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Education And Debate

Recent Advances: Hepatology

BMJ 1995; 311 doi: (Published 18 November 1995) Cite this as: BMJ 1995;311:1351
  1. A N B McNair, lecturer in medicinea,
  2. C J Tibbs, consultant gastroenterologistb,
  3. R Williams, directora
  1. aInstitute of Liver Studies, King's College Hospital, London SE5 9PJ
  2. bQueen Mary's Hospital, Roehampton, London SW15 5PN
  1. Correspondence to: Dr McNair.

    In the past decade, molecular biological techniques have led to an explosion of information about the mechanisms underlying liver disease, particularly in the field of viral hepatitis, where at least five new viruses and a multitude of variants have been described since 1989. The impact of molecular biology on the treatment of liver disease has been less dramatic, although recombinant technology is allowing the production of some effective new treatments and vaccines. The single major factor that has transformed the clinical management and outcome of patients with acute or chronic liver failure has been the development of liver transplantation from a largely experimental technique to part of routine clinical practice.

    Viral hepatitis PREVENTION

    Several options are now available for the prevention of viral hepatitis in patients at risk of infection. Immune globulin has been used for some time to prevent hepatitis A and B, and vaccines have now been developed against these viruses. Screening of blood products for evidence of exposure to hepatitis B and hepatitis C viruses has also had a substantial impact on the development of post-transfusion hepatitis.

    Effective control of hepatitis B by vaccination in high prevalence areas will allow effective control of this infection and associated hepatocellular carcinoma. Viral escape mutants, in which alteration of a key viral antigen prevents neutralisation by vaccine induced antibodies in the host, do not substantially alter the effectiveness of vaccination programmes aimed at large populations; a field study in the Gambia has shown a clear reduction in the incidence of hepatitis B in a high prevalence area.1

    For travellers to developing countries, the recently developed vaccine against hepatitis A offers an important means of protection against this infection, which affects 3/1000 to 20/1000 people per month's stay abroad.2 This high incidence makes hepatitis A the most common infection in travellers that …

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