In the late 2000s, we witnessed revolutionary discoveries and advances in our understanding and management of chronic hepatitis C. Who knew that when IL-28B was first described in 2009, providing a genetic basis for patients’ response to interferon-based therapies, its impact would also be so swiftly supplanted by the introduction of direct acting antivirals a few years later? The pipeline for HCV treatment was feverish for several years, which resulted in a complete transformation of HCV treatment from a long, exhausting, side-effect filled course to a simple 8-to-12-week regimen. Furthermore, we now have established protocols for organ transplantation for patients without active HCV infection to receive HCV-positive organs due to the effectiveness of treatments for HCV. This kind of progress in our field demonstrates how awe-inspiring medical advances can be and how fortunate we are to have witnessed and lived this progress in such a short period of time.
Dr. Janice H. Jou
In recent years, non-alcoholic fatty liver disease (NAFLD) has supplanted HCV as the most prevalent chronic liver disease seen in GI and hepatology practices across the country.
The sheer number of these patients can be overwhelming for any practice, whether a GI practice or primary care. It has become clear that we have an urgent need for improved and easily accessible non-invasive methods to risk stratify NAFLD to identify patients at most risk for developing advanced fibrosis, decompensated cirrhosis, and hepatocellular carcinoma. Furthermore, effective strategies for prevention of these adverse outcomes in the general population still need to be further characterized. For treatment of non-alcoholic steatohepatitis, therapeutic agents being studied for their efficacy are wide ranging with particular interest in weight loss medications, diabetic medications, and anti-inflammatory medications. Yet, we can all see that there are sizeable gaps in our understanding and management of patients with NAFLD. However, rather than being intimidated, we should look forward to the progress that will surely come in the next 15 years.
Dr. Jou is associate professor of medicine, division of gastroenterology and hepatology, School of Medicine Fellowship program director, Medicine, Division of Gastroenterology and Hepatology, School of Medicine, Oregon Health and Science University, Portland. She reported no relevant financial conflicts of interest.
