Book on hepatitis from page 1 to 12

Book on hepatitis from page 1 to 12

Mauss − Berg − Rockstroh − Sarrazin − Wedemeyer
Hepatology 2012
Third Edition
This textbook was supported by a grant from
Roche Pharma, Germany
Hepatology 2012
A Clinical Textbook
Editors
Stefan Mauss
Thomas Berg
Juergen Rockstroh
Christoph Sarrazin
Heiner Wedemeyer
Flying Publisher
4
English language and style:
Rob Camp
camporama@gmail.com
Disclaimer
Hepatology is an ever-changing field. The editors and authors of Hepatology − A Clinical
Textbook have made every effort to provide information that is accurate and complete as of the
date of publication. However, in view of the rapid changes occurring in medical science, as well
as the possibility of human error, this site may contain technical inaccuracies, typographical or
other errors. Readers are advised to check the product information currently provided by the
manufacturer of each drug to be administered to verify the recommended dose, the method and
duration of administration, and contraindications. It is the responsibility of the treating physician
who relies on experience and knowledge about the patient to determine dosages and the best
treatment for the patient. The information contained herein is provided "as is" and without
warranty of any kind. The editors and Flying Publisher & Kamps disclaim responsibility for any
errors or omissions or for results obtained from the use of information contained herein.
© 2012 by Mauss et al.
Design: Attilio Baghino, www.baghino.com
ISBN: 978-3-924774-73-8
Printed in Germany by Druckhaus Süd, www.druckhaus-sued.de 
5
Foreword
3
rd
Edition – 2012
We are pleased to present you with the 3rd Edition of Hepatology − A Clinical
Textbook. We especially want to offer our thanks to all the authors who have
worked so hard to keep their chapters fresh and up-to-date. We have included very
exciting updates, especially regarding the new oral treatments for HCV. We also are
expanding our project to try to reach a broader range of readers and look forward to
collaborating with you to connect with newer specialists as well as those not
necessarily in large urban centers or those who have less access to information on
the latest diagnostics and treatments.
We would be especially interested in hearing from you regarding your experience
with the book, and how it could be made better for you. Please let us know at
www.hepatolgytextbook.com where you can also download this book by chapter, by
section or the full book, 100% free. We hope you can give us a few minutes of your
time to help us make the next edition better for you and that this project can
continue to be a lasting success.
The Editors
Stefan Mauss, Thomas Berg, Jürgen Rockstroh, Christoph Sarrazin, Heiner Wedemeyer
Foreword
2
nd
Edition – 2010
Because hepatology is such a dynamic and exciting area of medicine, regular
updates are mandatory in keeping a clinical textbook useful. We are delighted to
present this second edition of Hepatology – A Clinical Textbook. The first edition
was a major success, with more than 80,000 downloads worldwide. In addition, a
Romanian translation was carried out by Camelia Sultana and Simona Ruta shortly
after the appearance of the first edition. We invite qualified people everywhere to do
the same, into any appropriate language! This web-based free-of-charge concept
made possible by unrestricted grants from Roche and Gilead has allowed the
material to reach countries usually not easily covered by print media, a special
quality of this project. We hope this second edition of Hepatology – A Clinical
Textbook will continue to be a vluable source of information for our readers.
The Editors
Stefan Mauss, Thomas Berg, Jürgen Rockstroh, Christoph Sarrazin, Heiner Wedemeyer
6  Hepatology 2012
Preface
Hepatology is a rapidly evolving field that will continue to grow and maintain
excitement over the next few decades. Viral hepatitis is not unlike HIV 10 or 15
years ago. Today, hepatitis B viral replication can be suppressed by potent antiviral
drugs, although there are risks regarding the emergence of resistance. Strategies to
enhance the eradication rates of HBV infection still need to be developed. On the
other hand, hepatitis C virus infection can be eradicated by treatment with pegylated
interferon plus ribavirin, although the sustained virologic response rates are still
suboptimal, particularly in those infected by genotype 1. Many new antiviral drugs,
especially protease and polymerase inhibitors, are currently in preclinical and
clinical development, and the first data from larger clinical trials provide some
optimism that the cure rates for patients with chronic hepatitis C will be enhanced
with these new agents. In other areas of hepatology, e.g., hereditary and metabolic
liver diseases, our knowledge is rapidly increasing and new therapeutic options are
on the horizon.
In rapidly evolving areas such as hepatology, is the book format the right medium
to gather and summarise the current knowledge? Are these books not likely to be
outdated the very day they are published? This is indeed a challenge that can be
convincingly overcome only by rapid internet-based publishing with regular
updates. Another unmatched advantage of a web-based book is the free and
unrestricted global access. Viral hepatitis and other liver diseases are a global
burden and timely information is important for physicians, scientists, patients and
health care officials all around the world.
The editors of this web-based book –  Thomas Berg, Stefan Mauss, Jürgen
Rockstroh, Christoph Sarrazin and Heiner Wedemeyer – are young, bright, and
internationally renowned hepatologists who have created an excellent state-of-the-art textbook on clinical hepatology. The book is well-written and provides in-depth
information without being lengthy or redundant. I am convinced that all five experts
will remain very active in the field and will continue to update this book regularly as
the  science progresses. This e-book should rapidly become an international
standard.
Stefan Zeuzem – Frankfurt, January 2009
Preface
Therapeutic options and diagnostic procedures in hepatology have quickly advanced
during the last decade. In particular, the management of viral hepatitis has
completely changed since the early nineties. Before nucleoside and nucleotide
analogs were licensed to treat hepatitis B and before interferon α  + ribavirin
combination therapy were approved for the treatment of chronic hepatitis C, very
few patients infected with HBV or HCV were treated successfully. The only option
for most patients with end-stage liver disease or hepatocellular carcinoma was liver
transplantation. And even if the patients were lucky enough to be successfully
transplanted, reinfection of the transplanted organs remained major challenges. In
the late eighties and early nineties discussions were held about rejecting patients
with chronic hepatitis from the waiting list as post-transplant outcome was poor.
7
Today, just 15 years later, hepatitis B represents one of the best indications for liver
transplantations, as basically all reinfection can be prevented. In addition, the
proportion of patients who need to be transplanted is declining − almost all HBV-infected patients can nowadays be treated successfully with complete suppression of
HBV replication and some well-selected patients may even be able to clear HBsAg,
the ultimate endpoint of any hepatitis B treatment.
Hepatitis C has also become a curable disease with a sustained response of 50-80% using pegylated interferons in combination with ribavirin. HCV treatment
using direct HCV enzyme inhibitors has started to bear fruit (we draw your attention
to the HCV Chapters).
Major achievements for the patients do sometimes lead to significant challenges
for the treating physician. Is the diagnostic work-up complete? Did I any recent
development to evaluate the stage and grade of liver disease? What sensitivity is
really necessary for assays to detect hepatitis viruses? When do I need to determine
HBV polymerase variants, before and during treatment of hepatitis B? When can I
safely stop treatment without risking a relapse? How to treat acute hepatitis B and
C? When does a health care worker need a booster vaccination for hepatitis A and
B? These are just some of many questions we have to ask ourselves frequently
during our daily routine practice. With the increasing number of publications,
guidelines and expert opinions it is getting more and more difficult to stay up-to-date and to make the best choices for the patients. That is why HEPATOLOGY 2012
– A Clinical Textbook is a very useful new tool that gives a state-of-the art update
on many aspects of HAV, HBV, HCV, HDV and HEV infections. The editors are
internationally-known experts in the field of viral hepatitis; all have made
significant contributions to understanding the pathogenesis of virus-induced liver
disease, diagnosis and treatment of hepatitis virus infections.
HEPATOLOGY 2012 – A Clinical Textbook gives a comprehensive overview on
the epidemiology, virology, and natural history of all hepatitis viruses including
hepatitis A, D and E. Subsequent chapters cover all major aspects of the
management of hepatitis B and C including coinfections with HIV and liver
transplantation. Importantly, complications of chronic liver disease such as
hepatocellular carcinoma and recent developments in assessing the stage of liver
disease are also covered. Finally, interesting chapters on autoimmune and metabolic
non-viral liver diseases complete the book.
We are convinced that this new up-to-date book covering all clinically relevant
aspects of viral hepatitis will be of use for every reader. The editors and authors
must be congratulated for their efforts.
Michael P. Manns – Hannover, January 2009
8  Hepatology 2012
9
Contributing Authors
Fernando Agüero
Preventive Medicine and Public
Health
Parc de Salut Mar
Pompeu Fabra University
Public Health Agency of Barcelona
Barcelona, Spain
Hikmet Akkiz
Depatment of Gastroenterology and
Hepatology
Çukurova University, School of
Medicine
Adana, Turkey
Akif Altnibas
Yıldırım Beyazıt Education and
Research Hospital
Gastroenterology Clinic
Ankara, Turkey
Matthias J. Bahr
Dept. of Medicine I
Sana Kliniken Lübeck
Kronsforder Allee 71-73
23560 Lübeck, Germany
Lars P. Bechmann
Department of Gastroenterology and
Hepatology,
University Hospital Essen
Hufelandstr. 55
45122 Essen
Germany
Susanne Beckebaum
Department of Transplant Medicine
University Hospital Münster
Domagkstr. 3A
48149 Münster
Thomas Berg
Sektion Hepatologie
Klinik und Poliklinik für
Gastroenterologie & Rheumatologie
Universitätsklinikum Leipzig
Liebigstr. 20
04103 Leipzig, Germany
thomas.berg@medizin.uni-leipzig.de
Leber- und Studienzentrum am
Checkpoint
Charlottenstrasse 81
10969 Berlin
berg@leberzentrum-checkpoint.de
Albrecht Böhlig
Sektion Hepatologie
Klinik und Poliklinik für
Gastroenterologie & Rheumatologie
Universitätsklinikum Leipzig
Liebigstr. 20
04103 Leipzig, Germany
Florian van Bömmel
Sektion Hepatologie
Klinik und Poliklinik für
Gastroenterologie & Rheumatologie
Universitätsklinikum Leipzig
Liebigstr. 20
04103 Leipzig, Germany
Christoph Boesecke
Department of Medicine I
University Hospital Bonn
Sigmund-Freud-Strasse 25
53105 Bonn, Germany
Ali Canbay
Department of Gastroenterology and
Hepatology,
University Hospital Essen
Hufelandstr. 55
45122 Essen
Germany
10  Hepatology 2012
Carlos Cervera
Infectious Diseases Service
Hospital Clínic − IDIBAPS
University of Barcelona
Villarroel, 170
08036 Barcelona, Spain
Vito R. Cicinnati
Department of Transplant Medicine
University Hospital Münster
Domagkstr. 3A
48149 Münster
Markus Cornberg
Dept. of Gastroenterology,
Hepatology and Endocrinology
Medical School of Hannover
Carl-Neuberg-Str. 1
30625 Hannover, Germany
Maura Dandri
University Hospital Hamburg-Eppendorf
Zentrum für Innere Medizin
I. Medizinische Klinik
Labor Hepatologie und Virus
Hepatitis
Martinistr. 52
20246 Hamburg, Germany
Neus Freixa
Psychiatry Department
Hospital Clínic − IDIBAPS
University of Barcelona
Villarroel, 170
08036 Barcelona, Spain
Juan-Carlos García-Valdecasas
Liver Transplant Unit, Department of
Surgery
Hospital Clínic − IDIBAPS
University of Barcelona
Villarroel, 170
08036 Barcelona, Spain
Guido Gerken
Department of Gastroenterology,
University Hospital Essen
Hufelandstr. 55
45122 Essen, Germany
Frank Grünhage
Medical Department II
Saarland University Hospital
Kirrbergerstr. 1
66421 Homburg, Germany
Svenja Hardtke
Dept. of Gastroenterology,
Hepatology and Endocrinology
Medical School of Hannover
Carl-Neuberg-Str. 1
30625 Hannover, Germany
Bernd Kupfer
Department of Medicine I
University Hospital Bonn
Sigmund-Freud-Strasse 25
53105 Bonn, Germany
Montserrat Laguno
Infectious Diseases Service
Hospital Clínic − IDIBAPS
University of Barcelona
Villarroel, 170
08036 Barcelona, Spain
Frank Lammert
Medical Department II
Saarland University Hospital
Kirrbergerstr. 1
66421 Homburg, Germany
Christian Lange
J. W. Goethe-University Hospital
Medizinische Klinik 1
Theodor-Stern-Kai 7
60590 Frankfurt am Main, Germany
Contributing Authors 11
Michael P. Manns
Dept. of Gastroenterology,
Hepatology and Endocrinology
Medical School of Hannover
Carl-Neuberg-Str. 1
30625 Hannover, Germany
Christian Manzardo
Infectious Diseases Service
Hospital Clínic − IDIBAPS
University of Barcelona
Villarroel, 170
08036 Barcelona, Spain
Stefan Mauss
Center for HIV and
Hepatogastroenterology
Grafenberger Allee 128a
40237 Duesseldorf, Germany
stefan.mauss@center-duesseldorf.de
José M. Miró
Infectious Diseases Service
Hospital Clínic − IDIBAPS
University of Barcelona
Villarroel, 170
08036 Barcelona, Spain
Asuncion Moreno
Infectious Diseases Service
Hospital Clínic − IDIBAPS
University of Barcelona
Villarroel, 170
08036 Barcelona, Spain
Claus Niederau
Katholische Kliniken Oberhausen
gGmbH, St. Josef Hospital
Department of Internal Medicine
Academic Teaching Hospital of the
University
Duisburg-Essen
Mülheimer Str. 83
46045 Oberhausen, Germany
Jörg Petersen
Liver Unit IFI Institute for
Interdisciplinary Medicine
Asklepios Klinik St George Hamburg
Lohmühlenstr. 5
University of Hamburg
20099 Hamburg, Germany
Sven Pischke
Dept. of Gastroenterology,
Hepatology and Endocrinology
Medical School of Hannover
Carl-Neuberg-Str. 1
30625 Hannover, Germany
Kerstin Port
Dept. of Gastroenterology,
Hepatology and Endocrinology
Medical School of Hannover
Carl-Neuberg-Str. 1
30625 Hannover, Germany
Karl-Philipp Puchner
Charité, Campus Virchow-Klinikum,
Universitätsmedizin
Medizinische Klinik m. S.
Hepatologie und Gastroenterologie
Augustenburger Platz 1
13353 Berlin, Germany
Antonio Rimola
Liver Transplant Unit - CIBEREHD
Hospital Clínic − IDIBAPS
University of Barcelona
Villarroel, 170
08036 Barcelona, Spain
J. K. Rockstroh
Department of Medicine I
University Hospital Bonn
Sigmund-Freud-Strasse 25
53105 Bonn, Germany
rockstroh@uni-bonn.de
12  Hepatology 2012
Christoph Sarrazin
J. W. Goethe-University Hospital
Medizinische Klinik 1
Theodor-Stern-Kai 7
60590 Frankfurt am Main, Germany
sarrazin@em.uni-frankfurt.de
Martin Schäfer
Department of Psychiatry
and Psychotherapy
Kliniken Essen-Mitte
Ev. Huyssenstift
Henricistraße 92
45136 Essen, Germany
Carolynne Schwarze-Zander
Department of Medicine I
University Hospital Bonn
Sigmund-Freud-Strasse 25
53105 Bonn, Germany
Ulrich Spengler
Department of Internal Medicine 1
University Hospitals of Bonn
University
Sigmund-Freud-Strasse 25
53105 Bonn, Germany
Christian P. Strassburg
Dept. of Gastroenterology,
Hepatology and Endocrinology
Medical School of Hannover
Carl-Neuberg-Str. 1
30625 Hannover, Germany
Montserrat Tuset
Pharmacy Department
Hospital Clínic − IDIBAPS
University of Barcelona
Villarroel, 170
08036 Barcelona, Spain
Jan-Christian Wasmuth
Department of Medicine I
University Hospital Bonn
Sigmund-Freud-Strasse 25
53105 Bonn, Germany
Heiner Wedemeyer
Dept. of Gastroenterology,
Hepatology and Endocrinology
Medical School of Hannover
Carl-Neuberg-Str. 1
30625 Hannover, Germany
wedemeyer.heiner@mh-hannover.de
Johannes Wiegand
Sektion Hepatologie
Klinik und Poliklinik für
Gastroenterologie & Rheumatologie
Universitätsklinikum Leipzig
Liebigstr. 20
04103 Leipzig, Germany
Stefan Zeuzem
J. W. Goethe-University Hospital
Medizinische Klinik 1
Theodor-Stern-Kai 7
60590 Frankfurt am Main, Germany