Treatment of decompensated alcoholic liver disease.

John Menachery,Ajay Duseja

doi:10.4061/2011/219238

Abstract

Alcoholic liver disease (ALD) is a spectrum ranging from simple hepatic steatosis to alcoholic hepatitis and cirrhosis. Patients with severe alcoholic hepatitis can have clinical presentation almost similar to those with decompensated cirrhosis. Scoring with models like Maddrey discriminant function, a model for end-stage liver disease, Glasgow alcoholic hepatitis score, and Lille model are helpful in prognosticating patients with ALD. One of the first therapeutic goals in ALD is to induce alcohol withdrawal with psychotherapy or drugs. Most studies have shown that nutritional therapy improves liver function and histology in patients with ALD. The rationale for using glucocorticoids is to block cytotoxic and inflammatory pathways in patients with severe alcoholic hepatitis. Pentoxifylline, a tumor necrosis factor alpha (TNFα) suppressor, and infliximab, an anti-TNFα mouse/human chimeric antibody, has been extensively studied in patients with alcoholic hepatitis. Liver transplantation remains the definitive therapy for decompensated cirrhosis/alcoholic hepatitis despite the issues of recidivism, poor compliance with postoperative care, and being a self-inflicted disease.

Highlights

Alcohol is a major risk factor for chronic disease burden all over the world
alcoholic liver disease (ALD) is a spectrum that ranges from fatty liver to alcoholic steatohepatitis (ASH) and eventually cirrhosis
A recent study showed that among the various prognostic scores for acute alcoholic hepatitis (Lille, Glasgow, and Maddrey scores) and cirrhosis (MELD, Model for End-Stage Liver Disease (MELD)-Na, and ChildTurcotte-Pugh) in ALD patients treated with corticosteroids, Lille score ≥0.45 and Glasgow Alcoholic Hepatitis Score (GAHS) ≥9 were the most accurate models for the prediction of mortality [13]

Summary

Introduction

Alcohol abusers and patients with alcoholic liver disease (ALD) usually suffer negative consequences from drinking such as significant financial burden, unemployment, loss of family, accidental injury, or death [1]. ALD is a spectrum that ranges from fatty liver to alcoholic steatohepatitis (ASH) and eventually cirrhosis. Alcoholic hepatitis or ASH occurs in up to 35% of heavy drinkers and is usually a precursor of cirrhosis [2]. Only a minority of individuals who consume alcohol in excess develop significant ALD Synergistic factors such as chronic hepatitis C, obesity, and genetic factors may accelerate the development of ALD even at lower doses of alcohol consumption. The majority of patients with severe alcoholic hepatitis have either significant fibrosis or cirrhosis liver. Alcoholic hepatitis with underlying cirrhosis is one of the most important causes of acute on chronic liver failure (ACLF) [5]

Prognostic Models in Patients with Alcoholic Liver Disease

Treatment of Alcoholic Liver Disease

Antitumor Necrosis Factor Alpha Treatment