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1.
Opinion statement
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| – | All patients who test positive for hepatitis B virus (HBV) surface antigen (HBsAg) should be evaluated to determine the activity and severity of the infection. Assessment includes tests of disease activity (aspartate transaminase, alanine aminotransferase), tests of liver function (bilirubin, albumin, prothrombin time), and tests of replication status (hepatitis B early antigen [HBeAg], antibody to HBe, HBV DNA titer, and hepatitis D virus antibody). An ultrasound is recommended to assess for signs of cirrhosis and to exclude focal lesions in the liver. |
| – | In patients with abnormal liver enzyme levels (aspartate aminotransferase, alanine aminotransferase), a liver biopsy is recommended to assess the stage of disease (amount of fibrosis) and to determine the urgency and need for antiviral therapy. |
| – | Interferon alfa and lamivudine are the two antiviral therapies currently available. There are pros and cons associated with the use of either drug. Individualization of therapy, based upon factors such as patient comorbidities, response to prior therapies, and stage of disease, is recommended. |
| – | Patients with abnormal liver enzyme levels, indices of active viral replication (positive HBV DNA, with or without positive HBeAg), and compensated liver disease are candidates for treatment with interferon or lamivudine. |
| – | For patients with abnormal liver enzyme levels, indices of active viral replication (positive HBV DNA, with or without positive HBeAg), and decompensated liver disease, the treatment of choice is lamivudine. Concurrently, these patients should be considered for liver transplantation referral. |
| – | There are a number of new antiviral agents currently under evaluation in clinical trials. Combination therapy for chronic HBV infection is anticipated. The use of two or more anti-HBV drugs can be expected to enhance efficacy and reduce the likelihood of drug resistance. |
2.
Opinion statement
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| – | Treatment of hepatic cysts should be considered only for those patients who are symptomatic. |
| – | For simple cysts, percutaneous aspiration invariably leads to recurrence; laparoscopic deroofing is usually curative. |
| – | Open deroofing (fenestration) should be reserved for cysts inaccessible by laparoscopy. |
| – | Percutaneous instillation of sclerosing agents (ethanol, iophendylate, minocycline) into nonbiliary and nonparasitic cysts is an alternative therapeutic option in certain cases. |
| – | Due to increased morbidity, hepatic resection should be reserved for polycystic liver disease, diffuse hepatic involvement, or recurrence after a deroofing procedure. |
| – | Patients with congenital fibropolycystic disorders (eg, congenital hepatic fibrosis) with evidence of hepatic decompensation, should be considered for liver transplantation. |
| – | For hepatic hydatid cysts, simple cystectomy or the PAIR (puncture, aspirate, inject, and reaspirate) technique with albendazole treatment have been shown to be equally successful. |
| – | In the case of alveolar echinococcosis, hepatic resection and liver transplantation are the only effective modalities for localized and extensive hepatic disease, respectively. |
3.
Opinion Statement
相似文献
| – | Early diagnosis permits preventive therapy to preempt development of organ damage. |
| – | In all diagnosed patients, both symptomatic and asymptomatic, pharmacologic therapy is lifelong, and maintenance treatment to prevent copper toxicity is mandatory. |
| – | Patients with either fulminant hepatic failure or hepatic insufficiency unresponsive to medical therapy should be considered for orthotopic liver transplantation, which effectively cures Wilson’s disease. |
| – | Prognosis is excellent for compliant patients receiving pharmacologic therapy. |
4.
Buchman AL 《Current Treatment Options in Gastroenterology》2002,5(3):173-180
Opinion statement
相似文献
| – | An oral calcium supplement (1000 mg/day) is recommended. |
| – | Regular exercise should be performed. |
| – | Ethanol intake should be moderate. |
| – | Protein intake should be moderate. |
| – | The patient’s vitamin D status should be determined and corrected with an oral supplement when deficiency is present. |
| – | Baseline and yearly bone density measurement should be taken. |
| – | Alendronate, 10 mg/d orally, or risedronate, 5 mg/d orally, should be given to patients with osteopenia. |
| – | Use of corticosteroids, cyclosporin, tacrolimus, and methotrexate should be limited to the short term when possible. |
| – | Estrogen replacement therapy is recommended in postmenopausal women unless contraindications exist. |
5.
Shabetai R 《Current treatment options in cardiovascular medicine》2000,2(5):385-397
Opinion statement
相似文献
| – | The treatment of sarcoid cardiomyopathy can be considered in part the treatment of the systemic disorder, and in part cardiac involvement, the manifestations of which may differ greatly. Therapy for the systemic disease is corticosteroid. Therapy for cardiac involvement includes prednisone, but because treatment must ameliorate or abolish many differing manifestations, therapy differs among patients. |
| – | Asymptomatic patients (the majority) who are free from serious manifestations of the disease do not require pharmacologic or interventional treatment. |
| – | Patients with dilated cardiomyopathy require treatment for congestive heart failure. |
| – | High-grade atrioventricular conduction delay usually necessitates a permanent electronic pacemaker. |
| – | Life-threatening arrhythmia usually requires implantation of an automatic implantable cardiac defibrillator (AICD). Antiarrhythmic drugs may also be needed. |
| – | Cardiac tamponade should be treated by drainage of pericardial fluid. |
| – | Pericardiectomy is usually the appropriate treatment for patients who develop significant constrictive pericarditis. |
| – | Calcium channel blockers may be helpful for severe diastolic dysfunction that occurs in those with restrictive cardiomyopathy. |
| – | Therapy should be given to those few patients who manifest hypertrophic cardiomyopathy to relieve left ventricular outflow obstruction. |
| – | Cardiac transplantation for intractable heart failure or arrhythmia may be needed. |
6.
The initial approach to a patient with fulminant hepatic failure includes assessment of the grade of encephalopathy and the cause of hepatic failure.
相似文献
| – | Aggressive supportive therapy with early referral to a transplantation center is recommended for patients with advancing encephalopathy. |
| – | A critical component of the transplant decision process is the ongoing clinical assessment of reversibility of neurologic status; liver transplantation continues to be the only successful intervention in patients with advanced encephalopathy. |
| – | Emerging therapies such as auxiliary transplantation and extracorporeal liver assist devices are being perfected or rigorously evaluated. |
7.
Opinion statement
相似文献
| – | End-stage liver disease due to chronic hepatitis C is the leading indication for orthotopic liver transplantation in the United States. Twenty percent to 30% of hepatitis C patients are at increased risk of developing cirrhosis, and 1% to 4% of cirrhotic patients will develop hepatocellular carcinoma. These findings warrant treatment for hepatitis C virus (HCV)-infected patients. |
| – | Currently, the mainstay in treatment of HCV is the use of recombinant alpha interferon, or its equivalent, in combination with the oral antiviral agent ribavirin. |
| – | The major goals of therapy are clearance of the virus, achieving a noninfectious state, and halting the necro-inflammatory process that leads to fibrosis and progression to cirrhosis. |
| – | End of treatment response (ETR) is biochemical and virological remission—normalization of serum aminotransferase (ALT) and undetectable levels of HCV RNA, at the end of therapy. |
| – | Sustained virological response (SVR) is defined as the absence of viremia and persistently normal aminotransferase 6 months off treatment, and is the ultimate goal of therapy. Patients who achieve SVR will have significant and persistent histologic improvement. |
| – | HCV genotype, pretreatment levels of HCV-RNA (viral load), the presence of advanced fibrosis or cirrhosis, gender, and age are independent predictors of response. |
| – | Ribavirin is teratogenic, therefore, contraception is mandatory for both males and females during and up to 6 months after therapy. |
| – | Side effects of combination therapy are dose-dependent and most commonly include symptoms of irritability, depression and fatigue, and laboratory evidences of leukopenia, thrombocytopenia, and hemolytic anemia. |
8.
Opinion statement
相似文献
| – | Primary biliary cirrhosis (PBC) is one of the most common chronic cholestatic liver diseases affecting the adult population. |
| – | The clinical presentation of PBC can be diverse, ranging from the presymptomatic individual to the patient with advanced liver disease. The initial evaluation to establish the diagnosis, and the appropriate followup, are very important in the lifelong management of these patients. |
| – | The primary medical treatment in PBC should focus on reducing the rate of disease progression. To this extent, ursodeoxycholic acid has been extensively evaluated and proven to improve liver biochemistries and survival in patients with PBC. |
| – | The secondary medical management in PBC should address the treatment of complications of chronic cholestasis, hepatic cirrhosis, and failure. |
| – | Liver transplantation remains the only established therapeutic approach in treating patients with end-stage PBC and its associated complications. |
9.
Opinion statement
相似文献
| – | Fulminant ulcerative colitis necessitates immediate hospitalization. |
| – | Supportive therapy such as aggressive rehydration, restriction of oral intake, and consideration of parenteral nutrition should be initiated. |
| – | High-dose intravenous steroids should be started in almost all cases. |
| – | Antibiotics and cyclosporine should be considered, especially in disease refractory to steroid therapy. |
| – | Indications for surgery should always be kept in mind, and early involvement of the surgical team is always encouraged. |
| – | Avoidance of life-threatening complications such as toxic megacolon, hemorrhage, and perforation is the goal of any treatment for fulminant ulcerative colitis. |
10.
Donner RM 《Current treatment options in cardiovascular medicine》2000,2(6):469-480
Opinion statement
相似文献
| – | Prenatal diagnosis of hypoplastic left heart syndrome is strongly encouraged through careful, routine level II ultrasound screening, especially in highrisk families. |
| – | A decision for palliative care (leading to death) should be discouraged if cardiac anatomy or physiology is favorable, centers of expertise are available, sufficient resources exist, and there are no associated coexisting anomalies or genetic defects that permit little chance of meaningful survival. |
| – | Staged surgical palliation is preferred over cardiac transplantation as the initial therapeutic approach. |
11.
Opinion statement
相似文献
| – | Transposition of the great arteries (TGA) is a lethal condition without intervention. |
| – | Cross-sectional echocardiography is the diagnostic investigation of choice. |
| – | Intravenous infusion of prostaglandin is employed to maintain ductal patency and allow mixing of blood, thus improving tissue oxygenation. |
| – | Balloon atrial septostomy is recommended once the diagnosis is made. |
| – | The arterial switch is accepted as the best option for simple TGA. |
| – | Late follow-up includes survivors of the intra-atrial repair (Mustard and Senning operations), and the emerging cohort of survivors of the arterial switch procedure. |
| – | Arrhythmia, baffle stenosis, tricuspid valve dysfunction, systemic ventricular dysfunction, and sudden death may occur late during follow-up after the Mustard or Senning procedure. |
| – | There are less data for late follow-up after arterial switch; however, late death is rare, usually is related to reoperation, and important arrhythmias are uncommon. The long-term fate of the coronary circulation is unknown but coronary arterial obstruction has been reported. |
| – | Continuing long-term surveillance is essential to detect the development of late problems in all groups of survivors. |
12.
Albert J. Czaja MD 《Current Treatment Options in Gastroenterology》1999,2(5):423-436
Opinion statement
相似文献
| – | Autoimmune hepatitis can be treated effectively with either prednisone alone or a lower dose of prednisone in combination with azathioprine. |
| – | All types of autoimmune hepatitis should be treated similarly. |
| – | The combination schedule of prednisone and azathioprine is preferred since it is associated with fewer side effects than a higher dose of prednisone alone. |
| – | Lifestyle changes are essential if overeating, under-exercising, excessive alcohol consumption, or overexposure to hepatotoxic medication or chemicals are common. |
| – | Adjunctive therapies, including calcium supplementation, vitamin D, and hormonal replacement, are important in postmenopausal women to preserve skeletal integrity. |
| – | Initial treatment should be continued until complete clinical, laboratory and histologic resolution. Relapse after attainment of an “ideal” end point tempers the goals of subsequent treatments. |
| – | Relapse after a second treatment and drug withdrawal is associated with a diminishing benefit-risk ratio for retreatment. Long-term, indefinite therapy with low dose prednisone or azathioprine alone is the appropriate treatment strategy. |
| – | Deterioration despite compliance with conventional therapy (treatment failure), incomplete response, and drug toxicity are adverse outcomes that warrant modifications in the conventional treatment protocol. High dose corticosteroid regimens, longterm low dose maintenance schedules, and investigational drugs can be considered. |
| – | Liver transplantation is an effective strategy for patients who have decompensated disease despite corticosteroid therapy. |
| – | Tacrolimus and budesonide are the most promising new therapies for autoimmune hepatitis and controlled treatment trials are sorely needed. |
13.
Henderson JM 《Current Treatment Options in Gastroenterology》1999,2(1):61-67
Opinion Statement
相似文献
| – | Cirrhotic patients should receive an endoscopy. Those with medium to large varices identified by endoscopy should receive b-blocker therapy. |
| – | The initial episode of variceal bleeding should be managed with endoscopic therapy to control the acute bleeding and concurrent infusion of octreotide. Portal hypertension and liver disease should be fully evaluated after such an episode, and patients should be started on first-line treatment (endoscopic therapy and pharmacologic therapy) to reduce the risk of further bleeding. |
| – | Patients who bleed again after first-line therapy, and those with persistent risk factors whose varices are not obliterated by first-line treatment should be considered for second-line treatment, which is variceal decompression with transjugular intrahepatic portosystemic shunt (TIPS) or surgical shunt. |
| – | For patients with end-stage liver disease, liver transplantation may be the most appropriate treatment option. The management of variceal bleeding leading up to transplantation depends on the severity of the bleeding and available expertise. Minimal therapy to bridge the patient to transplantation is the goal. |
| – | Devascularization procedures are reserved for patients who are not candidates for decompression because of venous thrombosis. |
14.
Pedrosa M 《Current Treatment Options in Gastroenterology》2001,4(1):67-71
Opinion statement
相似文献
| – | Dysplasia is the most important marker of progression to invasive cancer in Barrett’s esophagus. |
| – | Intensive endoscopic surveillance with biopsy may identify invasive cancer in a patient with high-grade dysplasia (HGD). |
| – | Close relationship with an experienced gastrointestinal pathologist and thoracic surgeon will improve treatment decisions and patient outcomes. |
| – | No intervention is required in patients with low-grade dysplasia (LGD); continued surveillance is recommended. |
| – | Surgical resection is the currently accepted therapy for high-grade dysplasia. Endoscopic ablative therapy remains experimental. |
15.
Perlmutter DH 《Current Treatment Options in Gastroenterology》2000,3(6):451-456
Opinion statement
相似文献
| – | Most of the care of liver disease in alphα1-antitrypsin (α1-AT) deficiency involves supportive management for complications of chronic liver disease including gastrointestinal bleeding, ascites, edema, encephalopathy, coagulation disturbances, spontaneous bacterial peritonitis, and hepatorenal syndrome. |
| – | Some of these patients will have manifestations of cholestatic injury, including pruritus, hypercholesterolemia, and steatorrhea with fat-soluble vitamin deficiencies. |
| – | The major challenge for the clinician taking care of these patients is the timing of referral for liver transplantation therapy. |
| – | Timing of such referral is a relatively straightforward decision in α1-AT-deficient patients with progressive liver dysfunction. |
| – | Some patients have nonprogressive or slowly progressing liver disease even after the development of cirrhosis or portal hypertension. Timing of liver transplantation in these patients should not be based simply on the presence of cirrhosis, portal hypertension or mild liver synthetic dysfunction, but rather on the basis of a subjective judgment by the hepatologist, patient, and family that manifestations of liver disease are interfering with overall life functioning. |
16.
Opinion statement
相似文献
| – | There are four unique liver diseases that occur only during pregnancy and resolve after delivery. |
| – | Several liver diseases occur more commonly during pregnancy. |
| – | These must be distinguished form acute or chronic liver diseases that coincidentally occur during pregnancy. |
17.
Opinion statement
相似文献
| – | Balloon valvuloplasty provides optimal treatment for moderate and severe pulmonary valve stenosis. |
| – | Dysplastic pulmonary valves may not respond to balloon dilation and frequently require surgical treatment. |
| – | Balloon angioplasty with or without stenting is the preferred treatment of peripheral pulmonary stenosis. |
18.
Hyman PE 《Current Treatment Options in Gastroenterology》2000,3(5):387-394
Opinion statement
相似文献
| – | Many of the childhood functional gastrointestinal disorders are extremely common. |
| – | Using symptom-based diagnostic criteria for pediatric functional gastrointestinal disorders will improve patient care, enhance family satisfaction, and reduce costs. |
| – | Using symptom-based diagnoses, the emphasis shifts from evaluations to rule out rare diseases to family education and symptom management. |
| – | Well-meaning clinicians may co-create disability by failure to recognize and appropriately manage functional pediatric gastrointestinal disorders. |
19.
Opinion statement
相似文献
| – | Esophageal malignancies presenting with dysphagia from luminal obstruction generally are not resectable for cure, and palliative therapy is the primary focus. |
| – | Self-expandable metal stents (SEMS) have replaced plastic stents as a primary mode of palliation for malignant esophageal obstruction because of the relative ease of insertion, lower initial morbidity, and larger stent diameter. |
| – | Self-expandable metal stents are ideal for patients with midesophageal tumors. |
| – | A majority of patients experience relief of dysphagia with SEMS and dietary modification, but the initial cost is high and early morbidity may be significant. |
| – | The placement of SEMS across the gastroesophageal junction may result in free reflux that may improve with a stent containing a one-way gastric flap valve. |
| – | The placement of SEMS in the cervical esophagus, although more difficult, less effective, and less well tolerated, also may be successful. |
| – | Coated SEMS are a treatment of choice for individuals with tracheoesophageal fistula. |
| – | Delayed complications occur in up to 40% of patients and include stent migration, bleeding, perforation, fistula formation, and occlusion. Most complications can be managed endoscopically and additional stents may be placed for tumor overgrowth. |
| – | The comparison of three currently available SEMS for esophageal malignancy show no statistically significant differences with regard to ease of placement, effectiveness, complications, and mortality. |
| – | The use of SEMS for patients with benign disease is still considered experimental. |
20.
Michael K. Porayko MD Cuckoo Choudhary MD 《Current Treatment Options in Gastroenterology》2001,4(6):479-491
Opinion statement
相似文献
| – | Tumors of the liver often are discovered incidentally in asymptomatic individuals during diagnostic imaging or exploratory laparotomy performed for alternative reasons. |
| – | Hemangiomas are the most common benign liver tumors, followed in prevalence by focal nodular hyperplasia (FNH); other benign tumors are rare. |
| – | The growth and development of hemangiomas, FNH, and hepatic adenomas especially, have been linked to hormonal (eg, estrogen) stimulation. |
| – | Differentiating between benign and malignant neoplasms of the liver can be challenging. Radiologic imaging is essential for preliminary identification and classification of hepatic tumors, but tissue biopsy or surgical excision sometimes is required for a definitive diagnosis. |
| – | Individuals with hemangioma or FNH usually are asymptomatic, have a benign course, and can be managed conservatively. In contrast, hepatic adenomas need to be followed more carefully and often are excised to provide symptomatic relief, remove the risk of rupture, and avoid potential malignant transformation. |
| – | Liver transplantation in patients with benign hepatic neoplasms is exceedingly uncommon, and is recommended only when alternative methods of treatment are not feasible or have failed to control significant symptoms. |