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Volume 4, No 1 - Winter 2004

Volume 4, No 1 - Winter 2004

Table of Contents

Non-Invasive Tests for the Diagnosis of H. pylori Infection Diagnosis Update
Helicobacter pylori infection can be diagnosed by invasive techniques requiring endoscopy and biopsy (eg, histological examination, culture, polymerase chain reaction) and by non-invasive techniques such as serology, urea breath test, urine/blood test, or detection of H. pylori antigen in stool specimen. Some non-invasive tests, such as the urea breath test and the stool antigen test, detect active infection; these are called “active tests.” Non-invasive tests (eg, serology) are markers of exposure to H. pylori but do not indicate if active infection is ongoing; these are called “passive tests.” Non-invasive test-andtreat strategies are widely recommended in primary care settings. The choice of an appropriate test depends on the pre-test probability of infection, the characteristics of the test being used, and the cost-effectiveness of the test. This article reviews available non-invasive tests. [Rev Gastroenterol Disord. 2004;4(1):1-6]
Chronic Hepatitis C and Liver Transplantation Treatment Update
Chronic hepatitis C virus (HCV) is a worldwide health problem. Approximately 4 million people in the United States are chronically infected with HCV. The incidence of infection peaked between 2 and 3 decades ago, and we are now beginning to see an increase in the complications of cirrhosis from HCV. This trend is expected to continue for another 2 to 3 decades. Survival is poor once complications of cirrhosis, such as liver failure or hepatocellular carcinoma, ensue, and liver transplantation is often the only option. Complications of chronic HCV are the most common indication for liver transplantation, accounting for more than 40% of transplants performed in the United States and Europe. HCV recurs in all patients and rapid development of hepatic fibrosis is very common. Several strategies have been proposed to reduce the risk of graft loss from recurrent HCV infection after transplantation, as the progression of the resulting liver disease is rapid. Although antiviral treatment is successful in some patients, it is extremely difficult to administer and requires dose reductions in the majority of cases. Retransplantation in the current era of the Model for End-Stage Liver Disease (MELD) system for prioritizing listing for transplant is associated with very low survival rates at a high cost. Furthermore, the system raises difficult ethical issues of utilization of limited resources and fairness to other transplant candidates. [Rev Gastroenterol Disord. 2004;4(1):7-17]
Management of Chronic Constipation Management Update
Constipation is a common problem in the United States. Although most individuals do not seek health care for its symptoms, there are still more than 2 million visits to physicians annually for treatment. In this article, the author presents an overview of current diagnostic tools and treatment options for chronic constipation. [Rev Gastroenterol Disord. 2004;4(1):18-24]
Therapeutic Equivalence of Mesalamine Products Drug Review
No bioequivalence studies have been conducted for mesalamine because of differences in formulation. Based on U.S. Food and Drug Administration definitions for bioequivalence, none of these drugs can be classified as bioequivalent or therapeutically equivalent. No adequate comparative trials have been conducted with equivalent mesalamine doses to determine if any of the current formulations are superior in the treatment of ulcerative colitis. All of these mesalamine formulations are effective, but they differ with regard to where the drug is released in the intestinal tract, which may influence the outcome in some patients. Therefore, the selection of a mesalamine agent should be based on the results of the clinical trials, individual patient response, compliance issues, and price, until comparative clinical trials are published. [Rev Gastroenterol Disord. 2004;4(1):25-28]
Report from the ACG Highlights from the 68th Annual Scientific Meeting of the American College of Gastroenterology
Advances in Liver Disease Highlights from the 54th Annual Meeting of the American Association for the Study of Liver Diseases