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Volume 4, No 3 - Summer 2004

Volume 4, No 3 - Summer 2004

Table of Contents

Retreatment of Chronic Hepatitis C Virus Infection State of the Art Review
Despite advances in antiviral therapy for chronic hepatitis C, approximately half of patients undergoing initial treatment fail to achieve a sustained virologic response (SVR), thus prompting consideration of retreatment with alternative regimens. The decision to re-treat should be based on the severity of liver disease, as well as the presence of clinical and virologic predictors of a successful outcome of additional therapy. Retreatment of patients who were prior nonresponders to interferon monotherapy with interferon plus ribavirin results in SVR rates of 13% to 15%, which can be increased to 25% to 40% if peginterferon plus ribavirin is used. Retreatment of patients who were prior nonresponders to interferon plus ribavirin with peginterferon plus ribavirin unfortunately achieves SVR rates of approximately 10%. The growing number of patients who have been treated and have failed initial therapy highlights the need for the development of more efficacious antiviral agents for the treatment of chronic hepatitis C. [Rev Gastroenterol Disord. 2004;4(3):97-103]
Controversies With Aminosalicylates in Inflammatory Bowel Disease Treatment Update
Aminosalicylates have been shown to exhibit a wide range of anti-inflammatory and immunomodulatory properties. Since the discovery of sulfasalazine’s efficacy in ulcerative colitis and the subsequent development of sulfa-free mesalamine delivery systems, aminosalicylates have evolved to become an integral part of our therapeutic armamentarium and are now first-line therapies for the treatment of mildly to moderately active inflammatory bowel disease and for maintenance of remissions after successful induction therapy. Despite the substantial body of evidence supporting the use of aminosalicylates in ulcerative colitis and Crohn’s disease, gaps in our evidence base and controversies surrounding aminosalicylates’ clinical application have emerged. In this review, issues of dose response and optimization of the treatment regimen in ulcerative colitis, the discrimination between oral mesalamine formulations in left-sided colitis, and their efficacy in active and quiescent Crohn’s disease are discussed. [Rev Gastroenterol Disord. 2004;4(3):104-117]
Endpoints for The Assessment of Response to Gastroesophageal Reflux Disease Therapy- What Are The Appropriate Measures of Treatment Review
Therapeutic efficacy for gastroesophageal reflux disease (GERD) has been justified by a variety of different endpoints. Across the surgical, endoscopic, and pharmacologic treatment interventions, an attempt has been made to justify the “success” of the effect by objective and subjective means. This has included objective measures of esophageal sphincter pressure, intraesophageal acid exposure, and endoscopic esophagitis. More subjective measures have included symptom response as determined by questionnaires, severity scales, physician assessment, and quality-of-life impact. Despite the innumerable studies reporting various treatment interventions for GERD, overall there is a general lack of a standardized methodology to allow comparison of the relative success achieved among various methodologies. Furthermore, there is a striking lack of use of validated instruments to accurately assess treatment effect in many of these studies. This review focuses on the questions that should be raised by clinicians in their evidence-based evaluation of the outcomes achieved in these GERD intervention trials. [Rev Gastroenterol Disord. 2004;4(3):118-128]