DICHEVA M.D., Ph.D., gastroenterologist
POLUNINA M.D., Ph.D., professor, gastroenterologist, hepatologist
VYALOV M.D., Ph.D., gastroenterologist, hepatologist
The overall aim of the new division remains the same for EMC: to help patients remain healthy and, with work, rest a lifestyle of full value for many long years, and in the event of health problems, to resolve them quickly.
Unfortunately, the majority of patients with a “hepatitis” diagnosis are people of young, working age. Now the risk group includes teenagers from 15-19 years old and young men aged 20-29. Viral hepatitis B, C and D were and remain one of the most important issues in public health services all over the world; on our planet more than 500 million people suffer from chronic hepatitis. By analysis of statistics of viral hepatitis B, Russia provides all grounds to assume that in the coming years, the level of disease will tend to increase.
In the European Medical Center, the Hepatology Center opened under the direction of gastroenterologist and hepatologist, doctor of medical sciences, professor Tatyana Polunina, where patients with various liver diseases can receive complex, specialized advice, medical-diagnostic and therapeutic aid. Some technologies used in the Center are unique for Russia, although have shown to be very effective in evidence-based medicine around the world.
The EMC Hepatology Center specializes in the treatment of autoimmune and medicinal hepatitis, a cross syndrome of hemochromatosis, alcohol liver damage, non-alcohol fatty hepatosis, chronic viral hepatitis B, C, D, E, and TTV.
Modern technologies of genetic analysis will allow optimization of treatment and so, to personify it, eradicate or to reduce as much as possible the pharmacotherapy side-effects.
The EMC Hepatology Center has a wide range of laboratory and instrumental methods for diagnostics of various liver diseases, and for examination of its functional and anatomic features. The range of the examinations carried out in the Center includes:
Advantages the EMC Hepatology of Center:
In the EMC Hepatology Center, there is an individual approach to dealing with the patient, selection of medicinal therapy and further dynamic observation. Therapy is undertaken according to European and American consensuses on studying current chronic diseases, such as chronic viral hepatitis B and C.
The Healthy Liver Program
The main diseases of the liver that practical doctors see more frequently are: chronic viral hepatitis B and C, alcoholic liver disease, non-alcoholic steatohepatitis, medicinal hepatitis, primary billious cirrhosis and hemochromatosis.
The chronic virus hepatitis B is one of the main causes of chronic diffuse liver diseases all over the world, caused by hepatitis virus B, and is observed in more than 350-400 million people, which is 5% of the world’s population. In this population there is a high risk of developing cirrhosis, liver-cell deficiency and carcinoma. The infection caused by viral hepatitis B remains one of the largest viral pandemics.
Now in the world, there are more than 170 million people infected with the hepatitis C virus which totals about 3% of the world’s population. Last decade was marked by considerable successes in the creation of medical products for treatment of chronic hepatitis C. At the beginning of the 1990s, effectiveness of treatment was about 10%. The modern standard of treatment of chronic hepatitis C on average raises the effectiveness to 54-63%. Therefore, the overall treatment objective is a steady virological response which is defined as an RNA absence of the hepatitis C virus in blood plasma in 24 weeks after the termination of treatment. This criterion is considered quite adequate in the estimation of effectiveness of therapy, as there is a probability of 97-99% that among the patients who have reached a steady virological response, the RNA of the hepatitis C virus does not reappear for 5 years.
In the majority of developed countries, from half to two thirds of the adult population regularly consume alcohol, and approximately 10% of them are alcoholics or consume alcohol regularly and in a considerable quantity. The evolution of representations about alcohol caused pathology is characterized as follows: the description of individual patients with indications of dependence of pathology of the liver, heart etc. from alcohol intake, periodic denial of the possibility of such dependence and again the recognition of a link of pathology of several organs with alcohol intake. Entering this pathology into the international classification of diseases allows doctors, therapeutics and neuropathologists without participation of a narcologist to diagnose the alcoholic nature of disease of the liver, heart and other organs with recognition that the patient abused alcohol for a number of years.
Now it is known that along with viral, alcoholic, parasitic and medicinal factors, a large role in the development of chronic hepatitis and cirrhosis, infringements in metabolic exchange of fat in particular play a role. This includes fatty lesions of the liver developing in persons not regularly consuming alcoholic drinks. Two main forms of non-alcoholic fatty liver disease are steatosis and non- alcoholic steatohepatitis are distinguished.
Hemochromatosis is not such a rare disease as believed previously. Among inhabitants of Europe, the prevalence of a gene for this illness is approximately 5%, and the disease (homozygote) has a frequency of about 0.3%, and carriers (heterozygotes) -10%. Among men this disease is met 5-10 times more often than at women. In almost 70% of patients, the first symptoms appear at the age of 40-60 years.
EMC Laboratory Diagnostics of Liver Diseases
EMC Instrumental Diagnostics
Additional specialist consultations
In agreement with the patient:
Now in Russia there is a growth in indicators of incidence of acute hepatitis C. It is a frequent disease among persons of a young age, with a high level of becoming chronic with possible cirrhosis and primary cancer of the liver draw special attention to this disease, the urgency and importance of selecting rational methods of diagnostics, treatment and preventive care.
The hepatitis C virus is a member of the flaviviruses family. It causes disease only in humans. In the serum of the patient’s blood and virus carrier, the concentration of the hepatitis C virus does, as a rule, not exceed 104 copies/ml, which is significantly less than corresponding indicators in hepatitis B (107-1010 copies/ml) and also defines a higher infecting dose in comparison with hepatitis C.
Laboratory Diagnostics of Hepatitis C
Laboratory diagnostics of hepatitis C is based on revealing specific markers of viral infection of hepatitis C (anti-HCV-IgM/G, an RNA of the hepatitis virus) and carried out by diagnostic sets strictly under instructions.
At an excess above 2 times the norm of indicators of the biochemical range of blood serum: GPT, nuclear ACT, ALP, and general bilirubin is carried out by immunno-fermental analysis on anti-HCV. Presence of normal indicators of a biochemical spectrum assumes observation of patients by the attending physician according to medical standards. In the event of a positive result in carrying out the immunno-fermental analysis, and also for revealing the RNA of the hepatitis C virus, the genotype and level of viremia is defined using polymerase-chain reaction for the purpose of selection of antiviral therapies. In the event of an excess of the norm of indicators of the hepatic tests and a negative result of the immunno-fermental analysis, and also at a norm in excess in indicators of hepatic tests, positive result of the immunno-fermental analysis and negative result of polymerase-chain reaction, dynamic supervision once every three months is carried out. With increased indicators of hepatic tests, a positive result of the immunno-fermental analysis and polymerase-chain reaction, clinical diagnostics, selection of antiviral therapies and control over the effectiveness of treatment of the hepatitis C virus is carried out.
Clinical Diagnostics of Hepatitis C
Diagnosis of the hepatitis C virus is based on a complex clinical (liver and spleen enlargement), biochemical (increase of the level of activity of aminotransferase AST, GPT), virological (presence in blood of an RNA of the hepatitis C virus and/or hepatitis anti-virus), the data which has accurate links with parenteral manipulations 1-4 months prior to its development: blood transfusion, surgical operations, first injection of drugs, etc.
The majority of patients do not have signs of acute hepatitis. Detection an RNA of the hepatitis C virus against an anti-virus of hepatitis C does not permit distinguishing acute hepatitis C from aggravation of chronic hepatitis C. Diagnosis of acute hepatitis C in the majority of cases should be based on the presence of the corresponding data of epidemiological anamnesis 1-4 months prior to the first time signs of the hepatitis C anti-virus and enzymemia were revealed.
Criteria for diagnosis of chronic hepatitis C are: liver and spleen enlargement, hyperenzymemia and anti-virus of hepatitis C in the blood for not less than 6 months, with exclusion of other chronic liver diseases. The precise character of liver disease, namely, degree of necrosis and inflammatory changes and stage of fibrosis, can be defined by the liver biopsy.
The presence or absence of an RNA of the hepatitis C virus is, as a rule, not diagnostic criterion of chronic hepatitis C, and only defines a process phase (active, inactive).
Treatment of Hepatitis C
The EMC Hepatology Center carries out specialist treatment of patients with chronic hepatitis C.
If there are other serious accompanying diseases, treatment is carried out together with specialists according to the profile of disease of the patient (urologist, oncologist, cardiologist, endocrynologist, venereologist etc.).
In most cases, treatment can be carried out in out-patient polyclinic conditions. The following methods of treatment are applied: IFN treatment, combined therapy.
At the Hepatology Center, the following is possible: