gastroendonews.com
The Independent Monthly Newspaper for Gastroenterologists
Volume 65, Number 2 • February 2014
HEPATOLOGY
I N
F O C U S
HCV Antivirals Race to Market BY KATE O’ROURKE BOSTON—Over the next five years, a whirlwind of new direct-acting antiviral agents (DAA) for hepatitis C are expected to get the green light from the FDA. The recent approval of simeprevir (Olysio, Janssen) and sofosbuvir (Sovaldi, Gilead)–containing regimens is only the tip of the iceberg. see DAAs, page 13
IFN/RBV-Free Combo for HCV BY KATE O’ROURKE WASHINGTON— —The combination of daclatasvir plus asunaprevir, both manufactured by Bristol-Myers Squibb (BMS), looks poised to gain approval in Japan for treating patients with hepatitis C virus (HCV) genotype 1b infection. Experts speculate that BMS will seek approval in the United States for this drug combination at a later date, but with the addition of a see IFN/Ribavirin-Free, page 20
Lacking Data, Physicians Attempt To Manage Non-Celiac Gluten Sensitivity BY TED BOSWORTH BERLIN—After ruling out a diagnosis of celiac disease, the evidence base for managing patients with gluten sensitivity is limited. A diagnosis of nonceliac gluten sensitivity (NCGS) is based on the observation of symptom relief associated with a gluten-free diet, a step that many patients with gluten sensitivity have already taken. Physicians who are asked to confirm and manage a diagnosis of NCGS, which is rising in prevalence, may be better guided by common sense than any available data. “There does appear to be a growing number of individuals who believe themselves to be gluten sensitive, but we are missing the data to tell us whether all of these patients need to be on a lifetime gluten-free diet,” reported David S. Sanders, MD, of Royal Hallamshire Hospital, University of Sheffield, United Kingdom. Delivering a state-of-the-art lecture on the subject at the 2013 United European Gastroenterology Week (UEGW) meeting, Dr. Sanders attempted to sort through the trends in NCGS and what it all means for physicians and their patients.
NCGS or Celiac Disease? NCGS is remarkably common. In a populationbased survey presented at the UEGW meeting by Imran Aziz, MD, also of Royal Hallamshire Hospital, the self-reported prevalence of gluten sensitivity was 13%. Of 1,002 individuals who were surveyed at a shopping mall, 3.7% said they were following a gluten-free diet but only 0.8% reported a diagnosis of celiac disease. This latter figure is consistent with National Heath and Nutrition Examination Survey see Gluten, page 26
I N S I D E
Surgeon Pits PPIs Against Anti-Reflux Surgery
HEPATOLOGY
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FOCUS
EXPERTS’ PICKS EXPERT Best of The Liver Meeting 2013..................................... page 10
BY MONICA J. SMITH BALTIMORE—Tasked with creating a lecture for the American Society of Gastrointestinal and Endoscopic Surgeons (SAGES) to fit the title, “PPIs Are Just as Good as Anti-reflux Surgery for GERD,” Christy M. Dunst, MD, needed to set aside her prosurgery bias. “It was a good opportunity to really review the literature with an
Kris Kowdley, MD
Suthat Liangpunsakul, MD, MPH
Raj Vuppalanchi, MD
see GERD Surgery, page 28 PRINTER-FRIENDLY VERSION AVAILABLE AT GASTROENDONEWS.COM
CLINICAL REVIEW
First-Line Treatment Strategies for
Helicobacter pylori Infection RICHARD J. SAAD, MD, MS, AND WILLIAM D. CHEY, MD
see insert after page 46
First-Line Treatment Strategies for Helicobacter Pylorii Infection By Richard J. Saad, MD, MS, and William D. Chey, MD
Department of Internal Medicine Division of Gastroenterology University of Michigan Health System Ann Arbor, Michigan Dr. Saad has no relevant conflicts of interest. Dr. Chey has served as a consultant for AstraZeneca and Takeda Pharmaceuticals.
H
elicobacter pylori is a major cause of chronic gastritis and peptic ulcer disease (PUD); it is closely linked with gastric mucosa-associated lymphoid
tissue (MALT) lymphoma and gastric adenocarcinoma; and it is causally associated with unexplained iron-deficiency anemia, primary immune thrombocytopenia (formally termed idiopathic thrombocytopenic purpura), and vitamin B12 deficiency.
Given these known and potential complications of chronic H. pylorii infection, its identification mandates effective eradication (Table 1). Although it has been more than 3 decades since the discovery of H. pylori, no eradication therapy has been identified that guarantees a 100% cure rate. Moreover, there has been a tendency toward reduced efficacy of eradication regimens over time, largely because of the development of antibiotic resistance to H. pylori. In clinical practice, the initial course of eradication therapy generally offers the greatest likelihood for treatment success. Therefore, careful selection of firstline eradication therapy is essential. The most important factors to consider when choosing an initial course of eradication therapy are prior antibiotic exposure of the patient and, if available, the regional antibiotic-resistance profile of H. pylori.
G AST R O E N T E R O LO GY & E N D O S CO PY N E WS • F E B R UA RY 2 0 1 4
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