Alcoholic hepatitis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2] Shadan Mehraban, M.D.[3]
Overview
All patients with Alcoholic Hepatitis must be advised to stopped alcohol use. Additionally, nutritional supplements including [folic acid]], thiamine, vitamin B6, vitamin A and zinc can be provided. Glucocorticoids is the most common pharmacologic treatment in Alcoholic Hepatitis .Pentoxifylline can be used in patient with contraindication to steroids.
Medical Therapy
General therapy for Alcoholic Hepatitis includes:[1][2][3][4][5]
- Abstinence from alcohol has been shown to lead to resolution of hepatic steatosis and slow the progression of alcoholic fibrosis, cirrhosis and decompensated liver failure.
- Nutritional support - Adequate amounts of carbohydrates and calories as alcoholics are commonly malnourished
- Folic acid, thiamine, vitamin B6, vitamin A and zinc supplements are recommended.
Pharmacotherapy
- Glucocorticoids[6][7][8][9][10][11][12][13]
- Beneficial in patients with hepatic encephalopathy, Maddrey's discriminant function score ≥32, or a MELD score ≥21.
- Decreases short term mortality.
- Usually given for 1 month.
- Serum bilirubin is used as a predictor for treatment success. Failure of the serum bilirubin level to decline after 7 days of treatment predicts poor prognosis.
- Another predictor of treatment is Lille model comprising, age, serum creatinine, serum albumin, prothrombin time (or INR), serum bilirubin on admission, and serum bilirubin on day 7.
- Contraindicated in the presence of sepsis, hepatorenal syndrome, chronic hepatitis B virus infection and gastrointestinal bleeding.
- Pentoxifylline[14][15][14][16][17][18]
- It is a tumor necrosis factor inhibitor.
- Used in patients with contraindications to steroids.
- Usually given for 1 months.
- Decreases mortality.
- Decreases risk of hepatorenal syndrome.
- S-adenosylmethionine.
- Silymarin (silybum marianum-milk thistle).
References
- ↑ Sofair AN, Barry V, Manos MM, Thomas A, Zaman A, Terrault NA, Murphy RC, Stabach N, Huie S, Van Ness G, Bell BP, Bialek S (2010). "The epidemiology and clinical characteristics of patients with newly diagnosed alcohol-related liver disease: results from population-based surveillance". J. Clin. Gastroenterol. 44 (4): 301–7. doi:10.1097/MCG.0b013e3181b3f760. PMID 19745759.
- ↑ Moos RH, King MJ, Patterson MA (1996). "Outcomes of residential treatment of substance abuse in hospital- and community-based programs". Psychiatr Serv. 47 (1): 68–74. doi:10.1176/ps.47.1.68. PMID 8925349.
- ↑ Halsted CH (2004). "Nutrition and alcoholic liver disease". Semin. Liver Dis. 24 (3): 289–304. doi:10.1055/s-2004-832941. PMID 15349806.
- ↑ Kang YJ, Zhou Z (2005). "Zinc prevention and treatment of alcoholic liver disease". Mol. Aspects Med. 26 (4–5): 391–404. doi:10.1016/j.mam.2005.07.002. PMID 16099027.
- ↑ McCullough AJ, O'Connor JF (1998). "Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology". Am. J. Gastroenterol. 93 (11): 2022–36. doi:10.1111/j.1572-0241.1998.00587.x. PMID 9820369.
- ↑ Addolorato G, Russell M, Albano E, Haber PS, Wands JR, Leggio L (2009). "Understanding and treating patients with alcoholic cirrhosis: an update". Alcohol. Clin. Exp. Res. 33 (7): 1136–44. doi:10.1111/j.1530-0277.2009.00956.x. PMID 19389182.
- ↑ Christensen E (2002). "Alcoholic hepatitis--glucocorticosteroids or not?". J. Hepatol. 36 (4): 547–8. PMID 11943428.
- ↑ Ramond MJ, Poynard T, Rueff B, Mathurin P, Théodore C, Chaput JC, Benhamou JP (1992). "A randomized trial of prednisolone in patients with severe alcoholic hepatitis". N. Engl. J. Med. 326 (8): 507–12. doi:10.1056/NEJM199202203260802. PMID 1531090.
- ↑ Carithers RL, Herlong HF, Diehl AM, Shaw EW, Combes B, Fallon HJ, Maddrey WC (1989). "Methylprednisolone therapy in patients with severe alcoholic hepatitis. A randomized multicenter trial". Ann. Intern. Med. 110 (9): 685–90. PMID 2648927.
- ↑ Maddrey WC, Boitnott JK, Bedine MS, Weber FL, Mezey E, White RI (1978). "Corticosteroid therapy of alcoholic hepatitis". Gastroenterology. 75 (2): 193–9. PMID 352788.
- ↑ Rambaldi A, Saconato HH, Christensen E, Thorlund K, Wetterslev J, Gluud C (2008). "Systematic review: glucocorticosteroids for alcoholic hepatitis--a Cochrane Hepato-Biliary Group systematic review with meta-analyses and trial sequential analyses of randomized clinical trials". Aliment. Pharmacol. Ther. 27 (12): 1167–78. doi:10.1111/j.1365-2036.2008.03685.x. PMID 18363896.
- ↑ O'Shea R, McCullough AJ (2006). "Steroids or cocktails for alcoholic hepatitis". J. Hepatol. 44 (4): 633–6. doi:10.1016/j.jhep.2006.01.011. PMID 16503078.
- ↑ "LilleModel".
- ↑ 14.0 14.1 Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O (2000). "Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial". Gastroenterology. 119 (6): 1637–48. PMID 11113085.
- ↑ Assimakopoulos SF, Thomopoulos KC, Labropoulou-Karatza C (2009). "Pentoxifylline: a first line treatment option for severe alcoholic hepatitis and hepatorenal syndrome?". World J. Gastroenterol. 15 (25): 3194–5. PMC 2705746. PMID 19575503.
- ↑ Louvet A, Diaz E, Dharancy S, Coevoet H, Texier F, Thévenot T, Deltenre P, Canva V, Plane C, Mathurin P (2008). "Early switch to pentoxifylline in patients with severe alcoholic hepatitis is inefficient in non-responders to corticosteroids". J. Hepatol. 48 (3): 465–70. doi:10.1016/j.jhep.2007.10.010. PMID 18164508.
- ↑ De BK, Gangopadhyay S, Dutta D, Baksi SD, Pani A, Ghosh P (2009). "Pentoxifylline versus prednisolone for severe alcoholic hepatitis: a randomized controlled trial". World J. Gastroenterol. 15 (13): 1613–9. PMC 2669113. PMID 19340904.
- ↑ Whitfield K, Rambaldi A, Wetterslev J, Gluud C (2009). "Pentoxifylline for alcoholic hepatitis". Cochrane Database Syst Rev (4): CD007339. doi:10.1002/14651858.CD007339.pub2. PMID 19821406.
- ↑ Lee TD, Sadda MR, Mendler MH, Bottiglieri T, Kanel G, Mato JM, Lu SC (2004). "Abnormal hepatic methionine and glutathione metabolism in patients with alcoholic hepatitis". Alcohol. Clin. Exp. Res. 28 (1): 173–81. doi:10.1097/01.ALC.0000108654.77178.03. PMID 14745316.
- ↑ Song Z, McClain CJ, Chen T (2004). "S-Adenosylmethionine protects against acetaminophen-induced hepatotoxicity in mice". Pharmacology. 71 (4): 199–208. doi:10.1159/000078086. PMID 15240996.
- ↑ McClain CJ, Hill DB, Song Z, Chawla R, Watson WH, Chen T, Barve S (2002). "S-Adenosylmethionine, cytokines, and alcoholic liver disease". Alcohol. 27 (3): 185–92. PMID 12163148.
- ↑ Ferenci P, Dragosics B, Dittrich H, Frank H, Benda L, Lochs H, Meryn S, Base W, Schneider B (1989). "Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver". J. Hepatol. 9 (1): 105–13. PMID 2671116.
- ↑ Parés A, Planas R, Torres M, Caballería J, Viver JM, Acero D, Panés J, Rigau J, Santos J, Rodés J (1998). "Effects of silymarin in alcoholic patients with cirrhosis of the liver: results of a controlled, double-blind, randomized and multicenter trial". J. Hepatol. 28 (4): 615–21. PMID 9566830.