Brief Article
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World J Gastrointest Pharmacol Ther. May 6, 2013; 4(2): 16-22
Published online May 6, 2013. doi: 10.4292/wjgpt.v4.i2.16
Management practices of hepatitis C virus infected alcoholic hepatitis patients: A survey of physicians
Ashwani K Singal, Habeeb Salameh, Anjna Singal, Sarat C Jampana, Daniel H Freeman, Karl E Anderson, Don Brunder
Ashwani K Singal, Habeeb Salameh, Anjna Singal, Sarat C Jampana, Daniel H Freeman, Karl E Anderson, Don Brunder, Departments of Internal Medicine, Gastroenterology, Biostatistics and Library, University of YX Medical Branch, Galveston, TX 77555, United States
Ashwani K Singal, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, AL 35294-0012, United States
Author contributions: Singal AK and Brunder D designed research; Singal AK and Singal A performed research; Singal AK, Salameh H and Jampana SC analyzed data; and Singal AK, Jampana SC and Anderson KE wrote the paper.
Correspondence to: Ashwani K Singal, MD, MSc, Assistant Professor, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, 1808 7th Ave S, Birmingham, AL 35294-0012, United States. ashwanisingal.com@gmail.com
Telephone: +1-205-9345614 Fax: +1-205-9346201
Received: March 21, 2013
Revised: March 28, 2013
Accepted: April 10, 2013
Published online: May 6, 2013
Abstract

AIM: To survey gastroenterologists and hepatologists regarding their current views on treating hepatitis C virus (HCV) infected alcoholic hepatitis (AH) patients.

METHODS: A sixteen item questionnaire was electronically mailed to gastroenterologists and hepatologists. A reminder was sent after 2 mo to increase the response rate. Participation of respondents was confidential. Accessing secured web site to respond to the questionnaire was considered as informed consent. Responses received on the secured website were downloaded in an excel sheet for data analysis.

RESULTS: Analyzing 416 responses to 1556 (27% response rate) emails, 57% respondents (56% gastroenterologists) reported HCV prevalence > 20% amongst AH patients. Sixty nine percent often treated AH and 46% preferred corticosteroids (CS). Proportion of respondents with consensus (75% or more respondents agreeing on question) on specific management of HCV infected AH were: routine HCV testing (94%), HCV not changing response to CS (80%) or pentoxifylline (91%), no change in approach to treating HCV infected AH (75%). None of respondent variables: age, specialty, annual number of patients seen, and HCV prevalence could predict respondent to be in consensus on any of or all 4 questions. Further, only 4% would choose CS for treating HCV infected AH as opposed to 47% while treating HCV negative AH.

CONCLUSION: Gastroenterologists and hepatologists believe that AH patients be routinely checked for HCV. However, there is lack of consensus on choice of drug for treatment and outcome of HCV positive AH patients. Studies are needed to develop guidelines for management of HCV infected AH patients.

Keywords: Survey, Alcoholic hepatitis, Hepatitis C virus, Alcoholic liver disease

Core tip: Alcoholic hepatitis (AH) carries about 40%-50% mortality amongst patients with severe disease. Physicians usually shy away from treating AH in presence of concomitant hepatitis C virus (HCV). We surveyed gastroenterologists and hepatologists to assess their practice patterns on treating HCV infected AH patients. We found that although, physicians agree on screening for HCV in these patients, there is lack of consensus on treatment approach. There was no agreement on choice of drug and response to corticosteroids or pentoxifylline amongst HCV infected AH patients. Guidelines are needed on treating AH in presence of HCV.