Treatment of severe alcoholic hepatitis: past, present and future

European Journal of Clinical Investigation
N Lanthier, Peter Stärkel

Abstract

Alcoholic hepatitis (AH) manifests as a clinical syndrome characterized by recent jaundice and liver function deterioration in an actively drinking patient. The principal cause of AH is alcoholic steatohepatitis (ASH) defined histologically by the coexistence of steatosis, hepatocyte ballooning and satellitosis. While nonsevere AH usually responds to alcohol abstinence, severe AH, identified by Maddrey scoring ≥ 32, has a bad prognosis and is traditionally treated by a 28-day course of prednisone therapy. A recent trial, which showed no improvement of long-term survival but significant reduced mortality after 28 days of corticoid therapy compared to placebo, opens a debate on its efficacy. N-acetyl-cysteine supplementation combined with steroid therapy is also able to reduce the 28-day mortality compared to steroid alone. While guidelines recommend high-calorie intake and protein supplementation in decompensated liver diseases, intensive enteral nutrition together with corticoid treatment does not reduce mortality compared to corticoid alone in a recent study with ASH patients. Stimulation of liver regeneration through interleukin-22, granulocyte colony-stimulating factor or farnesoid X receptor agonists, inhibition of apoptosi...Continue Reading

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Citations

Dec 19, 2017·Evidence-based Complementary and Alternative Medicine : ECAM·Qiong-Hui HuangYou-Liang Xie
Aug 14, 2018·Alcoholism, Clinical and Experimental Research·Veronica L MasseyFulton T Crews
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Apr 23, 2019·Experimental and Therapeutic Medicine·Mingyang LiQian Ji
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Mar 26, 2021·Seminars in Liver Disease·Chandan Kumar KedarisettyShiv Kumar Sarin
Jul 18, 2021·International Immunopharmacology·Amir Mohamed AbdelhamidRania Ramadan Abdelaziz

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