Handbook of Liver Disease fourth Edition PDF download
Handbook of Liver Disease fourth Edition PDF download I am pleased and honored to have been asked to prepare a Foreword for the fourth edition of Handbook of Liver Disease. is handbook has become an incredibly valuable resource for all levels of medical providers who deal with patients who have liver disease. It is easy to use and not overly detailed; nonetheless, all the essentials are present. Reading through the forewords from previous editions of the book shows an interesting array of dramatic adjectives describing the progress that has been made in the eld of hepatology. For example, the changes have been described as “astronomical” and “stunning.” at seems still to be the case in light of continued new develop- ments. For the young hepatologists in the eld, it might be hard for them to consider a time when we as hepatologists could only identify problems but not do anything about them. Furthermore, I can remember when it was jokingly said that all we had in our armamentarium was furosemide and lactulose. Now, in 2017, the diagnostic and therapeutic advances have been phenomenal. One need only compare the exhibit area at the annual meeting of the American Association for the Study of Liver Diseases (AASLD) over the years. In 1977, there were only 11 exhibitors, whereas in 2017 in Washington, DC, there were 85 exhibitors. Indeed, hepatology has become a very suc- cessful growth area.
Handbook of Liver Disease fourth Edition PDF download MPerhaps the greatest developments in hepatology over the past 30 years have come in the eld of viral hepatitis. In certain parts of the world, hepatitis B vaccination has signi cantly reduced the frequency of vertical transmission of the hepatitis B virus and in turn has reduced the risk of hepatocellular carcinoma (HCC) in young adults. In much of the United States, hepatitis D (delta) is rarely seen now, and identi cation of a case of hepatitis E is rare. However, the most dra- matic example of progress in hepatology has been in the eld of hepatitis C. e progress from the discovery of the hepatitis C virus (HCV) in the late 1980s to the ability to cure more than 90% to 95% of patients—and in some studies up to 100%—is truly remarkable. e new treatment regi- mens do not include interferon, are well tolerated, are safe, are highly e ective, and usually require only 12 weeks of oral treatment. Unfortunately, the biggest current problem related to viral hepati- tis, and particularly hepatitis C, is the increase in transmission of HCV associated with the opioid abuse problem in the United States. Also, the frequency of vertical transmission from mother to child is increasing slightly, and, unfortunately, the call for screening in baby boomers has not been vigorously received.
Handbook of Liver Disease fourth Edition PDF download Development of a hepatitis C vaccine has been slow, and some observers have opined that with treatment success approaching 100% with direct-acting antiviral agents, the need for a vaccine is not as great as once thought. At any rate, the availability of hepatitis C treatment regimens, with at least seven regimens by the end of 2017, has been a great achievement.
e explosion of successful therapies for hepatitis C has not been equaled for hepatitis B, but many of the scientists, clinicians, and investigators who had been working in hepatitis C are now working on treatments that will lead to cure of hepatitis B. Perhaps by the time the next edition of the Handbook has been prepared, we will have curative, direct-acting antiviral agents being tested for use in patients with hepatitis B.
The other major growth area in hepatology is nonalcoholic steatohepatitis (NASH). Although there may be three to ve million Americans with hepatitis C and approximately two million with hepatitis B, it has been estimated that there may be as many as 25 million Americans with nonalcoholic fatty liver disease (NAFLD). Clinical trials are rapidly being initiated, and numerous new agents are being tested, some alone and some in combination. Most patients with NAFLD or NASH have insulin resistance, and it seems likely that two or more mechanisms for de ning treatment may be necessary for success. It is also likely that the need for treatment may be long- term and perhaps lifelong. erefore expense will be a major consideration for access to these treatments, and health care providers will have to be careful about this issue.