Intensive Enteral Nutrition Is Ineffective for Patients With Severe Alcoholic Hepatitis Treated With Corticosteroids

Moreno, Christophe; Deltenre, Pierre; Senterre, Christelle; Louvet, Alexandre; Gustot, Thierry; Bastens, B.; Hittelet, Axel-Benoit; Piquet, Marie-Astrid; Laleman, Wim; Orlent, Hans; Lasser, Luc; Sersté, Thomas; Stärkel, Peter; Koninck, Xavier X De; Dastis, Sergio Negrin; Delwaide, Jean; Colle, Isabelle; Galocsy, Chantal de; Francque, Sven; Langlet, Philippe; Putzeys, V; Reynaert, Hendrik; Degré, Delphine; Trépo, Eric

doi:10.1053/j.gastro.2015.12.038

Cited by 134 publications

(117 citation statements)

References 29 publications

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“…While earlier randomized trials in relatively small patient numbers reported a possible benefit of vigorous nutritional support in patients with alcoholic cirrhosis and AH, including on improved survival,116 only one recent randomized controlled trial in 136 patients with biopsy-proven AH studied a combination of intensive enteral nutrition via feeding tube plus methylprednisolone against conventional nutrition plus methylprednisolone (controls) 117. The primary endpoint was 6-month survival, and secondary end points comprised mortality at 1 month, rates of infection, and occurrence of hepatorenal failure at 6 months.…”

Section: Therapy Of Patients With Aldmentioning

confidence: 99%

Pathophysiology and Management of Alcoholic Liver Disease: Update 2016

et al. 2017

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Alcoholic liver disease (ALD) is a leading cause of cirrhosis, liver cancer, and acute and chronic liver failure and as such causes significant morbidity and mortality. While alcohol consumption is slightly decreasing in several European countries, it is rising in others and remains high in many countries around the world. The pathophysiology of ALD is still incompletely understood but relates largely to the direct toxic effects of alcohol and its main intermediate, acetaldehyde. Recently, novel putative mechanisms have been identified in systematic scans covering the entire human genome and raise new hypotheses on previously unknown pathways. The latter also identify host genetic risk factors for significant liver injury, which may help design prognostic risk scores. The diagnosis of ALD is relatively easy with a panel of well-evaluated tests and only rarely requires a liver biopsy. Treatment of ALD is difficult and grounded in abstinence as the pivotal therapeutic goal; once cirrhosis is established, treatment largely resembles that of other etiologies of advanced liver damage. Liver transplantation is a sound option for carefully selected patients with cirrhosis and alcoholic hepatitis because relapse rates are low and prognosis is comparable to other etiologies. Still, many countries are restrictive in allocating donor livers for ALD patients. Overall, few therapeutic options exist for severe ALD. However, there is good evidence of benefit for only corticosteroids in severe alcoholic hepatitis, while most other efforts are of limited efficacy. Considering the immense burden of ALD worldwide, efforts of medical professionals and industry partners to develop targeted therapies in ALF has been disappointingly low.

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Section: Therapy Of Patients With Aldmentioning

confidence: 99%

Pathophysiology and Management of Alcoholic Liver Disease: Update 2016

et al. 2017

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“…One multicenter study indicated that enteral nutrition was comparable to glucocorticoids in reducing 28-day mortality and more effective in reducing long-term mortality (67). However, another multicenter study reported that adding enteral supplementation via nasogastric (NG) tube to glucocorticoid therapy was no more effective than glucocorticoids alone (68). This study was under-powered, and there was a higher than expected rate of NG tube complications.…”

Section: Best Practice Advice For Treatment Of Ah (Table 2)mentioning

confidence: 99%

“…This study was under-powered, and there was a higher than expected rate of NG tube complications. Importantly, nutritional intake (regardless of the arm of the study) was a major determinant of mortality, with those consuming < 21.5 Kcal/kg/day having lower survival (68). Therefore, all patients with AH should be encouraged to meet their nutritional goals as early as possible.…”

Section: Best Practice Advice For Treatment Of Ah (Table 2)mentioning

confidence: 99%

Medical Management of Severe Alcoholic Hepatitis: Expert Review from the Clinical Practice Updates Committee of the AGA Institute

Mitchell

Friedman

McClain

2017

Clinical Gastroenterology and Hepatology

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“…(Calvey et al, 1985, Cabre et al, 2000, Mendenhall et al, 1985, Mendenhall et al, 1993, Moreno et al, 2010) A recent RCT showed that enteral nutrition is difficult to achieve in these patients and also confirmed lack of survival benefit of nutritional supplementation as adjuvant to corticosteroids. (Moreno et al, 2016a)Parenteral nutrition may be considered when enteral feeding is difficult in patients having ileus, bowel obstruction, or protracted nausea or vomiting. After documentation of survival benefit with parenteral nutrition in AH patients in one study,(Nasrallah and Galambos, 1980) six further studies failed to show this survival benefit.…”

Section: Resultsmentioning

confidence: 99%

“…(Fialla et al, 2015, Salameh H, 2013) This observation has also been made in other studies examining the correlation of caloric intake with the survival outcome in AH patients. ((Mendenhall et al, 1995a, Moreno et al, 2016b) Hence, AH patients should have daily calorie counts to identify individuals who could benefit from nutritional supplementation.…”

Section: Resultsmentioning

confidence: 99%

Diagnosis and Treatment of Alcoholic Hepatitis: A Systematic Review

Singal

Kodali

Vucovich

et al. 2016

Alcohol Clin Exp Res

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Alcoholic hepatitis occurs in about one third of individuals reporting long term heavy alcohol use. It is associated with high short-term mortality, economic burden, and hospital resources utilization. We performed this systematic review to a) describe clinical characteristics and genomics associated with the risk of alcoholic hepatitis; b) discuss role and limitations of liver biopsy and prognostic scoring systems; c) summarize evidence regarding the currently available therapies including liver transplantation; and d) outline emerging therapies with areas of unmet need. Literature search was performed for studies published in English language (January 1971 through - March 2016). Following search engines were used: Pubmed, Elsevier Embase, PsychINFO, and Cochrane Library. For the treatment section, only randomized controlled studies were included for this review. A total of 138 studies (59 randomized, 22 systematic reviews or meta-analyses, 7 surveys or guidelines, 7 population based, and 43 prospective cohort) were cited. There are over 325,000 annual admissions with alcoholic hepatitis contributing to about 0.8% of all hospitalizations in the US. Liver biopsy may be required in about 25–30% cases for uncertain clinical diagnosis. Corticosteroids with or without N-acetylcysteine remains the only available therapy for severe episode. Data are emerging on the role of liver transplantation as salvage therapy for select patients. Abstinence remains the most important factor impacting long-term prognosis. Results from the ongoing clinical trials within the National institute on Alcohol Abuse and Alcoholism funded consortia are awaited for more effective and safer therapies. Alcoholic hepatitis is a potentially lethal condition with a significant short-term mortality. A high index of suspicion is required. There remains an unmet need for non-invasive biomarkers for diagnosis, and predicting prognosis and response to therapy.

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Intensive Enteral Nutrition Is Ineffective for Patients With Severe Alcoholic Hepatitis Treated With Corticosteroids

Cited by 134 publications

References 29 publications

Pathophysiology and Management of Alcoholic Liver Disease: Update 2016

Pathophysiology and Management of Alcoholic Liver Disease: Update 2016

Medical Management of Severe Alcoholic Hepatitis: Expert Review from the Clinical Practice Updates Committee of the AGA Institute

Diagnosis and Treatment of Alcoholic Hepatitis: A Systematic Review

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