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Clinical Review Recent advances


BMJ 1999; 318 doi: (Published 08 May 1999) Cite this as: BMJ 1999;318:1256
  1. M McCarthy, senior specialist registrar,
  2. M L Wilkinson, senior lecturer.
  1. Gastroenterology Unit, Guy's, King's College, and St Thomas's Hospitals' Medical and Dental School, Guy's Hospital, London SE1 9RT
  1. Correspondence to: Dr Wilkinson
  • Accepted 25 November 1998

Progress in hepatology has continued steadily in recent years. Routine use of molecular biology techniques has helped to explain the mechanisms of liver diseases with genetic and viral origins and provided insight into susceptibility to other common liver disorders. Clinical research has concentrated on new drugs, such as antiviral agents, refinements to well established techniques of liver transplantation, and new methods of supporting the failing liver. In this review, we aim to highlight the most important scientific and clinical advances in hepatology in the past two years.


We selected topics by reviewing the current clinical and scientific areas of interest at scientific meetings of British, European, and American hepatology groups. We also reviewed published reports by database and journal scanning and discussed ideas with colleagues.

Metabolic liver diseases

Genetic haemochromatosis

Genetic haemochromatosis is an autosomal recessive disorder of iron metabolism. Excessive iron is absorbed from the gut and deposited in tissues such as the liver, heart, pancreas, anterior pituitary, joints, and skin. This results in end organ damage, which may include cirrhosis and hepatocellular carcinoma. Genetic haemochromatosis is common—in the north European population, the gene carrier rate is 10%, and the disorder may affect up to 1 in 300 heterozygotes. Early detection of haemochromatosis has proved difficult until now, but a sensitive screening method has been developed. This means that liver disease in affected people can be prevented by early prophylactic treatment with repeated venesection.

Recent advances

Detection of the gene for haemochromatosis allows early screening and treatment for asymptomatic homozygotes for the disease

Lamivudine is an effective treatment for chronic hepatitis B infection before and after liver transplantation

In chronic hepatitis C infection, combination therapy with interferon and ribavirin is more effective than interferon alone

N-acetylcysteine treatment for paracetamol hepatotoxicity reduces mortality, even when given more than 24 hours after overdose

Split livers, auxiliary livers, and live related donor …

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