David A. Sass, MD, AGAF, Guest Editor

In the first article, Dr Andrew Muir discusses the new advances in hepatitis C therapy with the introduction of the exciting direct-acting antiviral agents that were introduced this summer. We will now be able to offer our genotype 1 patients a cocktail of drugs that may allow for a greater chance at achieving the holy grail of an sustained virologic response. Dr Emmet Keeffe then follows with a discussion of the plethora of oral agents that are now available to combat hepatitis B infection. He delves into current treatment endpoints and offers an approach to the early detection and management of viral resistance. In recent years there has been a major research effort to discover new, noninvasive ways to determine hepatic fibrosis without resorting to the needle biopsy. Dr Jayant A. Talwalkar discusses the diagnostic performance of various serum biomarkers and innovative imaging modalities that have emerged and provides suggestions on how these may be incorporated into clinical practice. In his article on acute liver failure, Dr Obaid Shaikh summarizes a comprehensive management approach to this deadly disease and comments on advances in the field of bioartificial liver support devices to aid the failing liver and provide a bridge to transplantation. As clinicians, we are all acutely aware of the growing epidemic of obesity and the metabolic syndrome in the United States. It is felt by many that NASH will soon surpass hepatitis C as the leading indication for liver transplantation. It is thus timely for Dr Jawad Ahmad to present pharmacologic and surgical treatment options for this highly prevalent disease.

The next three articles deal with specific complications of cirrhosis. An understanding on how to manage these is imperative in order to afford our patients the opportunity to survive to transplantation. Dr Garcia-Tsao provides a detailed evidence-based approach to the pharmacologic, endoscopic, radiologic, and surgical management of varices, while Dr Florence Wong addresses the ominous hepatorenal syndrome and the current application of vasoconstrictor agents to combat this disease. Hepatocellular carcinoma is a leading cause of morbidity and mortality worldwide and progressive disease poses a constant threat to patients being removed from the liver transplant waitlist. Dr Robert Gish’s review explores the realm of locoregional therapies in treating HCC with an emphasis on novel developments in localized chemoembolization and systemic molecular-based targeted therapies. With the exceptionally high short-term mortality facing individuals with severe alcoholic hepatitis, an accurate assessment of disease severity is an important and practical issue for the gastroenterologist. Dr Vijay Shah describes the various prognostic scoring systems and discusses our rather limited treatment options. The final two articles specifically address liver transplantation. In today’s climate of organ donor scarcity, Drs Sass and Reich explore the innovation in transplantation geared toward increasing the donor pool and the issues pertaining to matching of these grafts to suitable recipients. Finally, because of the improved long-term survival of liver transplant recipients, many of whom are being followed by community gastroenterologists, Dr Kenneth Rothstein and colleagues offer a detailed management approach to this patient cohort and, in so doing, provide important pearls of wisdom to the practicing clinician.

In summary, readers of this issue of Gastroenterology Clinics will not only find new concepts and strategies to apply to their patients with liver disease but also gain a glimpse into what the future holds with regard to emerging therapies. I am greatly indebted to each of the authors and their respective coauthors for their truly invaluable contributions and it is our collective intent to provide a practical, stimulating resource that will be of value in your daily practice. I would like to extend my sincere gratitude to Kerry Holland and her editorial staff at Elsevier for their assistance in compiling this issue. Finally, my love and heartfelt appreciation go to my wife and best friend, Allison, and children, Lauren and Aaron, for their unwavering support and in selflessly allowing me the time to devote many hours so that this project could reach fruition.