Chronic hepatitis B: A critical appraisal of current approaches to therapy

Robert P. Perrillo, Robert G. Gish, Marion Peters, Emmet B. Keeffe, Alfredo Alberti, Maria Buti, W. Graham E. Cooksley, Michael W. Fried, Stephanos J. Hadziyannis, Yun Fan Liaw, Nikolai V. Naoumov, Eugene R. Schiff, Chloe L. Thio, Naoky Tsai, Solko Schalm

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Background & Aims: Treatment of chronic hepatitis B (CHB) involves a number of complex and controversial issues. Expert opinions may differ from those of practicing hepatologists and gastroenterologists. We aimed to explore this issue further after a critical review of the literature. Methods: A panel of 14 international experts graded the strength of evidence for 16 statements addressing 3 content areas: patient selection, therapeutic end points, and treatment options. Available data relating to the statements were reviewed critically in 3 small work groups. After discussion of each statement with the entire panel, the experts voted anonymously to accept or reject statements based on the strength of evidence and their experience. A total of 241 members of the American Association for the Study of Liver Diseases (AASLD) responded to the same statements and their responses were compared with those of the experts. A discordant response was defined as a difference of more than 20% in any of the 5 graded levels of response (accept or reject) between the 2 groups. Results: With the exception of 2 statements, the experts' responses were relatively uniform. However, the responses of the AASLD members were discordant from the experts in 12 statements, spanning all 3 content areas. Conclusions: Several areas of disagreement on the management of CHB exist between experts and AASLD members. Our results indicate a potential knowledge gap among practicing hepatologists. Better educational efforts are needed to meet the challenge of managing this complex disorder in which even expert opinion occasionally may disagree.

Original languageEnglish (US)
Pages (from-to)233-248
Number of pages16
JournalClinical Gastroenterology and Hepatology
Issue number2
StatePublished - Feb 2006

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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