Separation of Specialty Training in Hepatology and Gastroenterology: The Imminent Divorce of Gastroenterology and Hepatology?

摘要

It is fascinating to watch the rapid growth of a major field, and an excellent example in internal medicine is hepatology. It is hard to believe that despite the discovery of the hepatitis B virus in 1967 and the introduction in the early 1970s of endoscopic sclerotherapy for esophageal varices, little really could be done for most chronic liver disease patients in the late 1970s when I was in medical school. Dying patients with alcoholic or other types of end-stage liver disease filled hospital beds then, and the treatment was palliative, at best. Soon, however, the field began to change, and much more rapidly than expected. The landmark discoveries included the identification of the hepatitis C virus in 1999, and then, the subsequent introduction of viable anti-hepatitis C therapies, with continued improvement in sustained virologi-cal remission rates. The first successful liver transplant was in 1965, but survival of the liver transplants only began to dramatically improve following the introductionof cyclosporine in the early 1980s and the development of dedicated liver transplant units, leading to the current situation, where figures for graph survival and function at 1 yr are now up to 90% with a 5- to 10-yr survival of around 70%