Nouveaux traitements de l'hépatite alcoolique aiguë

Abstract

Alcoholic hepatitis is a common disease with an overall 1-year mortality of 20 %. Although the classical treatment for alcoholic hepatitis is abstinence, in some individuals abstinence alone is inadequate to promote survival and recovery. This is particularly true of patients with severe alcoholic hepatitis. Several agents have been examined as treatments for alcoholic hepatitis and cirrhosis. They have targeted several key processes in the pathophysiology of alcoholic liver disease, including hypermetabolism, inflammation, cytokine dysregulation and oxidant stress. The compounds that offer the greatest survival benefit to patients with severe alcoholic hepatitis are corticosteroids. But positive results are not uniform and there remains some controversy over their efficacy. Even if corticosteroids are beneficial for alcoholic hepatitis, they are not recommended for all patients at risk. In this regard other agents are being tested : pentoxifylline shows some promise, as does enteral feeding with medium chain triglycerides. Independent efforts are also being directed toward treatment of inflammation injuries of chronic alcoholic liver disease and alcoholic cirrhosis, anti-oxidants and anti-tumour necrosis factor alpha have received the greatest attention. Liver transplantation is sometime the only treatment of severe acute alcoholic hepatitis.