Diagnostic Approaches and Clinical End Points of Treatment in Alcoholic Liver Disease

Cheong, J.Y.; Stein, Eva; Bataller, Ramón

doi:10.1007/978-3-319-20538-0_10

Cited by 3 publications

(5 citation statements)

References 96 publications

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“…Thus, females may be at greater risk of developing ALD than men, even when consuming a lesser amount of alcohol (Banerjee et al., ; Becker et al., ; Lieber, ; Wagnerberger et al., ). In addition, females are often at an advanced stage of liver disease at the time of diagnosis, even though they have a shorter history of alcohol consumption and a lower intake of alcohol than men (Cheong et al., ; Wilkinson, ).…”

Section: Discussionmentioning

confidence: 99%

Effects of Sex, Drinking History, and Omega‐3 and Omega‐6 Fatty Acids Dysregulation on the Onset of Liver Injury in Very Heavy Drinking Alcohol‐Dependent Patients

Vatsalya

Song

Schwandt

et al. 2016

Alcoholism Clin & Exp Res

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Background Heavy alcohol consumption frequently causes liver inflammation/injury, and certain fatty acids (FAs) may be involved in this liver pathology. In this study, we evaluated the association of heavy drinking and the changes in the FA levels involved in the ω-6 (pro-inflammatory) and ω-3 (anti-inflammatory) state in alcohol-dependent (AD) patients who had no clinical manifestations of liver injury. We aimed to identify sex-based differences in patients with mild or no biochemical evidence of liver injury induced by heavy drinking. Methods A total of 114 heavy drinking AD female and male patients aged 21 to 65 years without clinical manifestations of liver injury, who were admitted to an alcohol dependence treatment program, were grouped by the alanine aminotransferase (ALT) levels: ≤40 IU/l, as no liver injury (GR.1), and >40 IU/l, as mild liver injury (GR.2). Patients were actively drinking until the day of admission. Comprehensive metabolic panel, comprehensive FA panel, and drinking history data were evaluated. Results Elevated ALT and aspartate aminotransferase (AST) showed close association with markers of heavy alcohol intake. In the patients with mild biochemical liver injury (GR.2), females showed significantly higher AST level than males. Significant association of AST and total drinks in past 90 days (TD90) in females, and AST and heavy drinking days in past 90 days (HDD90) in males was observed. The ω-6:ω-3 ratio showed a significant pro-inflammatory response only in females with mild liver injury (GR.2) when adjusted by drinking history marker, TD90. Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) were increased in males with liver injury, while females did not show any comparable rise in EPA; and DHA levels were lower. Conclusions Measures of heavy drinking, TD90 and HDD90, predicted changes in liver injury. Changes in the ω-3 and ω-6 FA levels and the ω-6:ω-3 ratio showed a pro-inflammatory shift in patients with biochemical liver injury with a significant effect in females. Changes in FAs involved in the inflammatory state may represent one mechanism for liver inflammation/injury in response to heavy alcohol drinking.

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Section: Discussionmentioning

confidence: 99%

Effects of Sex, Drinking History, and Omega‐3 and Omega‐6 Fatty Acids Dysregulation on the Onset of Liver Injury in Very Heavy Drinking Alcohol‐Dependent Patients

Vatsalya

Song

Schwandt

et al. 2016

Alcoholism Clin & Exp Res

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“…Mortality rates range from 20 to 50% at 3 months [2,3]. Few advances have been made in the management of patients with AH [4,5]. To date, the only therapies that improve survival in AH are corticosteroids alone and liver transplantation [6–8].…”

Section: Introductionmentioning

confidence: 99%

“…The lack of advances in the field of AH have been due to intrinsic difficulties in performing randomized clinical trials (RCTs) in patients with active addiction and advanced clinical illness as is the case in patients with severe AH. Furthermore, the lack of experimental models of advanced ALD has held back the discovery of treatments based on basic mechanisms, and hampered proof of concept therapeutic interventions [1,5,9,10]. Undoubtedly, there is an urgent need to develop novel therapies to treat AH.…”

Section: Introductionmentioning

confidence: 99%

Controversies in clinical trials for alcoholic hepatitis

Lieber

Rice

Lucey

et al. 2018

Journal of Hepatology

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Alcoholic hepatitis (AH) is the most severe form of alcoholic liver disease, contributing to significant morbidity and mortality. Yet, the only available therapies that improve survival are corticosteroids and liver transplantation, with no new drugs successfully developed for decades. This article briefly describes the current state of affairs in AH therapy and examines the practical and ethical challenges of conducting controlled trials in patients with severe AH. While prednisolone is considered standard of care in severe AH, this recommendation remains controversial given the marginal benefits and questionable long-term safety of steroids. Placebo-controlled trials without steroids may be necessary and ethically justified in certain populations with AH who have not been adequately investigated. Ultimately, we suggest that the field will advance with the development of a plausible animal model of true AH, a consensus on a composite clinical endpoint that does not rely solely on mortality, as well as the adoption of the NIAAA Alcoholic Hepatitis Consortia recommendations regarding standard definitions and when to request a liver biopsy prior to study entry.

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“…Ultrasound is a non-invasive diagnostic imaging technique that uses high-frequency sound waves. The tools used are an ultrasound machine with a transducer which acts to transmit and receive sound waves from several tissues in the body (Chen et al, 2010). The transducer will be driven by the radiologist on the surface of a patient's body, which had previously been smeared with gel.…”

Section: Introductionmentioning

confidence: 99%

“…The liver has homogeneous parenchyma. The liver is the most echogenic organ on ultrasound after the pancreas (Chen et al, 2010). Healthy liver on ultrasound examination showed a smooth surface that bordered by the image of the blood vessels.…”

Section: Introductionmentioning

confidence: 99%

USG Liver examination of Tahfiz Quran Primary School students in Berastagi

Daulay

Tala

2019

ABDIMAS

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The Liver is the largest solid organ in the human body and has many roles in maintaining a healthy body. Non-alcoholic Fatty Liver Disease (NAFLD) is a fatty liver without being accompanied by the consumption of alcohol. NAFLD is a condition that is often found in children. The majority of patients with NAFLD are asymptomatic. The diagnosis of NAFLD is usually made through imaging the liver or abnormal liver function with the presence of metabolic syndrome and or overweight. Ultrasound has high sensitivity and specificity in diagnosing NAFLD into an imaging technique that is widely used in cases with fatty liver. This community service is done to find out about the liver health of Tahfiz Quran Primary School students in Berastagi. It is also an effort to screening and early detection of liver health problems in those students. It also aims to raise awareness of heart health among students, teachers, and parents. Ultrasound liver examination of the 59 Tahfiz Quran Primary School students. Educational activities also done to educate the students about liver health. Out of 59 students, 10 students (16.9%) had mild fatty liver, 1 student (1.7%) had a calcified liver, and 36 students (61.0%) had ascites. Fatty liver was found among the students also the majority of the students had ascites.

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Diagnostic Approaches and Clinical End Points of Treatment in Alcoholic Liver Disease

Cited by 3 publications

References 96 publications

Effects of Sex, Drinking History, and Omega‐3 and Omega‐6 Fatty Acids Dysregulation on the Onset of Liver Injury in Very Heavy Drinking Alcohol‐Dependent Patients

Effects of Sex, Drinking History, and Omega‐3 and Omega‐6 Fatty Acids Dysregulation on the Onset of Liver Injury in Very Heavy Drinking Alcohol‐Dependent Patients

Controversies in clinical trials for alcoholic hepatitis

USG Liver examination of Tahfiz Quran Primary School students in Berastagi

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