumption of carbohydrates, starches and fructose increases the risk of developing gallstones during pregnancy, according to a new study from the University of Washington (UW). Pregnant women are frequently diagnosed with gallstones, and gallstone-related diseases are the most common non-obstetric cause of hospitalization in the first year after a woman gives birth. With other studies in men and non-pregnant women tying high carbohydrate intake to gallbladder problems, the UW researchers focused on dietary risk factors for the development of gallstones during pregnancy and the incidence of consequent illnesses and surgeries.

Dr. Ko will present these data on Sunday, May 8, at 8:45 a.m. CT in S401D, McCormick Place.

Do symptoms of lactose intolerance reveal a somatoform disorder? (Abstract #493)
Patients may mistakenly think their digestive problems are caused by lactose intolerance, when actually their problems may be attributed to a somatoform disorder, a psychological disorder characterized by symptoms that mimic physical disease, but for which there is no identifiable physical cause, according to new. These results suggest that symptoms of lactose intolerance could reveal a somatoform disorder and that counterproductive behaviour such as diets excluding milk products should be discouraged as they can contribute to osteoporosis and other calcium deficiencies.
Dr. Basilisco will present these data on Sunday, May 8 at 2:15 p.m. CT in E351, McCormick Place.

Should screen-detected and asymptomatic celiac patients be treated? A prospective and randomized trial (Abstract #620)
A recent study analyzed the benefits of serological screening and maintaining a gluten-free diet in asymptomatic celiac patients. The study results showed that although patients were apparently asymptomatic, they in fact suffered from subclinical gastrointestinal symptoms and lower health-related quality of life when on a regular gluten-containing diet. In contrast, patients on a gluten-free diet saw significant improvements in these parameters and felt that the treatment was valuable and beneficial.
Dr. Kaukinen will present these data on Monday, May 9 at 8:00 a.m. and Tuesday, May 10 at 2:00 p.m. CT in S406B, McCormick Place.

###

Digestive Disease Week® 2011 (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, the AGA Institute, the American Society for Gastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract, DDW takes place May 7 – May 10, 2011 in Chicago, IL. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology.

DDW; Lymphoma In Celiac Patients,IBD, Barrett's and Obesity In Children

DDW Coverage From Medpage;

Chicago • May 7 - 10, 2011

DDW: IBD Patients See Shift in Cancer Risk
5/8/2011CHICAGO -- Patients with inflammatory bowel disorders are at elevated risk for many types of cancer, but the risk is lower than formerly thought and has not worsened with the increased use of immunomodulators and biologic drugs, a researcher said here.

DDW: Study Reveals Clues to Lymphoma In Celiac Patients
5/8/2011CHICAGO -- Certain subgroups of patients with celiac disease, such as those who develop this autoimmune disease in older middle age, also are a higher risk for lymphoproliferative disorders.

DDW: Many Gastro Docs Overdiagnose Barrett's
5/7/2011CHICAGO -- Asked about criteria for diagnosing and managing Barrett's esophagus, most gastroenterologists gave answers at variance from published guidelines that suggested overdiagnosis and an excessive burden on patients, a researcher reported here.

DDW: Start Obesity Screening as Early as Age 2
5/6/2011CHICAGO -- Screening children as young as 2 years for obesity may be more successful in weight control and preventing metabolic abnormalities than waiting until they are older, a researcher said here.  

DDW- Screening for hepatitis C based on age not risk may help prevent liver disease

Digestive Disease Week

Strides in identifying and improving screening practices and treatment for liver diseases

Health outcomes explored at DDW 2011
CHICAGO, IL (May 8, 2011) — Research being presented at Digestive Disease Week® (DDW) shows that screening individuals for hepatitis C based on age instead of conventional risk factors may help increase detection rates as well as prevent liver disease. Additionally, the rate of vaccination against viral hepatitis in patients with chronic liver disease and type 2 diabetes is relatively low, and these patients are at increased risk of severe liver injury once infected. DDW is the largest international gathering of physicians and researchers in the field of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.
"These studies suggest that innovative detection practices, as well as different methods of screening, can go a very long way in preventing liver-related diseases and can stave off premature death due to liver disease," said Adrian Di Bisceglie, MD, chairman, department of internal medicine, Saint Louis University.

Low vaccination rates against hepatitis A and hepatitis B in patients with chronic liver disease and with type 2 diabetes: a study of the U.S. population (Abstract #Su1020)
Vaccination rates against severe hepatitis A (HAV) and B (HBV) are relatively low in patients with chronic liver disease (CLD) and type 2 diabetes (DM) who are at risk of severe liver injury if they become acutely infected with HAV or HBV, according to new research from the Inova Fairfax Hospital, therefore mechanisms should be put in place to help increase vaccination rates for this high risk population. Patients who suffer from chronic liver disease are already more prone to develop severe liver disease; when they are afflicted with additional liver trouble the injury is exacerbated and they can suffer liver failure, resulting in liver transplant or even death.

Dr. Younossi will present these data on Sunday, May 8 at 8:00 a.m. CT in Hall A, McCormick Place.
The impact of birth-cohort screening for hepatitis C virus compared with current risk-based screening on lifetime incidence of and mortality from advanced liver disease in the U.S. (Abstract #477)
Screening individuals for hepatitis C virus (HCV) based on age rather than risk factors could have significant implications for prevention of liver disease and premature death due to liver disease, according to new research led by Lisa McGarry, MPH, director of health economics and outcomes research at Innovus, part of Ingenix Life
Sciences, in Medford, MA. Between 3 and 4 million Americans are infected with HCV, and more than 2 million are in what investigators call the "Baby Boomer Plus" birth cohort (individuals born between 1945 and 1970). Investigators sought to study this population because current risk-based screening practices have had limited success; current estimates suggest less than 3% of infected individuals are screened each year.
Ms. Lisa McGarry will present these data on Sunday, May 8 at 2:15 p.m. CT in S106B, McCormick Place

Telaprevir-based Regimen in Genotype 1 Hepatitis C Virus-infected Patients with Prior Null Response, Partial Response or Relapse to Peg-interferon/Ribavirin: REALIZE Trial Final Results (Abstract #625r)
Treating hepatitis C with a drug regimen that adds the protease inhibitor telaprevir to the standard therapy of pegylated interferon alfa-2a and ribavirin is far more effective, both for patients who have not responded to usual therapy and those who relapsed after treatment, according to researchers at the Scripps Clinic. The findings in the international randomized, double-blind trial offer new hope to individuals with chronic hepatitis C. The study involved 662 patients with hepatitis C genotype 1, which is particularly difficult to treat.
Dr. Paul Pockros will present these data on Monday, May 9, at 8:30 a.m. CT in S105, McCormick Place and on Tuesday, May 10 at 2:00 p.m. CT in S406B, McCormick Place.

###

Digestive Disease Week® 2011 (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, the AGA Institute, the American Society for Gastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract, DDW takes place May 7 – May 10, 2011 in Chicago, IL. The meeting showcases more than 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology.

Digestive Disease Week® (DDW) 2011 Liver Meeting May 7-10, 2011

Update May 6; DDW: Start Obesity Screening as Early as Age 2

Chicago • May 7 - 10, 2011

5/6/2011
CHICAGO -- Screening children as young as 2 years for obesity may be more successful in weight control and preventing metabolic abnormalities than waiting until they are older, a researcher said here.

AGA presents cutting-edge research during DDW
Advances highlight progress being made in the treatment and research of GI disorders

Clinicians, researchers and scientists from around the world will gather for Digestive Disease Week^® (DDW) 2011, the largest and most prestigious gastroenterology meeting, from May 7-10, 2011, at McCormick Place, Chicago, IL. DDW, which is jointly sponsored by the American Association for the Study of Liver Diseases, the American Gastroenterological Association (AGA) Institute, the American Society for Gastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract, is the annual meeting of the AGA Institute. American Gastroenterological Association

AGA researchers will present exciting, cutting-edge data during the meeting that will help change the way physicians diagnose and treat GI disorders. All data presented during DDW is embargoed until the beginning of the presentation or an official DDW press conference, whichever occurs first. A list of press conferences is available at www.ddw.org/press.

Late-Breaking Session
On May 10, 8:30 a.m. CT, Room S406B*, the AGA will feature its late-breaking clinical abstracts, which include exciting data on:

• Effects of A3309, an Ileal Bile Acid Transporter Inhibitor, on Colonic Transit and Symptoms in Patients with Functional Constipation (Abstract #908). B. S. Wong et al.
• High Sustained Virologic Response (SVR) Among Genotype 1 Previous Non-Responders and Relapsers to Peginterferon/Ribavirin When Re-treated with Boceprevir (BOC) Plus Peginterferon Alfa-2A/Ribavirin (Abstract #903). S. L. Flamm et al.
• Increased Risk of New or Missed Colorectal Cancers After Flexible Sigmoidoscopy Compared with Colonoscopy among Older Patients in the United States: A Population-Based Analysis of the SEER-Medicare Linked Database, 1998-2005 (Abstract #906). Y. R. Wang et al.
• Obtaining SVR to Antiviral Therapy Highly Protects Patients with HCV Recurrence on the Graft after Liver Transplantation from Liver Related Death: Insights from the AISF-RECOLT-C Group (Abstract #905). M. Rendina et al.
• Telaprevir-Based Regimens Substantially Improved SVR Rates Across All IL28B Genotypes in the ADVANCE Trial (Abstract #904). I. M. Jacobson et al.
• Teduglutide, a Novel Analogue of Glucagon-like Peptide 2 (GLP-2), Is Effective and Safe in Reducing Parenteral Support Volume in Short Bowel Syndrome-Intestinal Failure Subjects: Results From a 24-Week, Placebo-Controlled Phase 3 Trial (STEPS) (Abstract #907). P. B. Jeppesen et al.

Plenary Sessions
During the Presidential Plenary Session, AGA Institute President, Ian L. Taylor, MD, PhD, AGAF, will focus on the latest research and clinical advances in the field of gastroenterology. Two additional plenary sessions feature noteworthy clinical and basic science research presented at DDW.
The Presidential Plenary Session presentations (May 9, 10 a.m. CT, Room S100AB) include:

• Colon Cancer Screening. D. Provenzale.
• Hepatitis C in Minority Populations. A. E. Reid.
• Inflammatory Bowel Disease. S. R. Targan.
• Endoscopic Ultrasound. R. H. Hawes.
• The Brain-Gut Axis in Chronic GI Disease. E. A. Mayer.
• The Role of Inflammation in the Causation of GI Cancers. S. E. Crowe.
• Type II Diabetes Is a GI Disease and Should be Treated by Gastroenterologists. I. L. Taylor.
• Impact of Health Reform on GI. J. V. Brill.
• Towards Digestivism. P. B. Cotton.

The Basic Science Plenary Session presentations (May 8, 2:15 p.m. CT, Room S404) include:

• Regeneration of Damaged Colonic Tissue by Transplantation of Colonic Epithelial Stem Cells Maintained and Expanded in Vitro (Abstract #534). S. Yui et al.
• Neurotensin (NT) Receptor 1 (NTR1)-MicroRNA Networks in Human Colon Epithelial Cells. Characterization of Novel Pathways Connecting Neurotensin and Tumor Growth (Abstract #535). K. Bakirtzi et al.
• Stem Cells, Growth Factor Signaling Pathways and Colon Cancer. R. J. Coffey.
• A Chimeric Vaccine Prevents Primary and Recurrent Clostridium Difficile Infection (Abstract #536). H. Feng et al.
• Restoration of Adult-Like Colonic Motility in Aged Transgenic Mice Expressing Phosphomimic HSP27 (Abstract #537). S. Somara et al.

The Clinical Plenary Session presentations (May 9, 8:30 CT, Room S105) include:

• A Prospective Clinical Trial Shows that Intravenous N-acetylcysteine (NAC) Does Not Improve Survival in Pediatric Patients with Non-Acetaminophen Acute Liver Failure (Abstract #622). R. Squires et al.
• Functional Disability and Informal Caregiving Among Older Patients with Decompensated Cirrhosis: An Analysis of the Health and Retirement Study (Abstract #623). M. O. Rakoski et al.
• Abnormal Cerebral Hemodynamics in Hepatic Cirrhosis and Encephalopathy (Abstract #624). M. Green et al.
• Telaprevir-Based Regimen in Genotype 1 Hepatitis C Virus-Infected Patients with Prior Null Response, Partial Response or Relapse to Peginterferon/Ribavirin: REALIZE Trial Final Results (Abstract #625). P. Pockros et al.
• Anemia Had No Effect on Efficacy Outcomes in Treatment-Naïve Patients Who Received Telaprevir-Based Regimen in the ADVANCE and ILLUMINATE Phase 3 Studies (Abstract #626). F. Poordad et al.
• Antiviral Treatment for Hepatitis C Virus Is Associated with a Reduced Risk of Hepatocellular Carcinoma in a National Cohort of U.S. Veterans (Abstract #627). J. R. Kramer et al.

Other exciting data will be presented during DDW, including 31 clinical symposia, 20 translational symposia, 11 research symposia and seven state-of-the-art lectures on a range of GI topics. Additionally, the AGA Institute will sponsor four curbside consultant sessions. A total of 11 focused research roundtables and focused clinical updates — breakfast sessions designed to help participants choose the must-see basic science and clinical research abstracts presented during DDW — will occur throughout the meeting.

Foreign Language Sessions
We are excited to announce that this year, the AGA will offer sessions at DDW entirely in Spanish and Japanese. At The Best of AGA at DDW: En Español, presenters will highlight clinical advances from 2010 to 2011 and at DDW in inflammatory bowel disease, liver and pancreatic diseases, and endoscopic therapies, in Spanish (May 10, 2:15 p.m. CT, Room S405). Topics include hepatitis, pancreatitis and pancreatic cancer, intestinal inflammatory illness, new developments in endoscopy, and esophageal disease.
The Japanese language program will showcase some of the best abstracts submitted to DDW 2011 from Japan (May 10, 2:15 p.m. CT, Room S402), including:

• Regeneration of Damaged Colonic Tissue by Transplantation of Colonic Epithelial Stem Cells Maintained and Expanded in Vitro (Abstract #534r). S. Yui et al.
• Intestinal Epithelial Cells with Impaired Autophagy Lose their Adhesive Capacity in the Presence of TNF-α (Abstract #422r). M. Saito et al.
• Suppressive Effects of Pioglitazone, A PPAR Gamma Ligand, on Colorectal Carcinogenesis Induced in Obese KK-Ay Mice by Azoxymethane (Abstract #410r). A. Yanaka et al.
• Efficacy and Safety of Acotiamide (Z-338) Administered Orally for Four Weeks in Patients with Functional Dyspepsia: Results From a Randomized, Double-Blind, Placebo-Controlled Phase III Trial in Japan (Abstract #122r). K. Matsueda et al.
• Oral Intake Oligosaccharide Synthase Decrease HbA1c in Diabetes Patients, Randomized Double Blind Placebo Control Trial-Intestinal Flora and Effect Forecast (Abstract #124r). M. Sasaki et al.
• A Study of the Efficacy of Proton Pump Inhibitors in Treating Upper Abdominal Symptoms (Abstract #374r). T. Kamada et al.

Trainee and Young GI TrackTo address the needs of physicians new to the field, the AGA is introducing a trainee and young GI track at DDW. The track consists of exciting new sessions that provide the necessary tools and information for a successful clinical practice career:

• Mentor and Advisor Networking Reception (May 7, 5:45 p.m. CT, CC11A, Hyatt Regency McCormick) — presents an opportunity for attendees to network and interact with peers and colleagues.
• Board Review Session (May 8, 1:45 p.m. CT, Room E451B) — will prepare attendees for the board certification exam using AGA's popular Digestive Diseases Self-Education Program^® (DDSEP) 6. DDSEP editors and authors will cover select questions, answers and critiques from the book.
• Career- and Professional-Related Issues (May 8, 5:45 p.m. CT, Room E451B) — provides practical advice on how to address common career and professional issues. Topics include choosing a practice type and location, developing an effective CV, learning how to interview successfully, negotiating contracts, and maintaining a healthy work-life balance.
• Immediate Advancement in Skills for Teaching (May 10, 8:30 a.m. CT, Room S505) — offers expert insight on how to successfully pursue a teacher/clinician educator career path; uses questions and vignettes to engage attendees in discussions about how to deliver effective presentations, use team-building learning techniques and manage small-group dynamics.
• Advance Your Leadership Skills: How to Rise to a Position of Leadership in Gastroenterology or Hepatology (May 10, 10:30 a.m. CT, Room S505) — helps participants develop a leadership growth plan, learn how to recognize steps for success and avoid issues, improve interpersonal communication skills, practice challenging decision-making, and more.
• Immediate Advancement in Skills for Clinical Practice (May 10, 2:15 p.m. CT, Room S505) — presents essential skills, including practice management and managerial skills, for building a successful clinical practice career. Topics cover how to deal with support staff, understanding the financial stresses and benefits of clinical practice, and more.

Rome Foundation-AGA Institute Lectureship
Tarique Perera, MD, assistant professor in clinical psychiatry, will join Michael D. Gershon, MD, professor of pathology and cell biology, to bring their unique perspectives to a discussion that will include a look at the possibility of reversing functional GI disorders with serotonin agents. Both internationally renowned experts teach at Columbia University in New York. During Sunday's fifth annual Rome Foundation-AGA Institute Lectureship (May 8, 10:30 a.m. CT, Room E451A), these experts will provide a comprehensive overview of The Role of Neurogenesis in the Brain and Gut and its Implications for Functional GI and Motility Disorders. Co-chairs Lin Chang, MD, AGAF, and Douglas A. Drossman, MD, AGAF, agreed that bringing these experts together is a way to harmonize the knowledge from investigators in two different areas but on the same process. "This lecture will provide cutting-edge science with many potential practical and clinical implications," said Dr. Drossman.

###

*All sessions will be held in McCormick Place unless otherwise noted.
About the AGA Institute The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, the AGA has grown to include 17,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization. http://www.gastro.org/.
Become an AGA fan on Facebook.
Join our LinkedIn group.
Follow us on Twitter @AmerGastroAssn.
Check out our videos on YouTube.

About DDW
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, the American Gastroenterological Association Institute, the American Society for Gastrointestinal Endoscopy and the Society for Surgery of the Alimentary Tract, DDW takes place May 7-10, 2011, at McCormick Place, Chicago, IL. The meeting showcases approximately 5,000 abstracts and hundreds of lectures on the latest advances in GI research, medicine and technology. For more information, visit http://www.ddw.org/.
Follow us on Twitter @DDWMeeting; hashtag #DDW11. Become a fan of DDW on Facebook.