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Diagnosis and management of alcoholic liver disease.

Abstract

Alcohol is the most commonly used hepatotoxin worldwide. About 90% of heavy drinkers (more than 60 g/day of alcohol) show evidence of fatty livers, while only 10-35% develop alcoholic hepatitis and 5-15% developed cirrhosis. The daily intake of alcohol that results in liver injury varies and depends on a number of risk factors. Alcoholic disease developes at lower doses in females, Hispanic, obese objects, and patients with hepatitis C. Insights into the pathogenesis of alcohol-induced liver injury has improved significantly but the translation into clinical benefit has been slow. The importance of continued abstinence and correction of nutritional deficiencies are major components in the long-term management of liver disease. Alcohol hepatitis has a variable mortality and the prognosis is determined most commonly by the modified discriminant function. The mocel of end-stage liver disease (MELD) is being increasingly used to predict outcome in alcoholic hepatitis even though standard cut offs are not available. Anti-inflammatory therapy with corticosteroids and anticytokine therapy with corticosteroids and pentoxifylline are effective for patients with severe alcoholic hepatitis. Patients with endstage liver disease should be considered for liver transplantation. Six months of abstinence is considered to be a requirement prior to transplant, but this length of time may be adjusted in individual bases.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Gastroenterology and Hepatology and The Digestive Disease Institute and the Cleveland Clinic Lerner College of Medicine at Case Western University, Cleveland, Ohio 44195, USA. mcculla@ccf.org

    ,

    Source

    Journal of digestive diseases 12:4 2011 Aug pg 257-62

    MeSH

    Adrenal Cortex Hormones
    Hepatitis, Alcoholic
    Humans
    Liver Diseases, Alcoholic
    Liver Transplantation
    Pentoxifylline
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    21091932

    Citation

    McCullough, Arthur J., et al. "Diagnosis and Management of Alcoholic Liver Disease." Journal of Digestive Diseases, vol. 12, no. 4, 2011, pp. 257-62.
    McCullough AJ, O'Shea RS, Dasarathy S. Diagnosis and management of alcoholic liver disease. J Dig Dis. 2011;12(4):257-62.
    McCullough, A. J., O'Shea, R. S., & Dasarathy, S. (2011). Diagnosis and management of alcoholic liver disease. Journal of Digestive Diseases, 12(4), pp. 257-62. doi:10.1111/j.1751-2980.2010.00470.x.
    McCullough AJ, O'Shea RS, Dasarathy S. Diagnosis and Management of Alcoholic Liver Disease. J Dig Dis. 2011;12(4):257-62. PubMed PMID: 21091932.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Diagnosis and management of alcoholic liver disease. AU - McCullough,Arthur J, AU - O'Shea,Robert S, AU - Dasarathy,Srinivasan, PY - 2010/11/25/entrez PY - 2010/11/26/pubmed PY - 2011/12/14/medline SP - 257 EP - 62 JF - Journal of digestive diseases JO - J Dig Dis VL - 12 IS - 4 N2 - Alcohol is the most commonly used hepatotoxin worldwide. About 90% of heavy drinkers (more than 60 g/day of alcohol) show evidence of fatty livers, while only 10-35% develop alcoholic hepatitis and 5-15% developed cirrhosis. The daily intake of alcohol that results in liver injury varies and depends on a number of risk factors. Alcoholic disease developes at lower doses in females, Hispanic, obese objects, and patients with hepatitis C. Insights into the pathogenesis of alcohol-induced liver injury has improved significantly but the translation into clinical benefit has been slow. The importance of continued abstinence and correction of nutritional deficiencies are major components in the long-term management of liver disease. Alcohol hepatitis has a variable mortality and the prognosis is determined most commonly by the modified discriminant function. The mocel of end-stage liver disease (MELD) is being increasingly used to predict outcome in alcoholic hepatitis even though standard cut offs are not available. Anti-inflammatory therapy with corticosteroids and anticytokine therapy with corticosteroids and pentoxifylline are effective for patients with severe alcoholic hepatitis. Patients with endstage liver disease should be considered for liver transplantation. Six months of abstinence is considered to be a requirement prior to transplant, but this length of time may be adjusted in individual bases. SN - 1751-2980 UR - https://www.unboundmedicine.com/medline/citation/21091932/Diagnosis_and_management_of_alcoholic_liver_disease_ L2 - https://doi.org/10.1111/j.1751-2980.2010.00470.x DB - PRIME DP - Unbound Medicine ER -