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2016 ; 4
(2
): 113-22
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Current Management of Alcoholic Hepatitis and Future Therapies
#MMPMID27350941
Saberi B
; Dadabhai AS
; Jang YY
; Gurakar A
; Mezey E
J Clin Transl Hepatol
2016[Jun]; 4
(2
): 113-22
PMID27350941
show ga
Alcohol is one of the most common etiologies of liver disease, and alcoholic
liver disease overall is the second most common indication for liver
transplantation in the United States. It encompasses a spectrum of disease,
including fatty liver disease, alcoholic hepatitis (AH), and alcoholic cirrhosis.
AH can range from mild to severe disease, with severe disease being defined as:
Discriminant Function (DF) ? 32, or Model for End-stage Liver Disease (MELD) ?
21, or presence of hepatic encephalopathy. Management of the mild disease
consists mainly of abstinence and supportive care. Severe AH is associated with
significant mortality. Currently, there is no ideal medical treatment for this
condition. Besides alcohol cessation, corticosteroids have been used with
conflicting results and are associated with an inherent risk of infection.
Overall steroids have shown short term benefit when compared to placebo, but they
have no obvious long term benefits. Pentoxifylline does not improve survival in
patients with severe AH and is no longer recommended based on the results of the
STOPAH (Steroid Or Pentoxifylline for Alcoholic Hepatitis) trial. Anti-tumor
necrosis factor (TNF) agents are associated with increased risk of life
threatening infections and death. Currently, early stage trials are underway,
mainly targeting novel pathways based on disease pathogenesis, including
modulation of innate immune system, inhibition of gut-liver axis and cell death
pathways, and activation of transcription factor farnesyl X receptor (FXR).
Future treatment may lie in human induced pluripotent stem cell (iPSC)
technology, which is currently under investigation for the study of pathogenesis,
drug discovery, and stem cell transplantation. Liver transplantation has been
reported with good results in highly selected patients but is controversial due
to limited organ supply.