OBJECTIVE: To evaluate the practice patterns of gastroenterologists in the diagnosis and management of chronic hepatitis B infection at St. Luke's Medical Center (SLMC) using the American Association for the Study of Liver Diseases Practice Guidelines.
METHODS: A written survey was distributed among active gastroenterologists from the Institute of Digestive Diseases, SLMC. The survey contained 22 items and addressed the following points: the number of hepatitis B surface antigen (HBsAg) positive patients seen every month; hepatitis B risk factors and screening blood tests; management of hepatitis B, including counseling; the use of antivirals; follow-up of patients; and screening for hepatocellular carcinoma.
RESULTS: A total of 21 (58 percent) gastroenterologists responded and returned the completed test questions out of the 36 sent out. Majority of the respondents (62 percent) encounter six to 10 patients with hepatitis B monthly. All of them indicated they offer blood testing for hepatitis B in patients with known risk factors. The most common blood test used to screen patients for hepatitis B was HBsAg (100 percent), total antibody to hepatitis B core antigen (86 percent) and antibody to HBsAg (71 percent). All of the respondents would request for alanine aminotransferase (ALT), hepatitis B e antigen, and liver ultrasound as part of the initial evaluation among HBsAg positive patients. After a diagnosis of hepatitis B is made, 95 percent of the respondents would counsel their patients to receive hepatitis A vaccination. Ninety-five percent of the respondents would routinely screen patients with chronic HBV infection for hepatocellular carcinoma using alpha fetoprotein and liver ultrasound regardless of the ALT level. The therapy of choice in 100 percent of the respondents for HBeAg positive patients with elevated ALT was pegylated interferon, while 81 percent of the respondents would choose Lamivudine. For HBeAg negative patients with elevated ALT, the therapy of choice was pegylated interferon (71 percent), Lamivudine (62 percent) and Adefovir (62 percent).
CONCLUSION: Majority of the gastroenterologists of SLMC followed an acceptable approach to the diagnosis and management of patients with chronic hepatitis B infection but substantial practice variation still exists.