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Controversies in the management of alcoholic liver disease.
Mt Sinai J Med 2009; 76(5):484-98MS

Abstract

Alcohol is a risk factor for chronic disease burden in developed countries. Alcoholic liver disease affects 1% of the North American population and is the second most frequent indication for liver transplantation in the United States. It is a spectrum that ranges from simple hepatic steatosis to alcoholic hepatitis to steatohepatitis and eventually cirrhosis. The clinical spectrum of alcoholic hepatitis is wide and ranges from the asymptomatic patient to overt liver failure and death. Liver biopsy as a means of prognostication in alcoholic hepatitis has mostly been replaced with less invasive scoring systems. The management of alcoholic liver disease is challenging. Abstinence is the cornerstone of therapy and should include rehabilitation with a multidisciplinary approach. No specific treatment is required in mild to moderate alcoholic hepatitis. In patients with severe hepatitis, there appears to be a moderate survival benefit from the use of either corticosteroids or pentoxifylline in the absence of contraindications to their use. Nonresponders should have steroid therapy withdrawn by day 7, as persistence with therapy is not beneficial. Orthotopic liver transplantation remains the definitive therapy for decompensated alcoholic cirrhosis despite alcohol abstinence. More studies are needed to define the optimal timing of orthotopic liver transplantation and patients at risk of alcohol relapse post-transplant. Mt Sinai J Med 76:484-498, 2009. (c) 2009 Mount Sinai School of Medicine.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore. mhyhui@gmail.comNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19787655

Citation

Tan, Hui-Hui, et al. "Controversies in the Management of Alcoholic Liver Disease." The Mount Sinai Journal of Medicine, New York, vol. 76, no. 5, 2009, pp. 484-98.
Tan HH, Virmani S, Martin P. Controversies in the management of alcoholic liver disease. Mt Sinai J Med. 2009;76(5):484-98.
Tan, H. H., Virmani, S., & Martin, P. (2009). Controversies in the management of alcoholic liver disease. The Mount Sinai Journal of Medicine, New York, 76(5), pp. 484-98. doi:10.1002/msj.20135.
Tan HH, Virmani S, Martin P. Controversies in the Management of Alcoholic Liver Disease. Mt Sinai J Med. 2009;76(5):484-98. PubMed PMID: 19787655.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Controversies in the management of alcoholic liver disease. AU - Tan,Hui-Hui, AU - Virmani,Sharad, AU - Martin,Paul, PY - 2009/9/30/entrez PY - 2009/9/30/pubmed PY - 2011/1/15/medline SP - 484 EP - 98 JF - The Mount Sinai journal of medicine, New York JO - Mt. Sinai J. Med. VL - 76 IS - 5 N2 - Alcohol is a risk factor for chronic disease burden in developed countries. Alcoholic liver disease affects 1% of the North American population and is the second most frequent indication for liver transplantation in the United States. It is a spectrum that ranges from simple hepatic steatosis to alcoholic hepatitis to steatohepatitis and eventually cirrhosis. The clinical spectrum of alcoholic hepatitis is wide and ranges from the asymptomatic patient to overt liver failure and death. Liver biopsy as a means of prognostication in alcoholic hepatitis has mostly been replaced with less invasive scoring systems. The management of alcoholic liver disease is challenging. Abstinence is the cornerstone of therapy and should include rehabilitation with a multidisciplinary approach. No specific treatment is required in mild to moderate alcoholic hepatitis. In patients with severe hepatitis, there appears to be a moderate survival benefit from the use of either corticosteroids or pentoxifylline in the absence of contraindications to their use. Nonresponders should have steroid therapy withdrawn by day 7, as persistence with therapy is not beneficial. Orthotopic liver transplantation remains the definitive therapy for decompensated alcoholic cirrhosis despite alcohol abstinence. More studies are needed to define the optimal timing of orthotopic liver transplantation and patients at risk of alcohol relapse post-transplant. Mt Sinai J Med 76:484-498, 2009. (c) 2009 Mount Sinai School of Medicine. SN - 1931-7581 UR - https://www.unboundmedicine.com/medline/citation/19787655/Controversies_in_the_management_of_alcoholic_liver_disease_ L2 - https://doi.org/10.1002/msj.20135 DB - PRIME DP - Unbound Medicine ER -