Alcoholic hepatitis

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In gastroenterology, alcoholic hepatitis is "inflammation of the liver due to alcohol abuse. It is characterized by necrosis of hepatocytes, infiltration by neutrophils, and deposit of mallory hyaline bodies. depending on its severity, the inflammatory lesion may be reversible or progress to liver cirrhosis."[1]A practice guideline is available from the American College of Gastroenterology.[2]

Treatment

Corticosteroids may help in severe cases, but not all cases according to a meta-analysis. [3] In this study, the relative risk ratio of glucocorticosteroids for patients with severe hepatitis for mortality at various times was 0.4 and the relative risk reduction was 63%. In populations similar to those in this study which had a rate of risk as measured by the mortality at various times of 38% without treatment, the number needed to treat is 4. [3]

The role of pentoxifylline is uncertain. "The current available data may indicate a possible positive intervention effect of pentoxifylline on all-cause mortality and mortality due to hepatorenal syndrome, and conversely, an increase in serious and non-serious adverse events" according to a meta-analysis by the Cochrane Collaboration. [4] In this study, the relative risk ratio of pentoxifylline for mortality at various times was 0.6 and the relative risk reduction was 36.8%. In populations similar to those in this study which had a rate of risk as measured by the mortality at various times of 38% without treatment, the number needed to treat is 7. [4] the mortality during hospitalization of 46% without treatment, the number needed to treat is 5. [5]

"Although combination therapy with prednisolone plus N-acetylcysteine increased 1-month survival among patients with severe acute alcoholic hepatitis, 6-month survival, the primary outcome, was not improved" according to a randomized controlled trial. [6] In this trial, the relative risk ratio of N-acetylcysteine for mortality at one month was 0.3 and the relative risk reduction was 66.7%. In populations similar to those in this study which had a rate of risk as measured by the mortality at one month of 24% without treatment, the number needed to treat is 6. [6]

Treatment of severe alcoholic hepatitis[3][6][4]
Trial Patients Intervention Comparison Outcome Results Comment
Intervention Control
Cochrane[3]
2008
Meta-analysis
Six trials
• 249 patients
Glucocorticosteroids Placebo Mortality at various times 14% 38% RRR = 63%
(subgroup with severe hepatitis)
Nguyen-Khac[6]
2011
Randomized controlled trial
One trial
• 174 patients
• All patients receiving steroids
N-Acetylcysteine Placebo Mortality at one month 8% 24% RRR = 67%
• No benefit after 3 months
Cochrane[5]
2009
Meta-analysis
Five trials
• 336 patients
• Unclear if all patients receiving steroids
Pentoxifylline Placebo Mortality at various times 24% 38% RRR = 35%
• May cause epigastric discomfort

References

  1. Anonymous (2015), Alcoholic hepatitis (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. "Alcoholic Liver Disease: Proposed Recommendations", Am J Gastroenterol 105: 14–32, 10 November 2009, DOI:10.1038/ajg.2009.593
  3. 3.0 3.1 3.2 3.3 Rambaldi A, Saconato HH, Christensen E, Thorlund K, Wetterslev J, Gluud C (2008). "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 Ther 27 (12): 1167-78. DOI:10.1111/j.1365-2036.2008.03685.x. PMID 18363896. Research Blogging.
  4. 4.0 4.1 4.2 Whitfield K, Rambaldi A, Wetterslev J, Gluud C (2009). "Pentoxifylline for alcoholic hepatitis.". Cochrane Database Syst Rev (4): CD007339. DOI:10.1002/14651858.CD007339.pub2. PMID 19821406. Research Blogging.
  5. Cite error: Invalid <ref> tag; no text was provided for refs named pmid11113085
  6. 6.0 6.1 6.2 6.3 Nguyen-Khac E, Thevenot T, Piquet MA, Benferhat S, Goria O, Chatelain D et al. (2011). "Glucocorticoids plus N-acetylcysteine in severe alcoholic hepatitis.". N Engl J Med 365 (19): 1781-9. DOI:10.1056/NEJMoa1101214. PMID 22070475. Research Blogging.