Información del artículo
Resumen
En el pasado congreso de la American Gastroenterological Association se han presentado novedades de interés en el tratamiento de la hepatitis C, especialmente relacionadas con el esperanzador incremento de la eficacia terapéutica de la combinación del tratamiento convencional con telaprevir, inhibidor selectivo de la proteasa viral. También se puso de manifiesto la influencia de la replicación viral del virus B en el desarrollo de complicaciones, especialmente el desarrollo de hepatocarcinoma. En este sentido, parece que fármacos como entecavir y tenofovir son capaces de proporcionar inhibiciones sostenidas de la replicación viral sin desarrollo de resistencias. En el campo de las complicaciones de la cirrosis se ha evidenciado la creciente influencia pronóstica de las infecciones bacterianas, asociadas a un incremento del riesgo de muerte. Asimismo, diversas comunicaciones han profundizado en el papel de la elastografía hepática tanto en la evaluación de la fibrosis hepática como en el seguimiento de la respuesta al tratamiento y en el trasplante hepático. La importancia de la enfermedad hepática por depósito de grasa ha quedado claramente reflejada en diversos estudios que confirman la influencia de la diabetes en la inflamación y la fibrosis y el incremento en la indicación de trasplante hepático por esta enfermedad, que por otra parte puede recidivar en el injerto, especialmente en pacientes con mayor elevación del índice de masa corporal. En relación con el hepatocarcinoma, un metaanálisis y un modelo de decisión no fueron capaces de detectar diferencias en la supervivencia de los pacientes con tumores pequeños tratados con radiofrecuencia o cirugía.
Palabras clave:
Hepatitis C
Hepatitis B
Carcinoma hepatocelular
Elastografía de transición
Hígado graso no alcohólico
Insuficiencia hepática aguda
Infecciones bacterianas en la cirrosis
Abstract
In Digestive Disease Week 2008, interesting advances in the treatment of hepatitis C were presented, especially related to the promising increase in the therapeutic efficacy of the combination of conventional treatment with the protease inhibitor, telaprevir. Also revealed was the influence of viral replication of hepatitis B virus in the development of complications, including hepatocarcinoma. In this sense, drugs such as entecavir and tenofovir seem to provide sustained inhibition of viral replication without the development of resistance.
Among the complications of cirrhosis, the growing prognostic implications of bacterial infections, associated with an increased risk of death, have been demonstrated. Likewise, diverse studies have provided greater understanding of the role of elastography in the evaluation of liver fibrosis, including the role of this technique in the evaluation of treatment response and in liver transplantation. The importance of fatty acid liver disease was clearly shown in several studies confirming the influence of diabetes in the presence of inflammation and fibrosis and the increase in the indication of liver transplantation for this disease, which may recur in the graft, especially in patients with a high body mass index. A meta-analysis of hepatocarcinoma and a decision model were unable to detect differences in survival in small tumors treated with radiofrequency or surgery.
Key words:
Hepatitis C
hepatitis B
hepatocellular carcinoma
transient elastography
non-alcoholic fatty liver
acute liver failure
bacterial infections in cirrhosis
El Texto completo está disponible en PDF
Bibliografía
[1.]
M. Manns, D. Hueppe, P. Marotta, S. Mauss, E. Zehter, I. Jacobson, et al.
Sustained virologic response and relapse rates with Peg interferon alfa 2b plus ribavirin in clinical trials are comparable to those in community-based studies.
Gastroenterology, 134 (2008), pp. A830
[2.]
M. Rodríguez-Torres, L. Jeffers, M. Sheikh, L. Rossaro, V. Ankoma-Sey, P. Martin.
Virologic response to peg-ifn 2a/rivabirin in treatment naive latino vs no latino caucasians infected with genotype 1: the latino study.
Gastroenterology, 134 (2008), pp. A755
[3.]
S. Yu, J. Douglass, C. Qualls, S. Arora, J. Dunkelberg.
Response to therapy with pegylated interferon and ribavirin in hispanics with hepatitis C compared to non hispanic whites.
Gastroenterology, 134 (2008), pp. A772
[4.]
Castro J, Vicente C, Quintanilla E, Moran M, Collado D, Guerra I, et al. Are non invasive biochemical markers useful in the asessment liver fibrosis in patients with chronic hepatitis C? Gastroenterology. 2088;134:A797.
[5.]
T. Poynard, E. Schiff, R. Terg, R. Moreno-Otero, S. Flamm, W. Schimidt, et al.
Results from Epic-3 program: platelets counts are strong predictors of sustained viral response (SVR) in the re-treatment of previous interferon/ ribavirin non responders.
Gastroenterology, 134 (2008), pp. A772
[6.]
P. Marcellin, B. Freilich, P. Andreone, A. Di Bisceglie, C. Brandao-Mello.
HCV-RNA status at week 12 of treatment with peginterferon alfa 2a / rbv predicts SVR in patients with prior non response to pegylated interferon alfa 2b /RBV: results from repeat study.
Gastroenterology, 134 (2008), pp. A788
[7.]
N. Afdhal, J. McHutchinson, F. Cambell, J. Bussel, G. Cheng, N. Blackman, et al.
Effects of eltrombopag levels during antiviral therapy in HCV patients with cirrhosis.
Gastroenterology, 134 (2008), pp. 833
[8.]
J.G. McHutchison, G. Dusheiko, M.L. Shiffman, M. Rodriguez-Torres, S. Sigal, M. Bourliere, et al.
Eltrombopag for thrombocytopenia in patients with cirrhosis associated with hepatitis C.
N Engl J Med, 357 (2007), pp. 2227-2236
[9.]
A. Neumann, L. Rozember, V. Bain, J. McHutchinson, E. Pulkstenis, M. Subramanian.
Viral kinetics and pharmacodynamics of albinterferon alfa 2b in interferon treatment naive patients with genotype 1 chronic hepatitis C.
Gastroenterology, 134 (2008), pp. A788
[10.]
S. Pianko, E. Cosida, S. Zeuzem, Y. Benhamou, V. Bain, E. Pulkstenis, et al.
Health-related quality of life with albinterferon plus ribavirin in IFN treatment naive patients with genotype 1 chronic hepatitis C.
Gastroenterology, 134 (2008), pp. A787
[11.]
G. Everson, I. Jacobson, S. Gordon, J. McHutchinson, R. Kaufman, L. McNair, et al.
Prove 1: results from a phase 2 study of telaprevir with Peg-IFN and ribavirin in treatment naive subjets with hepatitis C.
Gastroenterology, 134 (2008), pp. A758
[12.]
C. Hezode, P. Ferenci, G. Dusheiko, A. Tran, J. Grange, P. Mathurin, et al.
Prove 2 study: treatment of chronic hepatitis C with telaprevir in combination with peginterferon alfa 2a with or without ribavirin. Interim analysis results.
Gastroenterology, 134 (2008), pp. A755
[13.]
E. Schiff, F. Poordad, I. Jacobson, S. Flamm, B. Bacon, E. Lawitz, et al.
Role of interferon response during retreatment of null responders with boceprevir combination therapy: results of phase II trial.
Gastroenterology, 134 (2008), pp. A755
[14.]
C. Hezode, L. Castéra, I. Rosa, D. Roulot, V. Leroy, V. Dhalluin-Venier, et al.
Dynamics of liver stiffnes during peginterferon alpha-Ribavirin treatment in patients with chronic hepatitis C.
Gastroenterology, 134 (2008), pp. A774
[15.]
J. Chen, H. Yang, U. Iloeje, S. You, S. Lu, L. Wang, et al.
Liver disease progresión in chronic hepatitis B infected persons with normal alanine aminotrasferase level: update from R.E.V.E.A.L. study.
Gastroenterology, 134 (2008), pp. A50
[16.]
K. Hu, E. Schiff, K. Kowdley, A. Min, M. Schiffman, W. Lee, et al.
Histologic evidence of active liver injury in HBeAg negative chronic hepatitis B patients with normal o minimally elevated alanine transaminase.
Gastroenterology, 134 (2008), pp. A813
[17.]
P. Tsang, R. Garcia, H. Trinh, J. Phan, N. Ha, H. Nguyen, et al.
Significant prevalence of histologic disease in chronic hepatitis B patients with midly elevated serum alanine aminotrasferase levels.
Gastroenterology, 134 (2008), pp. A312
[18.]
B. Degertekin, M. Hussain, K. Oberhelman, R. Fontana, J. Marrero, H. Conjeevaram, et al.
Detection of entecavir resistant mutations in nucleoside naive and in lamivudine refractory HBV patients and implications on response to entecavir treatment.
Gastroenterology, 134 (2008), pp. A807
[19.]
C. O’Brien, J. Jia, G. Zeldin.
Chronic hepatitis B genotype B or C E antigen positive patients; viral supresión, HBe loss and seroconversion rates are improved with telbivudine compared with lamivudine: results from pooled analysis.
Gastroenterology, 134 (2008), pp. A760
[20.]
P. Piccolo, L. De Melia, F. Bandiera, M. Piras, G. Antonucci, L. Nosoti, et al.
Peginterferon alfa 2a plus adefovir dipivoxil vs PEG IFN monotherapy for 48 weeks in HBeAg negative chronic hepatitis B: Final results of the PEG for B randomized multicenter trial.
Gastroenterology, 134 (2008), pp. A760
[21.]
J. Heathcote, J. George, S. Gordon, J. Bronowicki, J. Sperl, R. Williams, et al.
Tenofovir disoproxil fumarate for the treatment of HBe-Ag positive chronic hepatitis B: week 72 data and week 24 adefovir dipivoxil switch data (study 103).
Gastroenterology, 134 (2008), pp. A760
[22.]
P. Marcellin, I. Jacobson, N. Tsai, N. Bzowej, F. Habersetzer, H. Senturk, et al.
Tenofovir disoproxil fumarate for the treatment of HBe ag negative chronic hepatitis B: week 72 TDF data and week 24 adefovir dipivoxil switch data.
Gastroenterology, 134 (2008), pp. A808
[23.]
C. Wang, M. Buti, S. Hadziyannis, P. Mathurin, M. Sherman, S. Strasser, et al.
Tenofovir disoproxil fumarate is highly active for treatment of chronic hepatitis B in subjects with cirrhosis.
Gastroenterology, 134 (2008), pp. A808-A809
[24.]
F. Van Bommel, R. De Man, K. Stein, D. Huppe, C. Sarrazin, J. Trojan, et al.
A multicenter analysis of antiviral response alter one year of tenofovir monotherapy in HBV monoinfected patients with prior núcleos(t) ide analog experience.
Gastroenterology, 134 (2008), pp. A51
[25.]
T. Berg, B. Moeller, H. Trinh, S. Chan, P. Marcellin, E. Suarez, et al.
Tenofovir disoproxil fumarate vs emtricitabine plus TDF for treatment of chronic hepatitis B in subjects with persistent viral replication receiving adefovir dipivoxil.
Gastroenterology, 134 (2008), pp. A811
[26.]
N. Suraj, B. Gannavarapu, H. Maddur, et al.
Emergence of sepsis as the leading cause of mortality in cirrhotics.
Gastroenterology, 134 (2008), pp. A752
[27.]
S. Saab, J. Hernandez, A. Chi, M. Tong.
Spontaneous bacterial peritonities prophylaxis improves morbidity and mortality: a metaanalysis.
Gastroenterology, 134 (2008), pp. A751
[28.]
H. Maddur, S. Naik, A. Siddiqui, D. Rockey.
Adherence and adequacy of therapy in esophageal varices prophylaxis.
Gastroenterology, 134 (2008), pp. A789
[29.]
T. Hassanein, D. Oliver, F. Barakat, M. Carlson, J. Stange, E. Alpert, et al.
Extent of recovery of neurocognitive dysfunction in patients presenting with severe hepatic encephalopathy.
Gastroenterology, 134 (2008), pp. A759
[30.]
T.I. Hassanein, F. Tofteng, R.S. Brown Jr, B. McGuire, P. Lynch, R. Mehta, et al.
Randomized controlled study of extracorporeal albumin dialysis for hepatic encephalopathy in advanced cirrhosis.
Hepatology, 46 (2007), pp. 1853-1862
[31.]
L. Castéra, J. Vergniol, J. Foucher, B. Le Bail, E. Chanteloup, M. Haaser, et al.
Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C.
Gastroenterology, 128 (2005), pp. 343-350
[32.]
M. Friedrich-Rust, M. Ong, S. Martens, C. Sarrazin, J. Bojunga, S. Zeuzem, et al.
Performance of transient elastography for the staging of liver fibrosis: a meta-analysis.
Gastroenterology, 134 (2008), pp. 960-974
[33.]
J. Talwalkar, J. Gross, S. Venkatesh, M. Yin, J. Glockner, N. Takahashi, et al.
AST/ALT, APRI, and magnetic resonance elastography for detection of advanced fibrosis in clinical practice.
Gastroenterology, 134 (2008), pp. A796
[34.]
M. Jatoi, F. Walker, V. Jeevanantham, A. Silva, E. Carey, J. Rakela, et al.
Role of magnetic resonance elastography to assess hepatic fibrosis.
Gastroenterology, 134 (2008), pp. A828
[35.]
C. Hezode, L. Castéra, I. Rosa, D. Roulot, V. Leroy, M. Bouvier-Alias, et al.
Dynamics of liver stiffness during peginterferon alpharibavirin treatment in patients with chronic hepatitis C.
Gastroenterology, 134 (2008), pp. A774
[36.]
M. Kanamoto, M. Shimada, T. Ikegami, S. Imura, Y. Morine, T. Ikemoto, et al.
Real-time elastography for noninvasive diagnosis of liver fibrosis.
Gastroenterology, 134 (2008), pp. A828
[37.]
M. Friedrich-Rust, M. Ong, E. Herrmann, V. Dries, P. Samaras, S. Zeuzem, et al.
Real-time elastography for noninvasive assessment of liver fibrosis in chronic viral hepatitis.
AJR Am J Roentgenol, 188 (2007), pp. 758-764
[38.]
G. Lalazar, O. Pappo, R. Safadi, Y. Ashur, B. Mullhaupt, O. Goetze, et al.
The 13C methacetin breath test accurately identifies liver fibrosis in patients with chronic hepatitis C virus infection: a validation study.
Gastroenterology, 134 (2008), pp. A765
[39.]
N. Rafiq, B. Chunhong, Y. Fang, M. Srishord, A. McCullough, Z. Younossi.
Over twenty five years of follow-up for a non-alcoholic fatty liver disease (NAFLD) cohort.
Gastroenterology, 134 (2008), pp. A754
[40.]
Y. Lee, D. Jensen, H. Te, N. Reau, K. Reddy, R. Satoskar, et al.
Clinical and liver histological differences in patients with nonalcoholic fatty liver disease (NAFLD) with and without diabetes mellitus (DM).
Gastroenterology, 134 (2008), pp. A782
[41.]
M. Ahmad, K. Witztum, J. Fletcher, L. Hendershott, D. Klos, E. George, et al.
Xenon-133 accumulation in hepatic steatosis.
J Nucl Med, 18 (1977), pp. 881-885
[42.]
S. Al-Busafi, M. Ghali, P. Wong, M. Deschenes.
Utility of xenon-133 liver scan in the diagnosis and management of non-alcoholic fatty liver disease (NAFLD).
Gastroenterology, 134 (2008), pp. A783
[43.]
F. Rzouq, R. Mummadi, G. Sood.
Use of statins in patients with hyperlipidemia and abnormal liver enzymes. Survey of prescribing practice among primary care physicians.
Gastroenterology, 134 (2008), pp. A782
[44.]
N. Chalasani.
Statins and hepatotoxicity: focus on patients with fatty liver.
Hepatology, 41 (2005), pp. 690-695
[45.]
R. Vuppalanchi, N. Chalasani.
Statins for hyperlipidemia in patients with chronic liver disease: are they safe?.
Clin Gastroenterol Hepatol, 4 (2006), pp. 838-839
[46.]
Tn. Davern, L. James, J. Hinson, J. Polson, A. Larson, R. Fontana, et al.
Acute Liver Failure Study Group. Measurement of serum acetaminophen-protein adducts in patients with acute liver failure.
Gastroenterology, 130 (2006), pp. 687-694
[47.]
N. Khandelwal, L. James, P. Simpson, et al.
Identifying acetaminophen (APAP) toxicity amongst indeterminate cause of acute liver failure (ALF).
Gastroenterology, 134 (2008), pp. A752
[48.]
K. Jinjuvadia, R. Taylor, R. Fontana, T. Davern, O. Shaikh, S.B. Han, et al.
A prospective study of acute liver failure due to hepatic ischemia: clinical features and outcomes.
Gastroenterology, 134 (2008), pp. A759
[49.]
A. Kim, D. Tran, H. SB, S. Raman, P. Zimmermann, P. Sullivan, et al.
Accuracy of abdominal imaging in diagnosis submassive hepatic necrosis in acute liver failure versus cirrhosis.
Gastroenterology, 134 (2008), pp. A799
[50.]
G. Cote, J. Gottstein, A. Blei.
Hyperamylasemia in acute liver failure: analysis of data from acute liver failure study group.
Gastroenterology, 134 (2008), pp. A799
[51.]
J. Bruix, M. Sherman.
Management of hepatocellular carcinoma.
Hepatology, 42 (2005), pp. 1208-1236
[52.]
J. Davila, R. Morgan, X. Du, P. Richardson, K. McGlynn, H. El-Serag.
Utilization of screening for hepatocellular carcinoma in the United States.
Gastroenterology, 134 (2008), pp. A769
[53.]
A. Cooper, M. Maluccio.
A decision analysis model of hepatectomy vs. radiofrequency ablation for hepatocellular carcinoma.
Gastroenterology, 134 (2008), pp. A868
[54.]
S. Jaganmohan, S. Agarwal, K. Kasturi, G. Sood.
Surgical resection versus percutaneous radiofrequency ablation in treatment of hepatocellular carcinoma: A meta analysis.
Gastroenterology, 134 (2008), pp. A47
[55.]
C. Chen, H. Yang, J. Su, C. Jen, S. You, C. Chen, et al.
Serial monitoring of viral load and serum alanine aminotransferase level and the risk of hepatocellular carcinoma. R.E.V.E.A.L-HBV study update.
Gastroenterology, 134 (2008), pp. A758
[56.]
L. Shapiro, M. Lee, J. Lee, P. Myer, A. Kamal, A. Ahmed.
Dobutamine stress echocardiography is a poor predictor of coronary artery disease in patients undergoing liver transplant evaluation.
Gastroenterology, 134 (2008), pp. A766
[57.]
M. Berenguer, J. Crippin, R. Gish, N. Bass, A. Bostrom, G. Netto, et al.
A model to predict severe HCV-related disease following liver transplantation.
Hepatology, 38 (2003), pp. 34-41
[58.]
A. Retana, J. Wong.
Pre-transplant antiviral treatment of hepatitis C with decompensated cirrhosis: A systematic review of risks and benefits.
Gastroenterology, 134 (2008), pp. A774
[59.]
I. Hanouneh, N. Zein, R. Lopez, L. Yerian, J. Fung, B. Eghtesad.
IL-2 receptor antagonist (Il2-RA), basiliximab, is associated to rapid fibrosis progression in patients with recurrent hepatitis C afer liver transplantation using serial biopsy specimens.
Gastroenterology, 134 (2008), pp. A765
[60.]
M. Berenguer, M. Prieto, J.M. Rayon, J. Mora, M. Pastor, V. Ortiz, et al.
Natural history of clinically compensated hepatitis C virus-related graft cirrhosis after liver transplantation.
Hepatology, 32 (2000), pp. 852-858
[61.]
V. Clark, R. Firpi, C. Soldevila-Pico, G. Morelli, C. Levy, R. Cabrera, et al.
MELD score predicts 3-month mortality in hepatitis C liver transplant patients with recurrent graft cirrhosis.
Gastroenterology, 134 (2008), pp. A802
[62.]
A. Blasco, X. Forns, J.A. Carrion, J.C. Garcia-Pagan, R. Gilabert, A. Rimola, et al.
Hepatic venous pressure gradient identifies patients at risk of severe hepatitis C recurrence after liver transplantation.
Hepatology, 43 (2006), pp. 492-499
[63.]
J.A. Carrion, M. Navasa, J. Bosch, M. Bruguera, R. Gilabert, X. Forns.
Transient elastography for diagnosis of advanced fibrosis and portal hypertension in patients with hepatitis C recurrence after liver transplantation.
Liver Transplant, 12 (2006), pp. 1791-1798
[64.]
J. Marin-Gabriel, J. De la Cruz, M. Tocado, Y. Rodriguez-Gil, A. Martín-Algibez, I. Fernandez-Vazquez, et al.
Transient elastography in hepatitis C native liver vs. liver transplant recipients with recurrence: diagnostic performance and predictor of advanced fibrosis.
Gastroenterology, 134 (2008),
[65.]
A. McCullough.
The clinical features, diagnosis and natural history of nonalcoholic fatty liver disease.
Clin Liver Dis, 8 (2004), pp. 521-533
[66.]
K. Yalamanchili, S. Saadeh, D. Rockey.
Nonalcoholic fatty liver disease (NAFLD) occurring post-transplant – risk factors and outcome.
Gastroenterology, 134 (2008), pp. A765-A766
[67.]
P. Mathurin.
Corticosteroids for alcoholic hepatitis –what's next?.
J Hepatol, 43 (2005), pp. 526-533
[68.]
H. Tilg, A. Diehl.
Cytokines in alcoholic and nonalcoholic steatohepatitis.
N Engl J Med, 343 (2000), pp. 1467-1476
[69.]
N. Boetticher, C. Peine, P. Kwo, G. Abrams, T. Patel, B. Aqel, et al.
Randomized, double-blinded, placebo controlled multi-center trial of etanercept in the treatment of alcoholic hepatitis.
Gastroenterology, 134 (2008), pp. A765
Copyright © 2008. Elsevier España S.L.. Todos los derechos reservados
