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==Medical Therapy==
==Medical Therapy==
===Corticosteroids===
General therapy for alcoholic liver disease includes:<ref name="pmid19745759">{{cite journal |vauthors=Sofair AN, Barry V, Manos MM, Thomas A, Zaman A, Terrault NA, Murphy RC, Stabach N, Huie S, Van Ness G, Bell BP, Bialek S |title=The epidemiology and clinical characteristics of patients with newly diagnosed alcohol-related liver disease: results from population-based surveillance |journal=J. Clin. Gastroenterol. |volume=44 |issue=4 |pages=301–7 |year=2010 |pmid=19745759 |doi=10.1097/MCG.0b013e3181b3f760 |url=}}</ref><ref name="pmid8925349">{{cite journal |vauthors=Moos RH, King MJ, Patterson MA |title=Outcomes of residential treatment of substance abuse in hospital- and community-based programs |journal=Psychiatr Serv |volume=47 |issue=1 |pages=68–74 |year=1996 |pmid=8925349 |doi=10.1176/ps.47.1.68 |url=}}</ref><ref name="pmid10208148">{{cite journal |vauthors=Garbutt JC, West SL, Carey TS, Lohr KN, Crews FT |title=Pharmacological treatment of alcohol dependence: a review of the evidence |journal=JAMA |volume=281 |issue=14 |pages=1318–25 |year=1999 |pmid=10208148 |doi= |url=}}</ref><ref name="pmid8985274">{{cite journal |vauthors=Naveau S, Giraud V, Borotto E, Aubert A, Capron F, Chaput JC |title=Excess weight risk factor for alcoholic liver disease |journal=Hepatology |volume=25 |issue=1 |pages=108–11 |year=1997 |pmid=8985274 |doi=10.1002/hep.510250120 |url=}}</ref><ref name="pmid15349806">{{cite journal |vauthors=Halsted CH |title=Nutrition and alcoholic liver disease |journal=Semin. Liver Dis. |volume=24 |issue=3 |pages=289–304 |year=2004 |pmid=15349806 |doi=10.1055/s-2004-832941 |url=}}</ref><ref name="pmid16099027">{{cite journal |vauthors=Kang YJ, Zhou Z |title=Zinc prevention and treatment of alcoholic liver disease |journal=Mol. Aspects Med. |volume=26 |issue=4-5 |pages=391–404 |year=2005 |pmid=16099027 |doi=10.1016/j.mam.2005.07.002 |url=}}</ref><ref name="pmid9820369">{{cite journal |vauthors=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=10.1111/j.1572-0241.1998.00587.x |url=}}</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>
*Abstinence from [[alcohol]] has been shown to lead to resolution of [[hepatic steatosis]] and slow the progression of alcoholic [[fibrosis]], [[cirrhosis]] and decompensated [[liver failure]].
*Nutritional support - Adequate amounts of [[Carbohydrate|carbohydrates]] and [[calories]] as alcoholics are commonly [[malnourished]]
**[[Folic acid]], [[thiamine]], [[vitamin B6]], [[vitamin A]] and [[zinc]] supplements are recommended.


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"/>
===Pharmacotherapy===
===Pentoxifylline===
====Alcoholic hepatitis====
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>
* '''Glucocorticoids'''<ref name="pmid19389182">{{cite journal |vauthors=Addolorato G, Russell M, Albano E, Haber PS, Wands JR, Leggio L |title=Understanding and treating patients with alcoholic cirrhosis: an update |journal=Alcohol. Clin. Exp. Res. |volume=33 |issue=7 |pages=1136–44 |year=2009 |pmid=19389182 |doi=10.1111/j.1530-0277.2009.00956.x |url=}}</ref><ref name="pmid11943428">{{cite journal |vauthors=Christensen E |title=Alcoholic hepatitis--glucocorticosteroids or not? |journal=J. Hepatol. |volume=36 |issue=4 |pages=547–8 |year=2002 |pmid=11943428 |doi= |url=}}</ref><ref name="pmid1531090">{{cite journal |vauthors=Ramond MJ, Poynard T, Rueff B, Mathurin P, Théodore C, Chaput JC, Benhamou JP |title=A randomized trial of prednisolone in patients with severe alcoholic hepatitis |journal=N. Engl. J. Med. |volume=326 |issue=8 |pages=507–12 |year=1992 |pmid=1531090 |doi=10.1056/NEJM199202203260802 |url=}}</ref><ref name="pmid2648927">{{cite journal |vauthors=Carithers RL, Herlong HF, Diehl AM, Shaw EW, Combes B, Fallon HJ, Maddrey WC |title=Methylprednisolone therapy in patients with severe alcoholic hepatitis. A randomized multicenter trial |journal=Ann. Intern. Med. |volume=110 |issue=9 |pages=685–90 |year=1989 |pmid=2648927 |doi= |url=}}</ref><ref name="pmid352788">{{cite journal |vauthors=Maddrey WC, Boitnott JK, Bedine MS, Weber FL, Mezey E, White RI |title=Corticosteroid therapy of alcoholic hepatitis |journal=Gastroenterology |volume=75 |issue=2 |pages=193–9 |year=1978 |pmid=352788 |doi= |url=}}</ref><ref name="pmid18363896">{{cite journal |vauthors=Rambaldi A, Saconato HH, Christensen E, Thorlund K, Wetterslev J, Gluud C |title=Systematic review: glucocorticosteroids for alcoholic hepatitis--a Cochrane Hepato-Biliary Group systematic review with meta-analyses and trial sequential analyses of randomized clinical trials |journal=Aliment. Pharmacol. Ther. |volume=27 |issue=12 |pages=1167–78 |year=2008 |pmid=18363896 |doi=10.1111/j.1365-2036.2008.03685.x |url=}}</ref><ref name="pmid16503078">{{cite journal |vauthors=O'Shea R, McCullough AJ |title=Steroids or cocktails for alcoholic hepatitis |journal=J. Hepatol. |volume=44 |issue=4 |pages=633–6 |year=2006 |pmid=16503078 |doi=10.1016/j.jhep.2006.01.011 |url=}}</ref><ref name="urlLilleModel">{{cite web |url=http://www.lillemodel.com |title=LilleModel |format= |work= |accessdate=}}</ref>
**Beneficial in patients with [[hepatic encephalopathy]], Maddrey's discriminant function score ≥32, or a [[MELD Score|MELD]] score ≥21.
**Decreases short term [[mortality]].
**Usually given for 1 month.
**Serum [[bilirubin]] is used as a predictor for treatment success. Failure of the [[Bilirubin|serum bilirubin]] level to decline after 7 days of treatment predicts poor prognosis.
**Another predictor of treatment is '''Lille model''' comprising, [[age]], serum [[creatinine]], serum [[albumin]], [[prothrombin time]] (or INR), serum [[bilirubin]] on admission, and [[serum bilirubin]] on day 7.
**Contraindicated in the presence of [[sepsis]], [[hepatorenal syndrome]], [[chronic hepatitis B]] virus infection and [[gastrointestinal bleeding]].
* '''Pentoxifylline'''<ref name="pmid11113085">{{cite journal |vauthors=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= |url=}}</ref><ref name="pmid19575503">{{cite journal |vauthors=Assimakopoulos SF, Thomopoulos KC, Labropoulou-Karatza C |title=Pentoxifylline: a first line treatment option for severe alcoholic hepatitis and hepatorenal syndrome? |journal=World J. Gastroenterol. |volume=15 |issue=25 |pages=3194–5 |year=2009 |pmid=19575503 |pmc=2705746 |doi= |url=}}</ref><ref name="pmid11113085">{{cite journal |vauthors=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= |url=}}</ref><ref name="pmid18164508">{{cite journal |vauthors=Louvet A, Diaz E, Dharancy S, Coevoet H, Texier F, Thévenot T, Deltenre P, Canva V, Plane C, Mathurin P |title=Early switch to pentoxifylline in patients with severe alcoholic hepatitis is inefficient in non-responders to corticosteroids |journal=J. Hepatol. |volume=48 |issue=3 |pages=465–70 |year=2008 |pmid=18164508 |doi=10.1016/j.jhep.2007.10.010 |url=}}</ref><ref name="pmid19340904">{{cite journal |vauthors=De BK, Gangopadhyay S, Dutta D, Baksi SD, Pani A, Ghosh P |title=Pentoxifylline versus prednisolone for severe alcoholic hepatitis: a randomized controlled trial |journal=World J. Gastroenterol. |volume=15 |issue=13 |pages=1613–9 |year=2009 |pmid=19340904 |pmc=2669113 |doi= |url=}}</ref><ref name="pmid19821406">{{cite journal |vauthors=Whitfield K, Rambaldi A, Wetterslev J, Gluud C |title=Pentoxifylline for alcoholic hepatitis |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD007339 |year=2009 |pmid=19821406 |doi=10.1002/14651858.CD007339.pub2 |url=}}</ref>
**It is a [[tumor necrosis factor]] inhibitor.
**Used in patients with contraindications to [[steroids]].
**Usually given for 1 months.
**Decreases [[mortality]].
**Decreases risk of [[hepatorenal syndrome]].


=== Acute Pharmacotherapies ===
* '''Other less commonly used drugs'''<ref name="pmid14745316">{{cite journal |vauthors=Lee TD, Sadda MR, Mendler MH, Bottiglieri T, Kanel G, Mato JM, Lu SC |title=Abnormal hepatic methionine and glutathione metabolism in patients with alcoholic hepatitis |journal=Alcohol. Clin. Exp. Res. |volume=28 |issue=1 |pages=173–81 |year=2004 |pmid=14745316 |doi=10.1097/01.ALC.0000108654.77178.03 |url=}}</ref><ref name="pmid15240996">{{cite journal |vauthors=Song Z, McClain CJ, Chen T |title=S-Adenosylmethionine protects against acetaminophen-induced hepatotoxicity in mice |journal=Pharmacology |volume=71 |issue=4 |pages=199–208 |year=2004 |pmid=15240996 |doi=10.1159/000078086 |url=}}</ref><ref name="pmid12163148">{{cite journal |vauthors=McClain CJ, Hill DB, Song Z, Chawla R, Watson WH, Chen T, Barve S |title=S-Adenosylmethionine, cytokines, and alcoholic liver disease |journal=Alcohol |volume=27 |issue=3 |pages=185–92 |year=2002 |pmid=12163148 |doi= |url=}}</ref><ref name="pmid2671116">{{cite journal |vauthors=Ferenci P, Dragosics B, Dittrich H, Frank H, Benda L, Lochs H, Meryn S, Base W, Schneider B |title=Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver |journal=J. Hepatol. |volume=9 |issue=1 |pages=105–13 |year=1989 |pmid=2671116 |doi= |url=}}</ref><ref name="pmid9566830">{{cite journal |vauthors=Parés A, Planas R, Torres M, Caballería J, Viver JM, Acero D, Panés J, Rigau J, Santos J, Rodés J |title=Effects of silymarin in alcoholic patients with cirrhosis of the liver: results of a controlled, double-blind, randomized and multicenter trial |journal=J. Hepatol. |volume=28 |issue=4 |pages=615–21 |year=1998 |pmid=9566830 |doi= |url=}}</ref>
* In very severe disease, such as those with [[encephalopathy]] or other markers of advanced disease, treatment with steroids may improve 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.
:*[[S-Adenosyl methionine|S-adenosylmethionine]].
* Other considerations:
:*Silymarin ([[silybum marianum]]-[[milk thistle]]).
*:* [[Acetaminophen]] use should be < 2gm / day
*:* Fasting also increases the risk 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==
==References==

Revision as of 15:19, 31 July 2021

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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

Medical Therapy

General therapy for alcoholic liver disease includes:[1][2][3][4][5][6][7]

Pharmacotherapy

Alcoholic hepatitis

References

  1. ↑ Sofair AN, Barry V, Manos MM, Thomas A, Zaman A, Terrault NA, Murphy RC, Stabach N, Huie S, Van Ness G, Bell BP, Bialek S (2010). "The epidemiology and clinical characteristics of patients with newly diagnosed alcohol-related liver disease: results from population-based surveillance". J. Clin. Gastroenterol. 44 (4): 301–7. doi:10.1097/MCG.0b013e3181b3f760. PMID 19745759.
  2. ↑ Moos RH, King MJ, Patterson MA (1996). "Outcomes of residential treatment of substance abuse in hospital- and community-based programs". Psychiatr Serv. 47 (1): 68–74. doi:10.1176/ps.47.1.68. PMID 8925349.
  3. ↑ Garbutt JC, West SL, Carey TS, Lohr KN, Crews FT (1999). "Pharmacological treatment of alcohol dependence: a review of the evidence". JAMA. 281 (14): 1318–25. PMID 10208148.
  4. ↑ Naveau S, Giraud V, Borotto E, Aubert A, Capron F, Chaput JC (1997). "Excess weight risk factor for alcoholic liver disease". Hepatology. 25 (1): 108–11. doi:10.1002/hep.510250120. PMID 8985274.
  5. ↑ Halsted CH (2004). "Nutrition and alcoholic liver disease". Semin. Liver Dis. 24 (3): 289–304. doi:10.1055/s-2004-832941. PMID 15349806.
  6. ↑ Kang YJ, Zhou Z (2005). "Zinc prevention and treatment of alcoholic liver disease". Mol. Aspects Med. 26 (4–5): 391–404. doi:10.1016/j.mam.2005.07.002. PMID 16099027.
  7. ↑ McCullough AJ, O'Connor JF (1998). "Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology". Am. J. Gastroenterol. 93 (11): 2022–36. doi:10.1111/j.1572-0241.1998.00587.x. PMID 9820369.
  8. ↑ Addolorato G, Russell M, Albano E, Haber PS, Wands JR, Leggio L (2009). "Understanding and treating patients with alcoholic cirrhosis: an update". Alcohol. Clin. Exp. Res. 33 (7): 1136–44. doi:10.1111/j.1530-0277.2009.00956.x. PMID 19389182.
  9. ↑ Christensen E (2002). "Alcoholic hepatitis--glucocorticosteroids or not?". J. Hepatol. 36 (4): 547–8. PMID 11943428.
  10. ↑ Ramond MJ, Poynard T, Rueff B, Mathurin P, Théodore C, Chaput JC, Benhamou JP (1992). "A randomized trial of prednisolone in patients with severe alcoholic hepatitis". N. Engl. J. Med. 326 (8): 507–12. doi:10.1056/NEJM199202203260802. PMID 1531090.
  11. ↑ Carithers RL, Herlong HF, Diehl AM, Shaw EW, Combes B, Fallon HJ, Maddrey WC (1989). "Methylprednisolone therapy in patients with severe alcoholic hepatitis. A randomized multicenter trial". Ann. Intern. Med. 110 (9): 685–90. PMID 2648927.
  12. ↑ Maddrey WC, Boitnott JK, Bedine MS, Weber FL, Mezey E, White RI (1978). "Corticosteroid therapy of alcoholic hepatitis". Gastroenterology. 75 (2): 193–9. PMID 352788.
  13. ↑ Rambaldi A, Saconato HH, Christensen E, Thorlund K, Wetterslev J, Gluud C (2008). "Systematic review: glucocorticosteroids for alcoholic hepatitis--a Cochrane Hepato-Biliary Group systematic review with meta-analyses and trial sequential analyses of randomized clinical trials". Aliment. Pharmacol. Ther. 27 (12): 1167–78. doi:10.1111/j.1365-2036.2008.03685.x. PMID 18363896.
  14. ↑ O'Shea R, McCullough AJ (2006). "Steroids or cocktails for alcoholic hepatitis". J. Hepatol. 44 (4): 633–6. doi:10.1016/j.jhep.2006.01.011. PMID 16503078.
  15. ↑ "LilleModel".
  16. ↑ 16.0 16.1 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. PMID 11113085.
  17. ↑ Assimakopoulos SF, Thomopoulos KC, Labropoulou-Karatza C (2009). "Pentoxifylline: a first line treatment option for severe alcoholic hepatitis and hepatorenal syndrome?". World J. Gastroenterol. 15 (25): 3194–5. PMC 2705746. PMID 19575503.
  18. ↑ Louvet A, Diaz E, Dharancy S, Coevoet H, Texier F, Thévenot T, Deltenre P, Canva V, Plane C, Mathurin P (2008). "Early switch to pentoxifylline in patients with severe alcoholic hepatitis is inefficient in non-responders to corticosteroids". J. Hepatol. 48 (3): 465–70. doi:10.1016/j.jhep.2007.10.010. PMID 18164508.
  19. ↑ De BK, Gangopadhyay S, Dutta D, Baksi SD, Pani A, Ghosh P (2009). "Pentoxifylline versus prednisolone for severe alcoholic hepatitis: a randomized controlled trial". World J. Gastroenterol. 15 (13): 1613–9. PMC 2669113. PMID 19340904.
  20. ↑ Whitfield K, Rambaldi A, Wetterslev J, Gluud C (2009). "Pentoxifylline for alcoholic hepatitis". Cochrane Database Syst Rev (4): CD007339. doi:10.1002/14651858.CD007339.pub2. PMID 19821406.
  21. ↑ Lee TD, Sadda MR, Mendler MH, Bottiglieri T, Kanel G, Mato JM, Lu SC (2004). "Abnormal hepatic methionine and glutathione metabolism in patients with alcoholic hepatitis". Alcohol. Clin. Exp. Res. 28 (1): 173–81. doi:10.1097/01.ALC.0000108654.77178.03. PMID 14745316.
  22. ↑ Song Z, McClain CJ, Chen T (2004). "S-Adenosylmethionine protects against acetaminophen-induced hepatotoxicity in mice". Pharmacology. 71 (4): 199–208. doi:10.1159/000078086. PMID 15240996.
  23. ↑ McClain CJ, Hill DB, Song Z, Chawla R, Watson WH, Chen T, Barve S (2002). "S-Adenosylmethionine, cytokines, and alcoholic liver disease". Alcohol. 27 (3): 185–92. PMID 12163148.
  24. ↑ Ferenci P, Dragosics B, Dittrich H, Frank H, Benda L, Lochs H, Meryn S, Base W, Schneider B (1989). "Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver". J. Hepatol. 9 (1): 105–13. PMID 2671116.
  25. ↑ Parés A, Planas R, Torres M, Caballería J, Viver JM, Acero D, Panés J, Rigau J, Santos J, Rodés J (1998). "Effects of silymarin in alcoholic patients with cirrhosis of the liver: results of a controlled, double-blind, randomized and multicenter trial". J. Hepatol. 28 (4): 615–21. PMID 9566830.

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