Alcoholic hepatitis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Assosciate Editor(s)-In-Chief: Prashanth Saddala M.B.B.S
Medical Therapy
Corticosteroids
Clinical practice guidelines by the American College of Gastroenterology recommend corticosteroids.[1]
Patients with a discriminant function score > 32 or hepatic encephalopathy should be considered for treatment with prednisolone 40 mg daily for four weeks followed by a taper.[1]
Pentoxifylline
A randomized controlled trial found that 5 patients with a discriminant function score > 32 and at least one of palpable tender hepatomegaly, fever, leukocytosis, hepatic encephalopathy, or hepatic systolic bruit must be treated with pentoxifylline 400 mg orally 3 times daily for 4 weeks for one to prevent one patient from dying. [2]
Acute Pharmacotherapies
- In very severe disease, such as those with encephalopathy or other markers of advanced disease, treatment with steroids may improve outcome – Prednisolone 40 mg every day for 4 weeks and then tapered.
- Possible contraindications to steroids must be considered, such as acute infection, gastrointestinal (GI) hemorrhage, etc.
- Other considerations:
- Acetaminophen use should be < 2gm / day
- Fasting also increases the risk of acetaminophen toxicity in alcoholics
- Propylthiouracil (PTU) has been tried in these patients and may be moderately effective in patients who continue the treatment and discontinue alcohol.
- Colchicine 0.6 mg by mouth, twice daily may help to slow progression of liver disease, though the data is not conclusive.
References
- ↑ 1.0 1.1 McCullough AJ, O'Connor JF (1998). "Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology". Am. J. Gastroenterol. 93 (11): 2022–36. PMID 9820369.
- ↑ Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O (2000). "Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial". Gastroenterology. 119 (6): 1637–48. doi:10.1053/gast.2000.20189. PMID 11113085. (ACP Journal Club synopsis)