English

Abstract

BACKGROUND: Alcoholic hepatitis is an acute form of alcohol induced liver injury. Its severity is measured using Maddrey's discriminant function (DF). DF>32 indicates severe hepatitis and poor outcome. TNF is responsible for liver injury in alcoholic hepatitis. Pentoxifylline (PTX) is a nonselective phosphodiesterase inhibitor which inhibits TNF production. The drug is safe, cheap and found effective in improving short term survival in severe acute alcoholic hepatitis. The present study compares the outcome of patients treated with pentoxifylline with other patients who were given only supportive care in the Indian scenario. MATERIALS AND METHODS: 50 patients with signs and symptoms of acute alcoholic hepatitis admitted at GGH, Guntur were studied. Diagnosis was done based on clinical and biochemical profile. RESULTS: Majority of the patients (54%) were in the age group of 40-50 years. All the patients presented with jaundice; others include fever (84%), abdomen distension (74%), generalized weakness (68%). Altered sleep pattern and altered sensorium were present in 34% and 10% of patients respectively. All the patients had hyperbilirubinimia, elevated AST with AST/ALT ratio>2:1 and prolonged prothrombin time. Most of the patients 68% had INR 2.The mortality in pentoxifylline treated group was 16.7% compared to 47.8% in patients who did not receive pentoxifylline, indicating that there is significant difference in the mortality in the above two groups. (p=0.037). CONCLUSIONS: Patients with severe alcoholic hepatitis (Maddrey's discriminant function, ≥32; or MELD score, ≥21: or GAHS, ≥9) who do not have sepsis should be given a trial of prednisolone at a dose of 40 mg per day for 28 days. In situations where corticosteroids are contraindicated, pentoxifylline is safe, economical, and useful in improving short term mortality in