With more than 250 million people currently infected with chronic hepatitis B virus (HBV) worldwide, this disease remains a global public health concern and a primary cause of hepatic cirrhosis and hepatocellular carcinoma. The therapies currently available to treat HBV infection have been able to suppress HBV DNA, but there are no approved therapies to date that have been shown to achieve a functional cure. This month’s issue of Gastroenterology & Hepatology explores emerging therapies in the pipeline for patients with HBV infection. In a feature article, Dr Sunny Sandhu, Dr Paul Martin, and Dr Ira M. Jacobson review the complex HBV life cycle, define the goals of treatment, highlight the therapies currently on the market, and examine the latest data on potential therapeutic targets of different stages of HBV’s viral life cycle and immunomodulatory pathways.
In other HBV-related coverage, our Advances in Hepatology column places a spotlight on the recent HBV management guideline from the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America. Dr Mindie H. Nguyen discusses the recommendations for preventing vertical and horizontal transmission and managing patients in the immune-tolerant phase as well as the hepatitis B e antigen–negative indeterminate phase. Additionally, she discusses whether the guideline recommends discontinuing nucleos(t)ide analogue therapy until hepatitis B surface antigen loss and recommendations for liver cancer surveillance in different patient subgroups.
Our other feature article this month explores sleep and disorders of gut-brain interaction (DGBIs), including functional dyspepsia (FD) and irritable bowel syndrome (IBS). As Dr Brian E. Lacy, Dr Jessica C. Petrov, and Dr Pablo R. Castillo note, sleep has a vital role in the maintenance of both physical and emotional health. The authors examine the fundamentals of normal and abnormal sleep, various forms of testing to help diagnose sleep disturbances, and the effects of disordered sleep on the brain. The authors also discuss the research conducted to date on sleep disorders in FD, IBS, and other DGBIs and present tips for assessing and managing sleep disorders in these patients.
Early intervention in Crohn’s disease is the focus of our Advances in IBD column. Dr Bruno César da Silva discusses the rationale for early intervention, which patients are most likely to benefit from early advanced therapy, findings from the PROFILE study, and the overall benefits and risks of this approach. He also discusses the evolution of the definition of early Crohn’s disease and the biggest unanswered questions in this area.
Finally, our MASH in Focus column features an interview with Professor Juan G. Abraldes on portal hypertension in patients who have metabolic dysfunction-associated steatohepatitis. His discussion includes clinical manifestations and imaging findings, noninvasive methods for detecting clinically significant portal hypertension, the initiation of beta blocker therapy or endoscopic surveillance, and research on emerging therapies such as resmetirom and semaglutide in this patient population.
May this issue provide you with helpful information that you can put to good use in your clinical practice.
Sincerely,
Gary R. Lichtenstein, MD, FACG, AGAF, FCCF, FACP