Alcoholic hepatitis medical therapy: Difference between revisions
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{{Alcoholic hepatitis}} | {{Alcoholic hepatitis}} | ||
{{CMG}}; '''Assosciate Editor(s)-In-Chief:''' [[User: Prashanthsaddala|Prashanth Saddala M.B.B.S]] | |||
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==Medical Therapy== | ==Medical Therapy== | ||
===Corticosteroids=== | |||
[[Clinical practice guidelines]] by the [[American College of Gastroenterology]] recommend corticosteroids.<ref name="pmid9820369">{{cite journal |author=McCullough AJ, O'Connor JF |title=Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology |journal=Am. J. Gastroenterol. |volume=93 |issue=11 |pages=2022-36 |year=1998 |pmid=9820369 |doi=}}</ref> | [[Clinical practice guidelines]] by the [[American College of Gastroenterology]] recommend corticosteroids.<ref name="pmid9820369">{{cite journal |author=McCullough AJ, O'Connor JF |title=Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology |journal=Am. J. Gastroenterol. |volume=93 |issue=11 |pages=2022-36 |year=1998 |pmid=9820369 |doi=}}</ref> | ||
Patients with a [[discriminant function]] score > 32 or [[hepatic encephalopathy]] should be considered for treatment with [[prednisolone]] 40 mg daily for four weeks followed by a taper.<ref name="pmid9820369"/> | Patients with a [[discriminant function]] score > 32 or [[hepatic encephalopathy]] should be considered for treatment with [[prednisolone]] 40 mg daily for four weeks followed by a taper.<ref name="pmid9820369"/> | ||
===Pentoxifylline=== | |||
A randomized controlled trial found that 5 patients with a [[discriminant function]] score > 32 and at least one of palpable tender hepatomegaly, fever, leukocytosis, hepatic encephalopathy, or hepatic systolic bruit [[number needed to treat| must be treated]] with [[pentoxifylline]] 400 mg orally 3 times daily for 4 weeks for one to prevent one patient from dying. <ref name="pmid11113085">{{cite journal |author=Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O |title=Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial |journal=Gastroenterology |volume=119 |issue=6 |pages=1637-48 |year=2000 |pmid=11113085 |doi=10.1053/gast.2000.20189 }} ([http://www.acpjc.org/Content/135/1/ISSUE/ACPJC-2001-135-1-004.htm ACP Journal Club synopsis])</ref> | A randomized controlled trial found that 5 patients with a [[discriminant function]] score > 32 and at least one of palpable tender hepatomegaly, fever, leukocytosis, hepatic encephalopathy, or hepatic systolic bruit [[number needed to treat| must be treated]] with [[pentoxifylline]] 400 mg orally 3 times daily for 4 weeks for one to prevent one patient from dying. <ref name="pmid11113085">{{cite journal |author=Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O |title=Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial |journal=Gastroenterology |volume=119 |issue=6 |pages=1637-48 |year=2000 |pmid=11113085 |doi=10.1053/gast.2000.20189 }} ([http://www.acpjc.org/Content/135/1/ISSUE/ACPJC-2001-135-1-004.htm ACP Journal Club synopsis])</ref> | ||
=== Acute Pharmacotherapies === | |||
* In very severe disease, such as those with encephalopathy or other markers of advanced disease, treatment with steroids may improved outcome – Prednisolone 40 mg every day for 4 weeks and then tapered. | * In very severe disease, such as those with encephalopathy or other markers of advanced disease, treatment with steroids may improved outcome – Prednisolone 40 mg every day for 4 weeks and then tapered. | ||
*:* Possible contraindications to steroids must be considered, such as acute infection, gastrointestinal (GI) hemorrhage, etc. | *:* Possible contraindications to steroids must be considered, such as acute infection, gastrointestinal (GI) hemorrhage, etc. | ||
| Line 20: | Line 19: | ||
* Propylthiouracil (PTU) has been tried in these patients and may be moderately effective in patients who continue the treatment and discontinue alcohol. | * Propylthiouracil (PTU) has been tried in these patients and may be moderately effective in patients who continue the treatment and discontinue alcohol. | ||
* Colchicine 0.6 mg by mouth, twice daily may help to slow progression of liver disease, though the data is not conclusive. | * Colchicine 0.6 mg by mouth, twice daily may help to slow progression of liver disease, though the data is not conclusive. | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Needs | [[Category:Needs overview]] | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assosciate Editor(s)-In-Chief: Prashanth Saddala M.B.B.S
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Medical Therapy
Corticosteroids
Clinical practice guidelines by the American College of Gastroenterology recommend corticosteroids.[1]
Patients with a discriminant function score > 32 or hepatic encephalopathy should be considered for treatment with prednisolone 40 mg daily for four weeks followed by a taper.[1]
Pentoxifylline
A randomized controlled trial found that 5 patients with a discriminant function score > 32 and at least one of palpable tender hepatomegaly, fever, leukocytosis, hepatic encephalopathy, or hepatic systolic bruit must be treated with pentoxifylline 400 mg orally 3 times daily for 4 weeks for one to prevent one patient from dying. [2]
Acute Pharmacotherapies
- In very severe disease, such as those with encephalopathy or other markers of advanced disease, treatment with steroids may improved outcome – Prednisolone 40 mg every day for 4 weeks and then tapered.
- Possible contraindications to steroids must be considered, such as acute infection, gastrointestinal (GI) hemorrhage, etc.
- Other considerations:
- Acetaminophen use should be < 2gm / day
- Fasting also increases risks of acetaminophen toxicity in alcoholics
- Propylthiouracil (PTU) has been tried in these patients and may be moderately effective in patients who continue the treatment and discontinue alcohol.
- Colchicine 0.6 mg by mouth, twice daily may help to slow progression of liver disease, though the data is not conclusive.
References
- ↑ 1.0 1.1 McCullough AJ, O'Connor JF (1998). "Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology". Am. J. Gastroenterol. 93 (11): 2022–36. PMID 9820369.
- ↑ Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O (2000). "Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial". Gastroenterology. 119 (6): 1637–48. doi:10.1053/gast.2000.20189. PMID 11113085. (ACP Journal Club synopsis)