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Update on the management of alcoholic steatohepatitis.
J Gastrointestin Liver Dis. 2013 Jun; 22(2):189-97.JG

Abstract

Among heavy drinkers with liver disease, the development of severe alcoholic hepatitis (AH) is a serious complication. Prognosis is grave and associated with a high mortality due to liver failure, hepatorenal syndrome or intractable sepsis. Clinically, AH presents as a syndrome of progressive inflammatory liver injury in patients with recent or ongoing heavy alcohol consumption. Although approximately 20% of alcoholics undergoing liver biopsy reveal histological features of AH, only a minority progress to severe AH with markedly elevated serum liver enzymes, jaundice and impaired liver function. To establish the diagnosis of AH, histology is recommended but not mandatory. Prognostic scores include the Maddrey's discriminant function, the model of end-stage liver disease, the Glasgow Alcoholic Hepatitis score, and the ABIC score. While the former scores identify patients at risk of death or the need for corticosteroids, the response to corticosteroid therapy can be assessed using the Lille model. Treatments include abstinence and enteral nutrition, while pharmacotherapy using corticosteroids either with or without N-acetylcysteine may be indicated for patients with severe AH. Pentoxifylline was found to reduce the risk of hepatorenal syndrome, but data on mortality are limited. Although considered a contraindication in most transplant centers, recent evidence indicates that carefully selected patients with AH could be good candidates for liver transplantation with a prognosis comparable to other indications.

Authors+Show Affiliations

Hepatology Unit, Klinik Beau-Site, Department of Visceral Surgery and Medicine Inselspital, University of Bern, Bern, Switzerland. felix.stickel@ikp.unibe.chNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

23799218

Citation

Stickel, Felix, and Helmut K. Seitz. "Update On the Management of Alcoholic Steatohepatitis." Journal of Gastrointestinal and Liver Diseases : JGLD, vol. 22, no. 2, 2013, pp. 189-97.
Stickel F, Seitz HK. Update on the management of alcoholic steatohepatitis. J Gastrointestin Liver Dis. 2013;22(2):189-97.
Stickel, F., & Seitz, H. K. (2013). Update on the management of alcoholic steatohepatitis. Journal of Gastrointestinal and Liver Diseases : JGLD, 22(2), 189-97.
Stickel F, Seitz HK. Update On the Management of Alcoholic Steatohepatitis. J Gastrointestin Liver Dis. 2013;22(2):189-97. PubMed PMID: 23799218.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Update on the management of alcoholic steatohepatitis. AU - Stickel,Felix, AU - Seitz,Helmut K, PY - 2013/6/27/entrez PY - 2013/6/27/pubmed PY - 2013/12/16/medline SP - 189 EP - 97 JF - Journal of gastrointestinal and liver diseases : JGLD JO - J Gastrointestin Liver Dis VL - 22 IS - 2 N2 - Among heavy drinkers with liver disease, the development of severe alcoholic hepatitis (AH) is a serious complication. Prognosis is grave and associated with a high mortality due to liver failure, hepatorenal syndrome or intractable sepsis. Clinically, AH presents as a syndrome of progressive inflammatory liver injury in patients with recent or ongoing heavy alcohol consumption. Although approximately 20% of alcoholics undergoing liver biopsy reveal histological features of AH, only a minority progress to severe AH with markedly elevated serum liver enzymes, jaundice and impaired liver function. To establish the diagnosis of AH, histology is recommended but not mandatory. Prognostic scores include the Maddrey's discriminant function, the model of end-stage liver disease, the Glasgow Alcoholic Hepatitis score, and the ABIC score. While the former scores identify patients at risk of death or the need for corticosteroids, the response to corticosteroid therapy can be assessed using the Lille model. Treatments include abstinence and enteral nutrition, while pharmacotherapy using corticosteroids either with or without N-acetylcysteine may be indicated for patients with severe AH. Pentoxifylline was found to reduce the risk of hepatorenal syndrome, but data on mortality are limited. Although considered a contraindication in most transplant centers, recent evidence indicates that carefully selected patients with AH could be good candidates for liver transplantation with a prognosis comparable to other indications. SN - 1842-1121 UR - https://www.unboundmedicine.com/medline/citation/23799218/Update_on_the_management_of_alcoholic_steatohepatitis_ L2 - http://www.jgld.ro/2013/2/11.html DB - PRIME DP - Unbound Medicine ER -