New paradigms in management of alcoholic hepatitis: a review

Abstract

Severe alcoholic hepatitis (SAH) is defined by modified Maddrey discriminant function ≥32 or Model for End-Stage Liver Disease (MELD) >21 and/or hepatic encephalopathy. It has a 3-month mortality rate ≥30-70 %. Patients with severe alcoholic hepatitis need combined, i.e., static (MELD score) and dynamic (Lille's score), prognostication. Systemic inflammation and poor regeneration are hallmarks of SAH, rather than intrahepatic inflammation. SAH is characterized by dysregulated and uncontrolled systemic inflammatory response followed by weak compensatory antiinflammatory response that leads to increased susceptibility to infection and multiple organ failure. Massive necrosis of hepatocytes exceeds the proliferative capacity of hepatocytes. Liver progenitor cells proliferate to form narrow ductules which radiate out into the damaged liver parenchyma. Corticosteroids have been the standard-of-care therapy, albeit controversial. However, the recent Steroids or Pentoxifylline for Alcoholic Hepatitis (STOPAH) trial revealed that prednisolone was not associated with a significant reduction in 28-day mortality, with no improvement in outcomes at 90 days or 1 year. A paradigm shift from antiinflammatory therapy such as corticosteroids to liver regeneration treatment, e.g., granulocyte-colony stimulating factor, molecular targeted treatments, and fecal microbiota transplantation, for severe alcoholic hepatitis is taking place. Liver transplantation should be offered to select patients with severe alcoholic hepatitis who are nonresponsive to medical treatment.

A woman, age 35, with new-onset ascites

“…A variety of scoring systems have been used to assess the severity of alcoholic hepatitis and to guide treatment, including the Maddrey Discriminant Function score, the MELD score, and the Glasgow score. [11][12][13][14][15][16] They share similar laboratory values in their calculations, including prothrombin time (or INR) and total bilirubin. [11][12][13][14][15][16] Typically, a Maddrey Discriminant Function score greater than 32, a Glasgow score of greater than 9, or a MELD score greater than 21 is used to determine whether pharmacologic treatment is indicated.…”

“…[11][12][13][14][15][16] They share similar laboratory values in their calculations, including prothrombin time (or INR) and total bilirubin. [11][12][13][14][15][16] Typically, a Maddrey Discriminant Function score greater than 32, a Glasgow score of greater than 9, or a MELD score greater than 21 is used to determine whether pharmacologic treatment is indicated. [11][12][13][14][15][16] The typical treatment is prednisolone or pentoxifylline.…”

“…[11][12][13][14][15][16] Typically, a Maddrey Discriminant Function score greater than 32, a Glasgow score of greater than 9, or a MELD score greater than 21 is used to determine whether pharmacologic treatment is indicated. [11][12][13][14][15][16] The typical treatment is prednisolone or pentoxifylline. 11,[17][18][19][20][21] The Lille score is de- LIPPERT AND COLLEAGUES signed to help decide whether to stop corticosteroids after 1 week of administration due to lack of treatment response.…”

“…[11][12][13][14][15][16] The typical treatment is prednisolone or pentoxifylline. 11,[17][18][19][20][21] The Lille score is de- LIPPERT AND COLLEAGUES signed to help decide whether to stop corticosteroids after 1 week of administration due to lack of treatment response. 22 It predicts mortality rates within 6 months; a score of 0.45 or less indicates a good prognosis, and corticosteroid therapy should continue for 28 days (Figure 3).…”

The Place of Modern Enterosorption in Alcoholic Liver Disease Treatment and Prevention (Literature Review)

“…В связи с этим предпочтение следует отдавать несистемным лекарственным препаратам, работающим исключительно в просвете кишечника. К таковым относятся современные энтеросорбенты [6].…”