Treatment of acute alcoholic hepatitis
(2016) Falk Symposium 205: New Treatment Targets in Gut and Liver Diseases — Location: Lucerne (21.October.2016)
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- Acute alcoholic hepatitis (now called 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 non-severe 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 or to pentoxifylline treatment, opens a debate on its efficacy. This trial has to be interpreted with caution given the high rate of alcohol recidivism and no histological confirmation of ASH. N-acetyl-cysteine supplementation combined to steroid therapy is also able to reduce the 28-day mortality compared to steroid alone. While guidelines from nutrition societies recommend high calorie intake and protein supplementation in decompensated liver diseases, intensive enteral nutrition through a nasogastric tube 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 or granulocyte colony stimulating factor administration, inhibition of apoptosis or oxidative stress, early liver transplantation and modulation of systemic inflammation and gut microbiota through prebiotic, antibiotic or fecal transplantation approaches constitute new therapeutic perspectives that are investigated in current clinical trials. For long term survival, strategies for persistent alcohol abstinence remain the key of success, opening another large research field.
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Lanthier, N. (2016). Treatment of acute alcoholic hepatitis. Falk Symposium 205: New Treatment Targets in Gut and Liver Diseases, Lucerne. https://hdl.handle.net/2078.5/181315