hepatic and biliary disorders
Alcohol Related Liver Disease
Treatment of Alcohol Related Liver Disease
Abstinence Supportive care Corticosteroids and enteral nutrition for severe alcoholic hepatitis Sometimes transplantation Abstinence is the mainstay of treatment; it prevents further damage from alcohol-related liver disease and thus prolongs life. Because compliance is problematic, a compassionate team approach is essential. Behavioral and psychosocial interventions can help motivated patients; they include rehabilitation programs and support groups (see Maintenance ), brief interventions by primary care clinicians, and therapies that explore and clarify the motivation to abstain (motivational enhancement therapy). Medications, if used, should supplement other interventions. Opioid antagonists (naltrexoneornalmefene) and medications that modulate gamma-aminobutyric acid receptors (baclofenoracamprosate) appear to have a short-term benefit by reducing the craving and withdrawal symptoms.Disulfiraminhibits aldehyde dehydrogenase, allowing acetaldehyde to accumulate; thus, drinking alcohol within 12 hours of takingdisulfiramcauses flushing and has other unpleasant effects. However,disulfiramhas not been shown to promote abstinence and consequently is recommended only for certain patients. General management emphasizes supportive care. A nutritious diet and vitamin supplements (especially B vitamins) are important during the first few days of abstinence. Withdrawal requires use of benzodiazepines (eg, Severe acute alcoholic hepatitis commonly requires hospitalization, often in an intensive care unit, to facilitate enteral feeding (which can help manage nutritional deficiencies) and to manage specific complications (eg, infection, Varices , specific nutritional deficiencies, 32) and who do not have infection, gastrointestinal bleeding, renal failure, or pancreatitis ( Treatment references ). In a large prospective randomized controlled trial, -adenosyl-L-methionine, phosphatidylcholine, metadoxine) show promise in ameliorating liver injury during early Cirrhosis but require further study. Therapies directed at cytokines, particularly tumor necrosis factor (TNF)-alpha, and aiming to reduce inflammation have had mixed results in small trials. Liver Transplantation None 1.Rambaldi A, Saconato HH, Christensen E, et al: 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 Ther27(12):1167-1178, 2008. doi: 10.1111/j.1365-2036.2008.03685.x 2.Thursz MR, Richardson P, Allison M, et al:Prednisoloneorpentoxifyllinefor alcoholic hepatitis.N Engl J Med372:1619-1628, 2015. doi: 10.1056/NEJMoa1412278 3.Forrest EH, Atkinson SR, Richardson P, et al: Application of prognostic scores in the STOPAH trial: Discriminant function is no longer the optimal scoring system in alcoholic hepatitis.J Hepatol68(3):511-518, 2018. doi: 10.1016/j.jhep.2017.11.017 4.Anderson MS, Valbuena VSM, Brown CS, et al: Association of COVID-19 With New Waiting List Registrations and Liver Transplantation for Alcoholic Hepatitis in the United States.JAMA Netw Open4(10):e2131132, 2021. doi:10.1001/jamanetworkopen.2021.31132 5.Bittermann T, Mahmud N, Abt P: Trends in Liver Transplantation for Acute Alcohol-Associated Hepatitis During the COVID-19 Pandemic in the US.JAMA Netw Open4(7):e2118713, 2021. doi:10.1001/jamanetworkopen.2021.18713 