‘All hands on deck’: GIs should continue to be part of viral hepatitis care team
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Primary care providers and other specialists often refer patients to gastroenterologists with any liver-related health concerns, as they are the first touch point for newly diagnosed patients or those living with chronic liver disease.
In addition, in many practice settings hepatologists, or dedicated liver specialists, are not available. As such, it is often the gastroenterologists who are the front-line providers to identify and manage viral hepatitis. Thus, it is important that once GI providers see patients who are at risk for, or living with viral hepatitis, they conduct the appropriate testing and ensure that patients are linked to follow up care.
GIs ‘Play an Important Role’ in Implementing Recommendations
We now have national recommendations for screening for viral hepatitis.
The recommendations say that all adults in the United States should be screened for hepatitis C virus, at least once or more frequently, if they have risk factors. Additionally, all patients should be screened for hepatitis B virus with the triple panel. This was a recommendation by the CDC in 2023, which states that all adults in the U.S. should be tested with a hepatitis B surface antigen, hepatitis B core antibody and hepatitis B surface antibody. Patients who are not yet vaccinated for HBV should be vaccinated, and those who are found to have hepatitis B should be linked to treatment.
If this is a national recommendation, then to optimize adherence to this recommendation, it really should be all hands on deck. Gastroenterologists play an important role because as much as we try to encourage primary care providers to do a lot of this testing and vaccination, they have other considerations and may not have the background or time to order and interpret the needed tests. As we implement the national recommendations, gastroenterologists will play an important role in the identification of people with viral hepatitis and linkage to treatment and/or vaccination to those who need it.
Hepatitis B, Hepatitis C Treatment Should Not Be Siloed
There is a WHO goal to work toward global HBV and HCV elimination by the year 2030, and gastroenterologists play an important role in the screening, diagnosis and treatment for HBV and HCV to help hepatologists work toward this goal. By being involved in viral hepatitis elimination efforts, gastroenterologists will contribute to our efforts to decrease viral hepatitis burden nationally and globally.
We need more people to treat patients with HCV; it is not enough to keep it siloed in these super subspecialized hepatology practices. We need everyone involved in the treatment of hepatitis C, and gastroenterologists have the knowledge, background and ability to do it. We need them to continue to be involved in order to optimize patient health outcomes. Patients are much more likely to stay with a gastroenterologist specialist to undergo HCV and/or HBV treatment than having to go to another specialist for their liver care.
Screen for Hepatitis D While Screening for Hepatitis B
In terms of hepatitis D virus, gastroenterologists also can be helpful in terms of making sure that we are screening everyone and potentially linking patients with hepatitis D to clinical trials for treatment. If they are screening more people for HBV and finding more HBV-positive individuals, then they should also be screening for HDV.
Finally, gastroenterologists will play an important role in procedural evaluation in our patients with viral hepatitis. Patients with cirrhosis may need endoscopic evaluation for varices screening or for routine colorectal cancer screening, and gastroenterologists are the most skilled and do most of these procedures. Furthermore, some gastroenterologists are now performing liver biopsies via endoscopic ultrasound.
Thus, gastroenterologists will continue to play important roles in the procedural evaluation needed as part of liver care for people living with viral hepatitis and other liver diseases.
- For more information:
- Tatyana Kushner, MD, MSCE, is associate professor in the division of liver diseases at the Icahn School of Medicine at Mount Sinai. She can be reached at tatyana.kushner@mssm.edu.
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