The recent explosion of diagnostic and therapeutic modalities has provided much hope for our patients with liver disease and the treating hepatologist alike. However, it has also posed a challenge as many of the newer advances were not even on the drawing board during the training of the hepatologist looking after these patients. Moreover, even when the hepatologist receives information regarding the newer drugs or devices, it has often been through pharmaceutical-sponsored dinner meetings or symposia where a somewhat biased presentation may be made.
As recently as the late 1970s, therapy was restricted to the three L's — lactulose, lactone (spironolactone), and Lasix for patients with cirrhosis. Steroids and azathioprine were used only by the few hepatologists who were familiar with treatment of autoimmune hepatitis. Physicians looking after patients with liver disease required only a limited knowledge of pharmacology to manage their patients with liver disease. In the early 1980s, beta blockers were more widely used for prophylaxis against variceal bleeding, and vasopressin was increasingly used in the control of acute esophageal variceal hemorrhage. Chenodeoxycholic acid and ursodeoxycholic acid were subsequently introduced for dissolution of gallstones, but ursodeoxycholic acid is now mainly used for primary biliary cirrhosis. Technology for imaging of the liver was also limited, with gray scale ultrasound, poor quality nuclear scans, and invasive procedures such as spleno-porto-venograms being utilized to visualize the liver and its vasculature. Subsequently, agents were introduced for immunosuppression following liver transplantation, and there was an explosion of imaging technology including ultrasound, Doppler sonography, computer tomography and positron emission tomography (PET) scans, and magnetic resonance imaging. In the last decade several agents have been introduced for treatment of hepatitis B and hepatitis C and, more recently, for palliative therapy of hepatocellular carcinoma.
The current unmet need is finding a simple modality for educating the hepatologist in the proper use of newer drugs, devices or techniques. Beginning in this issue of HEPATOLOGY, we have introduced a new section termed “Diagnostic and Therapeutic Advances in Hepatology”. This section will feature on an intermittent basis and deal mainly with agents that have been recently added to the therapeutic and diagnostic armamentarium of the hepatologist. The section will typically be authored by an expert in the field who has had only limited ties with the particular drug or device company. The format to be followed will be standardized, very practical, and patient-based. For new drugs, the discussant will cover the pharmacology of the drug, including its mechanism of action, the adverse effect profile and, most important of all, how the drug is to be used, including monitoring and dose adjustments. Since it is anticipated that there will be not only several new drugs introduced for treatment of liver disease in the future, but also newer devices (artificial and bioartificial liver support systems), as well as newer imaging modalities (such as ultrasound and MR Elastography), new devices will also be discussed. We are confident that this section will be a step in the right direction in providing the practicing hepatologist with expert and unbiased advice regarding newer advances in the field.