BRON VAN HEPATOLOGIE IN NL Heymans v.d.Bergh 19141937 Utrecht L. Schalm, Brandt 1940-1980 Arnhem, Leerboek 1948 Que, Gips Groningen na 1968, P. Jansen vanaf 1993
Bilirubine dir.-indirect
v.Tongeren/ Yap Nijmegen vanaf 1975 S. Schalm R’dam vanaf 1980 H.Janssen na 2006 P. Jansen, AMC na 2003, Oude Elferink
Lever als syntheseontgiftingsorgaan HBV, HCV, Cholestase
Bilirubine, Regeneratie, Hepatitis, LTX 1968 LTX, Hepatitis, Cholestase
ERCP(Huybregtse) na 1975, Hepatitis, Cholestase
BRON VAN HEPATOLOGIE IN NL Heymans v.d.Bergh 19141937 Utrecht L. Schalm, Brandt 1940-1980 Arnhem, Leerboek 1948 Que, Gips Groningen na 1968, P. Jansen vanaf 1993,
Bilirubine dir.-indirect
v.Tongeren/ Yap Nijmegen vanaf 1975 S. Schalm R’dam vanaf 1980 H.Janssen na 2006 P. Jansen, AMC na 2003, Oude Elferink
Lever als syntheseontgiftingsorgaan HBV, HCV, Cholestase
Bilirubine, Regeneratie, Hepatitis, LTX 1968 LTX, Hepatitis, Cholestase
ERCP(Huybregtse) na 1975, Hepatitis, Cholestase
BRONNEN VAN HEPATOLOGIE IN NL Heymans v.d.Bergh 19141937 Utrecht L. Schalm, Brandt 1940-1980 Arnhem, Leerboek 1948 Que, Gips Groningen na 1968, P. Jansen > 1993,
Bilirubine dir.-indirect
v.Tongeren/ Yap Nijmegen vanaf 1975 S. Schalm R’dam >1980 H.Janssen na 2006 P. Jansen(AMC) na 2003, R.Oude Elferink
Lever als syntheseontgiftingsorgaan HBV, HCV, Cholestase
Bilirubine, Regeneratie, Hepatitis, LTX 1968 LTX, Hepatitis, Cholestase
ERCP(Huibregtse) na 1975, Hepatitis, Cholestase
ERCP HOOGSTE SCORE INNOVATIEVE TECHNOLOGIE >1970?
100 JAAR HEPATOLOGIE: ORGANISATIES Voor 1975
Na 1975
Oprichting EASL L. Schalm 1966 Marburg, DL
NVH 1977
EASL Congres Arnhem 1972 L. Schalm en Eerste vergadering Nederlandse Leverclub
NLS 1980, NLDS, MLDS 1995 Ned. Leverpat. Vereniging Nat. Hepatitis Centrum EASL Congressen: 1986 Groningen C. Gips 2000 Rotterdam S. Schalm 2013 A’ dam U. Beuers
100 JAAR HEPATOLOGIE: ORGANISATIES Voor 1975
Na 1975
Oprichting EASL L. Schalm 1966 Marburg, DL
NVH 1977
EASL Congres Arnhem 1972 L. Schalm en Eerste vergadering Nederlandse Leverclub
NLS 1980, NLDS, MLDS 1995 Ned. Leverpat. Vereniging Nat. Hepatitis Centrum EASL Congressen: 1986 Groningen C. Gips 2000 Rotterdam S. Schalm 2013 A’ dam U. Beuers
GALZOUTEN en GALVORMING: 1970- 2013 • • • •
Osmotisch gedreven proces? Galzoutafh. en onafh. fractie Specifieke transportsystemen >1990 Molecular cloning transporteiwitten >1995 • FXR/LXR en FXR-agonisten >2000 (Cheno type 2 Diabetes en NASH) • Bile Acids als hormonen voor receptor TGR5 >2010(energiebalans)
WHEN TRANSPORT SYSTEMS FAIL … Hereditary
Acquired
Cholestatic syndromes
Decreased transport proteins
cholestasis and icterus
Hereditary Defects in Hepato-biliary Transport System
Sitosterolemia Hepatocyte
Cystic fibrosis Bile duct
Primary Biliary Cirrhosis, an enigmatic disease: 1970? 2013? • Chronic cholestatic liver disease • Anti-mitochondrial antibody
• Non-suppurative destructive cholangitis • Females >> males
DUTCH MULTICENTRE PBC COHORT STUDY >300 patients
44 hospitals ALL TREATED WITH UDCA Med. follow-up >6 yrs Prospective study
HEPATOLOGY:
< 1985
LARGE SYNDROMES
DIAGNOSIS
THERAPY
CIRRHOSIS
CLINICAL Child Score BIOPSY
Eliminate causes LTX
ASCITES
CLINICAL, US ?
Bacterial Peritonitis
PUNCTION
Spironol. Paracentesis, Shunt ANTIBIOTICS
Variceal Bleeding
Endoscopy
Encephalopathy HCC
Scleroth, Balloon
EEG, NH3
Lactulose, Neomycin
AFP, US? Radiology
Surgery
AU-ANTIGEEN POS. CAH-PAT.(1969)
Hepatology < 1985 Etiology
Marker
Therapy
Hepatitis B
HBsAg, eAg, HBVDNA -
IFN
ALT- IgG, ANASMA AF- IgM, AMA
Pred-Aza
Non-A, non-B hepatitis Auto Immune Hepatitis Prim Biliary Cirrhosis Prim Sclerosing Cholangitis
-
-
Cholangiography -
HEPATOLOGY:
2013
LARGE SYNDROMES
Markers
Therapy
CIRRHOSIS
US-Fibroscan MELD, Child
Eliminate causes
LTX
Score ASCITES
Clinical- US
Spironol.’TIPS
Variceal Bleed
Endoscopy
Banding, TIPS
HCC
Contrast US, CT-MRI
Perc. Tumor Ablation, Surgery, LTX
HEPATOLOGY IN 2013 Etiology
Marker
Therapy
HBsAg, eAg, HBVDNA,
HBV-genotype
Interferon, Lamivudine, Entecavir, Tenofovir
HEPATITIS C
antiHCV, HCVRNA, HCV-genotype, IL-28
Interferon, Ribavirine, Telapravir, TMC435
Auto Immune Hepatitis
ALT- IgG, ANA-SMA
Prednison, Azathioprine
Prim Biliary Cirrhosis
AF- IgM, AMA
UDCA
Prim Sclerosing Chol
AF - Cholangiography
-
Hemochromatose
Ferritin, Fe, Transferrin C282Y
Phlebotomy
HEPATITIS B
HEALTH GAIN IN HEPATOLOGY OVER 50 YEARS: WHAT DID WE LEARN? In 2013 LARGE HEALTH GAIN
SMALL HEALTH GAIN
Removing cause disease
Treatment of Complications Cirrhosis
Regression Liver Fibrosis after biliary drainage or antiviral Rx/ Survival benefit after antiviral Rx/ in HBV and HCV
B-Blokkers in Var. Bleeding TIPS in survival
Survival after LTX
Treatment UDCA PBC / PSC?
The Rise of Modern Hepatology(naar S.Schalm) continued innovation from 1980-2013
Illustrious innovations from Clinical science: HBIg for HBV LTx, Ribavirin for HCV, TIPS, Perc Tumor Ablation, LTx
Illustrious innovations from Industry: HCV / HCVRNA, entecavir / tenofovir for HBV, STAT-C for HCV, fibroscan, V-scan?
Also illustrious innovations from Genomics & Epidemiology ?: Genomics: C282Y for hemochromatosis, markers in cholestasis? Epidemiology: only systematic studies & limited T1/2 of Truth ?
Real Challenge for the Netherlands >2013 • PREVENTION OF COMPLICATIONS by taking away primary cause: NASH, HBV, HCV, PBC, PSC • in The Netherlands mortality due to hepatitis b can be reduced by 80% if 6000 patients at high risk are identified and treated with a 3rd generation antihepatitis B drug *. • More emphasis on CLINICAL RESEARCH! * Toy M et al: Potential impact of therapy in chronic hepatitis B Hepatology 2009 30
