Alcoholic liver disease medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Medical therapy

General

• Abstinence from alcohol
• Counseling and family support during alcohol abstinence
• Naltrexone or acamprosate to reduce relapse
• Nutritional support - Adequate amounts of carbohydrates and calories as alcoholics are commonly malnourished. This prevents endogenous protein catabolism, and hypoglycemia. Administration of thiamine is important with glucose supplements. This is so because glucose administration increases B1 consumption and B1 deficiency may lead to Wernicke–Korsakoff syndrome.
• Folic acid, thiamine, and zinc supplements are recommended.

Drug therapy

Alcoholic hepatitis

• Methylprednisolone
  • 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
• Pentoxifylline
• 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

Other less commonly used drugs

• Steroids + N-acetylcysteine
• Propylthiouracil
• Oxandrolone
• S-adenosyl-L-methionine
• Infliximab