Abstract
Alcohol is a risk factor for chronic disease burden in developed countries. Alcoholic liver disease affects 1% of the North American population and is the second most frequent indication for liver transplantation in the United States. It is a spectrum that ranges from simple hepatic steatosis to alcoholic hepatitis to steatohepatitis and eventually cirrhosis. The clinical spectrum of alcoholic hepatitis is wide and ranges from the asymptomatic patient to overt liver failure and death. Liver biopsy as a means of prognostication in alcoholic hepatitis has mostly been replaced with less invasive scoring systems. The management of alcoholic liver disease is challenging. Abstinence is the cornerstone of therapy and should include rehabilitation with a multidisciplinary approach. No specific treatment is required in mild to moderate alcoholic hepatitis. In patients with severe hepatitis, there appears to be a moderate survival benefit from the use of either corticosteroids or pentoxifylline in the absence of contraindications to their use. Non-responders should have steroid therapy withdrawn by day 7, as persistence with therapy is not beneficial. Orthotopic liver transplantation remains the definitive therapy for decompensated alcoholic cirrhosis despite alcohol abstinence. More studies are needed to define the optimal timing of orthotopic liver transplantation and patients at risk of alcohol relapse post-transplant.
| Original language | English |
|---|---|
| Pages (from-to) | 484-498 |
| Number of pages | 15 |
| Journal | Mount Sinai Journal of Medicine |
| Volume | 76 |
| Issue number | 5 |
| DOIs | |
| State | Published - Oct 1 2009 |
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Keywords
- Alcohol abuse
- Alcohol tolerance
- Alcoholic hepatitis
- Alcoholic liver disease
- Liver transplant
ASJC Scopus subject areas
- Medicine(all)
Cite this
Controversies in the management of alcoholic liver disease. / Tan, Hui Hui; Virmani, Sharad; Martin, Paul.
In: Mount Sinai Journal of Medicine, Vol. 76, No. 5, 01.10.2009, p. 484-498.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Controversies in the management of alcoholic liver disease
AU - Tan, Hui Hui
AU - Virmani, Sharad
AU - Martin, Paul
PY - 2009/10/1
Y1 - 2009/10/1
N2 - Alcohol is a risk factor for chronic disease burden in developed countries. Alcoholic liver disease affects 1% of the North American population and is the second most frequent indication for liver transplantation in the United States. It is a spectrum that ranges from simple hepatic steatosis to alcoholic hepatitis to steatohepatitis and eventually cirrhosis. The clinical spectrum of alcoholic hepatitis is wide and ranges from the asymptomatic patient to overt liver failure and death. Liver biopsy as a means of prognostication in alcoholic hepatitis has mostly been replaced with less invasive scoring systems. The management of alcoholic liver disease is challenging. Abstinence is the cornerstone of therapy and should include rehabilitation with a multidisciplinary approach. No specific treatment is required in mild to moderate alcoholic hepatitis. In patients with severe hepatitis, there appears to be a moderate survival benefit from the use of either corticosteroids or pentoxifylline in the absence of contraindications to their use. Non-responders should have steroid therapy withdrawn by day 7, as persistence with therapy is not beneficial. Orthotopic liver transplantation remains the definitive therapy for decompensated alcoholic cirrhosis despite alcohol abstinence. More studies are needed to define the optimal timing of orthotopic liver transplantation and patients at risk of alcohol relapse post-transplant.
AB - Alcohol is a risk factor for chronic disease burden in developed countries. Alcoholic liver disease affects 1% of the North American population and is the second most frequent indication for liver transplantation in the United States. It is a spectrum that ranges from simple hepatic steatosis to alcoholic hepatitis to steatohepatitis and eventually cirrhosis. The clinical spectrum of alcoholic hepatitis is wide and ranges from the asymptomatic patient to overt liver failure and death. Liver biopsy as a means of prognostication in alcoholic hepatitis has mostly been replaced with less invasive scoring systems. The management of alcoholic liver disease is challenging. Abstinence is the cornerstone of therapy and should include rehabilitation with a multidisciplinary approach. No specific treatment is required in mild to moderate alcoholic hepatitis. In patients with severe hepatitis, there appears to be a moderate survival benefit from the use of either corticosteroids or pentoxifylline in the absence of contraindications to their use. Non-responders should have steroid therapy withdrawn by day 7, as persistence with therapy is not beneficial. Orthotopic liver transplantation remains the definitive therapy for decompensated alcoholic cirrhosis despite alcohol abstinence. More studies are needed to define the optimal timing of orthotopic liver transplantation and patients at risk of alcohol relapse post-transplant.
KW - Alcohol abuse
KW - Alcohol tolerance
KW - Alcoholic hepatitis
KW - Alcoholic liver disease
KW - Liver transplant
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U2 - 10.1002/msj.20135
DO - 10.1002/msj.20135
M3 - Article
C2 - 19787655
AN - SCOPUS:70350719344
VL - 76
SP - 484
EP - 498
JO - Annals of Global Health
JF - Annals of Global Health
SN - 2214-9996
IS - 5
ER -