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Volume 3, No 3 - Summer 2003

Volume 3, No 3 - Summer 2003

Table of Contents

Chronic Hepatitis B and Hepatitis C in Asian Americans Treatment Review
Both chronic hepatitis B and hepatitis C are prevalent among the 12 million Asians and Pacific Islanders living in the United States. Significant epidemiological and clinical differences exist between Asian Americans and the general U.S. population, most notably the higher rate of primary liver cancer and the differential response to various antiviral therapies. Perinatal and childhood transmission is common for hepatitis B virus. Transmission of hepatitis C virus probably also occurs early in life and results from nosocomial transmission and person-to-person spread. Asian patients with chronic hepatitis B commonly have hepatitis B e antigen-negative hepatitis B with either the precore or core-promoter mutant hepatitis B virus, which may require long-term antiviral viral therapy because of high rates of relapse following therapy. Asian patients with chronic hepatitis C may have a substantially higher risk of liver cancer but a better response to interferon-based therapy, both in terms of sustained virological response and reduced future incidence of liver cancer. Understanding these differences will lead to improved care for Asian Americans with viral hepatitis and better disease control for hepatitis B and hepatitis C for the entire U.S. population. This review briefly summarizes the major issues in the clinical care of patients with chronic viral hepatitis and focuses on pertinent epidemiological and clinical differences between Asian-American and Caucasian patients. [Rev Gastroenterol Disord. 2003;3(3):125–134]
Endoscopic Management of Pseudocysts Technique Review
Endoscopic retrograde cholangiopancreatography (ERCP) has gained acceptance as a treatment of pancreatic pseudocysts in patients suited to this procedure. This article describes a standard approach to the technique. Evaluation prior to endoscopic drainage of pseudocysts should involve review of a high-quality computed tomography (CT) scan; most experts agree that endoscopic ultrasound is also useful. Complications of the procedure include perforation, bleeding, and infection. Endoscopists performing the procedure should have a good understanding of these complications and how to minimize risks and should have expert, multidisciplinary backup available at their institution in the event of complication or failure. The endoscopist should try to obtain a complete pancreatogram at the index ERCP. Follow-up involves a CT scan 3 to 6 weeks after the procedure. Pseudocysts can recur and are largely related to ductal anatomy. [Rev Gastroenterol Disord. 2003;3(3):135-141]
Endoscopic Therapy for GERD-- Baking, Sewing, or Stuffing: An Evidence-Based Perspective Treatment Review
The concept of using endoscopic therapy for the treatment of symptomatic gastroesophageal reflux disease (GERD) is a relatively recent development. Currently, three basic techniques are approved for use in the United States. To date, clinical trials have examined either a thermal approach, endoscopic suturing, or injection interventi on in the area of the lower esophageal sphincter. However, the trials for each type of endoscopically directed therapy have varied in methodologic design and data analysis. It is important to recognize these differences when attempting to compare the efficacy and outcomes for each endoscopic therapy. Additionally, the risk/benefit profile must be carefully evaluated for each of these interventions before considering it a viable treatment strategy. [Rev Gastroenterol Disord. 2003;3(3):142-149]
Pharmacogenomics of Azathioprine and 6-Mercaptopurine in Gastroenterologic Therapy New Drug Review
The elimination of azathioprine and 6-mercaptopurine is greatly influenced by polymorphisms in the enzymes responsible for their metabolism. Patients who are deficient in thiopurine methyltransferase (TPMT) are at an increased risk for azathioprine- and 6-mercaptopurine–induced toxicities because of the accumulation of toxic metabolites, and patients with high TPMT activity may not receive maximum benefit because of the increased clearance. Therefore, routine TPMT genotyping prior to the initiation of azathioprine or 6-mercaptopurine therapy should be considered to decrease the risk of severe and possibly preventable adverse effects and to identify patients who might benefit from higher doses. However, measuring the TPMT activity at baseline is not a substitute for monitoring white blood cell counts throughout therapy because drug therapy and/or other conditions may still cause myelosuppression in these patients. [Rev Gastroenterol Disord. 2003;3(3):150–157]