Bruce Bacon, MD

The hepatology session at the AGA Postgraduate Course in Chicago had a range of excellent topics for the practicing gastroenterologist/hepatologist. Perhaps the area that is changing most rapidly is that of treatment of hepatitis C. Dr. Jordan Feld from the University of Toronto presented “Choosing the optimal HCV regimen.” Dr. Feld’s presentation highlighted the recent approval of simeprevir and sofosbuvir both with pegylated interferon and ribavirin for treatment of chronic hepatitis C genotype 1. HCV cure rates of 80% to 90% were described. He also told us about exciting developments with interferon-free regimens that will be available in October/November of 2014.

The combination of sofosbuvir and ledipasvir and the combination of three direct-acting antiviral agents with or without ribavirin will revolutionize our care of hepatitis C patients from now on. Many clinicians have already been using interferon-free regimens by combining simeprevir and sofosbuvir for 12 weeks with excellent results. Dr. Feld finished by highlighting the fact that the American Association for the Study of Liver Diseases/Infectious Diseases Society of America guidelines are now available and provide a useful resource for treatment for your hepatitis C patients.

Dr. Michael Lucey from the University of Wisconsin School of Medicine and Public Health talked about the management of alcoholic hepatitis. Dr. Stephen Harrison from Brooke Army Medical Center presented impressive data on the huge number of patients that we will be seeing with nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. By careful estimates, he predicts that there may be as many as 25 million patients in the United States with NASH. New treatments are being developed, but we are still a long way from having reliable treatments for this disease. Thus, lifestyle modifications with judicious weight loss and exercise regimens remain the most important treatments available for NASH/NAFLD. Dr. Harrison also highlighted the recent studies that demonstrate that regular coffee consumption may be helpful for reducing fibrosis in patients with NAFLD.

Dr. Jorge Marrero from the University of Texas Southwestern Medical School presented data on kidney injury in cirrhosis and how to differentiate acute kidney injury from hepatorenal syndrome. Finally, Dr. Sam Lee from the University of Calgary presented “Management of coagulation disorders in cirrhosis.” He discussed the use of anticoagulation and taught us to recognize that cirrhosis is not a hypocoagulable state and that there are situations where anticoagulant therapy in cirrhosis is definitely a benefit. The idea of using anticoagulation in patients with cirrhosis is counterintuitive to many of us, but Dr. Lee presented data to endorse this approach. I think all of will have to think hard in our practices on how we proceed with the use of anticoagulation in patients with portal vein thrombosis.

Dr. Bacon is the James F. King MD Endowed Chair in Gastroenterology, professor of internal medicine, and director of abdominal transplantation at Saint Louis University School of Medicine, division of gastroenterology and hepatology, St. Louis.

The hepatology session at the AGA Postgraduate Course in Chicago had a range of excellent topics for the practicing gastroenterologist/hepatologist. Perhaps the area that is changing most rapidly is that of treatment of hepatitis C. Dr. Jordan Feld from the University of Toronto presented “Choosing the optimal HCV regimen.” Dr. Feld’s presentation highlighted the recent approval of simeprevir and sofosbuvir both with pegylated interferon and ribavirin for treatment of chronic hepatitis C genotype 1. HCV cure rates of 80% to 90% were described. He also told us about exciting developments with interferon-free regimens that will be available in October/November of 2014.

The combination of sofosbuvir and ledipasvir and the combination of three direct-acting antiviral agents with or without ribavirin will revolutionize our care of hepatitis C patients from now on. Many clinicians have already been using interferon-free regimens by combining simeprevir and sofosbuvir for 12 weeks with excellent results. Dr. Feld finished by highlighting the fact that the American Association for the Study of Liver Diseases/Infectious Diseases Society of America guidelines are now available and provide a useful resource for treatment for your hepatitis C patients.

Dr. Michael Lucey from the University of Wisconsin School of Medicine and Public Health talked about the management of alcoholic hepatitis. Dr. Stephen Harrison from Brooke Army Medical Center presented impressive data on the huge number of patients that we will be seeing with nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. By careful estimates, he predicts that there may be as many as 25 million patients in the United States with NASH. New treatments are being developed, but we are still a long way from having reliable treatments for this disease. Thus, lifestyle modifications with judicious weight loss and exercise regimens remain the most important treatments available for NASH/NAFLD. Dr. Harrison also highlighted the recent studies that demonstrate that regular coffee consumption may be helpful for reducing fibrosis in patients with NAFLD.

Dr. Jorge Marrero from the University of Texas Southwestern Medical School presented data on kidney injury in cirrhosis and how to differentiate acute kidney injury from hepatorenal syndrome. Finally, Dr. Sam Lee from the University of Calgary presented “Management of coagulation disorders in cirrhosis.” He discussed the use of anticoagulation and taught us to recognize that cirrhosis is not a hypocoagulable state and that there are situations where anticoagulant therapy in cirrhosis is definitely a benefit. The idea of using anticoagulation in patients with cirrhosis is counterintuitive to many of us, but Dr. Lee presented data to endorse this approach. I think all of will have to think hard in our practices on how we proceed with the use of anticoagulation in patients with portal vein thrombosis.

Dr. Bacon is the James F. King MD Endowed Chair in Gastroenterology, professor of internal medicine, and director of abdominal transplantation at Saint Louis University School of Medicine, division of gastroenterology and hepatology, St. Louis.

The hepatology session at the AGA Postgraduate Course in Chicago had a range of excellent topics for the practicing gastroenterologist/hepatologist. Perhaps the area that is changing most rapidly is that of treatment of hepatitis C. Dr. Jordan Feld from the University of Toronto presented “Choosing the optimal HCV regimen.” Dr. Feld’s presentation highlighted the recent approval of simeprevir and sofosbuvir both with pegylated interferon and ribavirin for treatment of chronic hepatitis C genotype 1. HCV cure rates of 80% to 90% were described. He also told us about exciting developments with interferon-free regimens that will be available in October/November of 2014.

The combination of sofosbuvir and ledipasvir and the combination of three direct-acting antiviral agents with or without ribavirin will revolutionize our care of hepatitis C patients from now on. Many clinicians have already been using interferon-free regimens by combining simeprevir and sofosbuvir for 12 weeks with excellent results. Dr. Feld finished by highlighting the fact that the American Association for the Study of Liver Diseases/Infectious Diseases Society of America guidelines are now available and provide a useful resource for treatment for your hepatitis C patients.

Dr. Michael Lucey from the University of Wisconsin School of Medicine and Public Health talked about the management of alcoholic hepatitis. Dr. Stephen Harrison from Brooke Army Medical Center presented impressive data on the huge number of patients that we will be seeing with nonalcoholic fatty liver disease/nonalcoholic steatohepatitis. By careful estimates, he predicts that there may be as many as 25 million patients in the United States with NASH. New treatments are being developed, but we are still a long way from having reliable treatments for this disease. Thus, lifestyle modifications with judicious weight loss and exercise regimens remain the most important treatments available for NASH/NAFLD. Dr. Harrison also highlighted the recent studies that demonstrate that regular coffee consumption may be helpful for reducing fibrosis in patients with NAFLD.

Dr. Jorge Marrero from the University of Texas Southwestern Medical School presented data on kidney injury in cirrhosis and how to differentiate acute kidney injury from hepatorenal syndrome. Finally, Dr. Sam Lee from the University of Calgary presented “Management of coagulation disorders in cirrhosis.” He discussed the use of anticoagulation and taught us to recognize that cirrhosis is not a hypocoagulable state and that there are situations where anticoagulant therapy in cirrhosis is definitely a benefit. The idea of using anticoagulation in patients with cirrhosis is counterintuitive to many of us, but Dr. Lee presented data to endorse this approach. I think all of will have to think hard in our practices on how we proceed with the use of anticoagulation in patients with portal vein thrombosis.

Dr. Bacon is the James F. King MD Endowed Chair in Gastroenterology, professor of internal medicine, and director of abdominal transplantation at Saint Louis University School of Medicine, division of gastroenterology and hepatology, St. Louis.