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Volume 1, No 2 - Spring 2001

Volume 1, No 2 - Spring 2001

Table of Contents

Current Treatment for Chronic Hepatitis C Emerging Treatment
Treatment of chronic hepatitis C has seen phenomenal progress over the last 10 years. The short courses of interferon monotherapy that were used in the early 1990s led to sustained improvement in liver disease and durable loss of detectable virus in fewer than 10% of patients. Longer courses improved the durability of those responses slightly. The major recent advance in treatment is the addition of the nucleoside analogue ribavirin to the interferon regimen. Combination of these two drugs for 6 to 12 months results in a sustained virologic response in 30% to 40% of previously untreated patients. Long-acting pegylated interferon has just been approved by the FDA and promises to improve the ease of administration. Furthermore, when used in combination with ribavirin, pegylated interferon increases the sustained virologic response rate to more than 50%. [Rev Gastroenterol Disord. 2001;1(2):59–72]
Training and Competence in Gastrointestinal Endoscopy Technique Update
Patients, physicians, and health care providers want assurances that individuals performing gastrointestinal endoscopic procedures are competent and adequately credentialed. Definition of competence, however, has been an elusive goal. Most organizations, including professional societies and hospital privileging committees, have relied on estimated numbers of procedures performed or subjective assessment by a proctor as a surrogate marker of competence. Increasingly, objective assessment of performance is recognized as important in determining competence. Recent data have shown that learning curves for trainees are substantially more gradual than generally thought, and that the number of procedures required to achieve basic technical proficiency is much higher. Emerging data demonstrate that there is substantial variation in outcomes of endoscopy in clinical practice, related in part to the prior training, subspecialty background, ongoing case volume, and the individual endoscopist. Outcome variations correlate with both technical success and complications. Strategies for assessing competence in trainees and those in practice include numbers of procedures performed, subjective or objective assessment by a proctor, and self-assessment by the trainee. In the future, it is hoped that computers will be increasingly used to document outcomes of endoscopy in training and clinical practice as a part of routine report generation. [Rev Gastroenterol Disord. 2001;1(2):73–86]
Pegylated Interferons New Drug Review
Interferon therapy for chronic hepatitis C is not a cure, but it is able to decrease the viral load and may decrease the risk of complications (eg, cirrhosis, liver failure, liver cancer). Pegylation of the interferon increases the amount of time the interferon remains in the body by increasing the size of the interferon molecule. Increasing molecule size slows the absorption, prolongs the half-life, and decreases the rate of interferon clearance. Thus the duration of biological activity is increased with pegylated interferon over nonpegylated interferon. The peginterferon alfa products offer an advantage over nonpegylated interferon alfa products because of less frequent administration. Tolerability of the pegylated interferons is comparable to the nonpegylated formulations. Monotherapy with these agents produces a better response in some patients than monotherapy with the nonpegylated formulation. Combination therapy with ribavirin is more effective than monotherapy. Studies comparing peginterferon alfa-2b and peginterferon alfa-2a in the treatment of chronic hepatitis C have not been performed. [Rev Gastroenterol Disord. 2001;1(2):87–99]