Steve Flamm, MD, of the Feinberg School of Medicine, Northwestern University talked to DDW TV about the key events in the AASLD program for DDW 2014. View the information below for additional information and videos of 2014 AASLD programming.
Moderators: John R. Lake, MD and Michael H. Nathanson, MD, PhD
This program aimed to improve patient care by increasing clinicians’ awareness of recent research that strengthens current clinical care protocols. Investigators discussed new discoveries that advance the field of hepatology. This program represented a unique opportunity for expert hepatologists to summarize clinical and basic research publications on topics that were highly relevant to the practice of hepatology and liver-based research.
The best abstracts in basic and clinical hepatology were presented at these highly focused sessions.
Alcoholic and nonalcoholic fatty liver disease together constitute the most common cause of liver disease in the Western world. The clinical presentation and liver histology in these two entities pose a clinical challenge to clinicians in diagnosing the etiology of fatty liver disease. Furthermore, it is not entirely clear when to subject an individual to a liver biopsy, and how to treat patients with alcoholic steatohepatitis (ASH) and nonalcoholic stetaohepatitis (NASH). Emerging data on the long-term outcomes and treatment modalities for ASH and NASH is refining the management paradigms in these conditions. Therefore, clinicians were advised on the differences and similarities in the clinical presentation and management of ASH and NASH.
This activity educated caregivers of patients with cirrhosis and liver cancer on the recently updated AASLD practice guidelines for HCC. It also gave the practitioners practical advice on how to utilize the guidelines to deliver optimal care to their patients with liver disease.
Patients with chronic liver disease or inflammatory bowel disease, and liver transplant recipients, often look to the gastroenterologist/hepatologist as the primary, often sole, provider of their medical care. This care includes wide-ranging issues such as diabetes, cardiovascular disease, hypertension, cancer screening, metabolic bone disease, assessment for surgical procedures and reproductive issues. This clinical symposium both educated the GI practitioner in non-GI issues in their long-term patients with regard to disease management and discussed when to refer them to a specialist.
Over the past 10 years, there have been great strides in liver-directed therapies. For example, safe and effective oral antiviral agents with a high barrier to resistance are widely used to treat patients with chronic hepatitis B. Similarly, a series of potent antiviral agents have recently been approved for patients with HCV and there is growing efficacy data regarding the use of medical, surgical and behavioral therapies for patients with NAFLD. However, there has not been a recent program summarizing the evidence on how these treatments can prevent cirrhosis or even lead to regression in cirrhosis, portal HTN, and the risk for liver cancer. This program highlighted clinical evidence for preventing fibrosis progression.
The purpose of this program was to update clinicians on the rapidly evolving field of hepatitis C therapeutics. The recently approved therapies were reviewed. The treatment of hepatitis C has undergone a rapid transformation in the past 3 years with the introduction of direct-acting antivirals (DAA) with and without interferon and ribavirin. In January, the first oral regimen for hepatitis C was introduced, and now therapy for genotype 1 hepatitis C may be shortened for 12 weeks. Clinicians were updated on current treatment guidelines as well as the latest phase 2 and phase 3 data in all hepatitis C populations including treatment naïve , non-responders and special populations. Key phase 3 data from EASL and AASLD was presented regarding hepatitis C therapy. Finally, participants discussed how off label use of available HCV agents, in addition to which patients should be treated now versus those who can safely be deferred and how to help patients decide whether to seek treatment now or defer therapy. Watch the wrap up of the 2014 session on DDW TV.
Recurrent Liver Disease Following Liver Transplantation
Recurrence of the primary liver disease following liver transplantation is one of the leading causes of graft loss and death following liver transplantation. The risk of recurrent disease varies based on the underlying diagnosis, with hepatitis C, hepatocellular carcinoma and NAFLD having higher rates of recurrence and autoimmune, alcoholic and cholestatic liver diseases having lower rates. Understanding the risk factors and treatment options for recurrent disease thus are of paramount importance for clinicians managing liver transplant recipients. This clinical symposium addressed the issues for recurrence of common liver diseases after liver transplantation.
Pediatric Liver Disease in the Era of Genomics
(co-sponsored with NASPGHAN)
This symposium was designed to increase awareness of the availability and implications of genetic testing for pediatric liver disease in the current era of NextGen sequencing and genomics. The goals were to familiarize the audience with the terminology and testing available and then discuss the applicability of these tests and data generated to pediatric liver disease now and in the future.
Speaker: Craig J. McClain, MD
- Identify the multiple components of the intestinal barrier.
- Recognize how diet can affect the gut barrier.
- Explain how gut-barrier dysfunction can cause fatty liver.
Speaker: Donald M. Jensen, MD (watch his interview with DDW TV)
- Associate the role and indication for newer antiviral agents in hepatitis C therapy.
- Discover how these new all-oral DAAs may influence the practice of medicine in HCV treatment.
Do We Still Need Liver Biopsy?
Speaker: Nezam H. Afdhal, MD
- Discuss the use, indications and limitations of liver biopsy.
- Utilize the new serological and imaging tests use for the staging of liver fibrosis.
- Develop an understanding of the needs and guidelines for the evaluation of liver fibrosis using a multimodality approach.
Speaker: Kymberly Watt, MD
- Review indications for liver transplantation.
- Associate the evolution of NASH and accompanying comorbidities leading up to liver transplantation.
- Examine risk factors and outcomes of patients transplanted with NASH in comparison to other indications.
- Develop post-transplant management plans specific to NASH patients.
Non-Variceal Complications of Cirrhosis
Speaker: Michael B. Fallon, MD
- Recognize the causes and diagnostic features of common non-variceal complications of cirrhosis.
- Define the natural history and impact of non-variceal complications of cirrhosis on outcomes in patients.
- Apply the current state of the art in prevention and therapy of non-variceal complications of cirrhosis.
Other AASLD Programming
The Research/Topic Fora presented opportunities for presentation of original research and exchange of ideas and data. Topics included Autoimmune/Cholestatic Liver Disease, Cell and Molecular Biology, Hepatitis B and C, Liver Transplantation, NASH/ASH and Viral Hepatitis.
AASLD General Learning Objectives
The AASLD’s general goals and objectives were to:
- Provide a forum for the exchange of new scientific and clinical information relevant to the study of liver disease.
- Create an arena for the interchange of opinions regarding the care and management of all types of liver diseases.
- Assess new diagnostic or therapeutic techniques related to liver disease.