Dr Vikrant Sibartie
MRCP (Ireland), CSCST
Consultant Internal Medicine and Gastroenterology
Apollo Bramwell Hospital
Recent Developments in
Gastroenterology and Liver
Disease
New in Gastroenterology or New in
Mauritius ?
What’s new and relevant to practice
in Mauritius?
• Viral Hepatitis B and C.
• Endoscopic management of Gastro
Intestinal disease
CHRONIC HEPATITIS C:
CURRENT TREATMENT
WHY TREAT CHRONIC
HEPATITIS C?
Natural History of Hepatitis C
Acute Hepatitis C
10 - 30
years
Chronic Hepatitis
50 - 85 %
Cirrhosis 20 - 30 %
Decompensation
6 - 10 %
HCC
5 - 10 %
Death
5 - 10 %
Aim of Hepatitis C Treatment
• Achieve complete eradication of the Hep C
virus
• i.e. Undetectable levels of Hep C RNA
levels (using PCR)
• Clinical practice: Achieve a Sustained
Virological Response (SVR)
• SVR: Undetectable Hep C viral loads 6
months post treatment. Predictor of longterm response
• SVR = Cure from Hepatitis C
PEG- INTERFERON
The PEG-Interferon molecule
PEG-Interferon alfa-2b 1.5 μg/kg
pg/ml interferon α-2b
Interferon alfa-2b 3MIU
1000
T½ 40 hours
100
10
1
0
20 40 60 80 100 120 140 160 180
Hours
10
Hep C Virus Genotypes
• Genotypes 1,2,3 and 4
• Genotype 1 most common in Mauritius,
mainly in the IV Drug User (IVDU)
community.
• More than 95% of IVDU in Mauritius are
Hep C Positive !!!
Likelihood of Sustained Virological Response (SVR)
after first few weeks
WHAT ABOUT HEP C
GENOTYPE 1?
Peginterferon alfa-2a/2b + Ribavirin
for treatment of Hepatitis C Gen 1
100
Sustained virologic
response (%)
100
80
76
61
60
40
37
HCV-1
HCV-2,3
60
46
40
20
20
0
0
IFN + RBV
82
79
80
PEG-IFN
alfa-2a +
RBV
Fried et al., N Engl J Med 2002;
347:975-982
33
IFN + RBV
42
PEG-IFN
alfa-2b +
RBV
Manns et al., Lancet 2001;
358:958-965
Treatment response (%)
Weight-based exposure of
ribavirin and treatment response
90
80
70
60
50
40
30
20
10
0
86.7
<13.3 mg/kg/day
13.3-15.2 mg/kg/day
>15.2 mg/kg/day
72.1
82.1
67.7
48.4 50
46.4 48
22.5
25
7.1 5.9
24 wk tx
48 wk tx
Relapse
24 wk tx
48 wk tx
SVR
Yu et al., Hepatology 2008; 47:1884-1893
THE FUTURE FOR HEP C
GENOTYPE 1
The Protease inhibitors: Triple
Therapy
- Telaprevir
- Boceprevir
Addition of Boceprevir to IFN Alpha and Ribavirin
Chronic Hepatitis C :
Conclusions
• Hepatitis C is a treatable disease in
2011.
Chronic Hepatitis C:
Conclusions
• With evidence of significant liver disease,
or patient preference for early teatment,
treatment MUST be offered....
ENDOSCOPIC MANAGEMENT
OF GI DISEASES
- Upper Gastro-Intestinal Bleeding
- Endoscopic stenting of obstructing tumours
Endoscopic clips (Hemoclips)
Argon Plasma Coagulation
Bleeding Oesophageal varices
ENDOSCOPIC STENTING OF
GASTROINTESTINAL
TUMOURS
Obstructive Oesophageal cancer
Malignant duodenal obstruction
Obstructive Colon cancer
Stenting Biliary tract tumours at ERCP
THANK YOU