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Gastroenterology Jul 2015
Topics: Hepatitis, Alcoholic; Humans; Research
PubMed: 26008859
DOI: 10.1053/j.gastro.2015.05.015 -
Minerva Gastroenterologica E Dietologica Jun 2020
Topics: Acute Disease; Hepatitis, Alcoholic; Humans; Liver Transplantation; Severity of Illness Index
PubMed: 32218428
DOI: 10.23736/S1121-421X.20.02688-4 -
Digestive Diseases (Basel, Switzerland) 2016Alcoholic liver disease (ALD) is a leading cause of liver-related morbidity and mortality. ALD encompasses a spectrum of disorders ranging from asymptomatic steatosis,... (Review)
Review
Alcoholic liver disease (ALD) is a leading cause of liver-related morbidity and mortality. ALD encompasses a spectrum of disorders ranging from asymptomatic steatosis, alcoholic steatohepatitis, fibrosis, cirrhosis and its related complications. Moreover, patients can develop an acute-on-chronic form of liver failure called alcoholic hepatitis (AH). Most patients are diagnosed at advanced stages of the disease with higher rates of complications and mortality. The mainstream of therapy of ALD patients, regardless of the disease stage, is prolonged alcohol abstinence. The current therapeutic regimens for AH (i.e. prednisolone) have limited efficacy and targeted therapies are urgently needed. The development of such therapies requires translational studies in human samples and suitable animal models that reproduce clinical and histological features of AH. In recent years, new animal models that simulate some of the features of human AH have been developed, and translational studies using human samples have identified potential pathogenic factors and histological parameters that predict survival. In this review, we discuss the pathogenesis and management of ALD, focusing on AH, its current therapies and potential treatment targets.
Topics: Animals; Anti-Inflammatory Agents; Hepatitis, Alcoholic; Humans; Liver Diseases, Alcoholic; Prednisolone; Translational Research, Biomedical
PubMed: 27170388
DOI: 10.1159/000444545 -
Cells Feb 2020Alcohol use disorder is associated with a wide array of hepatic pathologies ranging from steatosis to alcoholic-related cirrhosis (AC), alcoholic hepatitis (AH), or... (Review)
Review
Alcohol use disorder is associated with a wide array of hepatic pathologies ranging from steatosis to alcoholic-related cirrhosis (AC), alcoholic hepatitis (AH), or hepatocellular carcinoma (HCC). Biomarkers are categorized into two main categories: biomarkers associated with alcohol consumption and biomarkers of alcoholic liver disease (ALD). No ideal biomarker has been identified to quantify the degree of hepatocyte death or severity of AH, even though numerous biomarkers have been associated with AH. This review provides information of some of the novel and latest biomarkers that are being investigated and have shown a substantial association with the degree and severity of liver injury and inflammation. Importantly, they can be measured noninvasively. In this manuscript, we consolidate the present understanding and prospects of these biomarkers; and their application in assessing the severity and progression of the alcoholic liver disease (ALD). We also review current and upcoming management options for AH.
Topics: Animals; Biomarkers; Female; Hepatitis, Alcoholic; Humans; Male
PubMed: 32106390
DOI: 10.3390/cells9030524 -
Journal of Viral Hepatitis Oct 2015Most HCV-infected patients regularly consume alcohol. Alcoholic liver disease (ALD) and chronic hepatitis C virus (HCV) infection together are the most common causes of... (Review)
Review
Most HCV-infected patients regularly consume alcohol. Alcoholic liver disease (ALD) and chronic hepatitis C virus (HCV) infection together are the most common causes of liver disease worldwide. Although both factors independently cause liver disease, they synergistically promote rapid liver disease progression with devastating outcomes for patients. This review focuses on the prevalence, clinical characteristics and molecular pathophysiologic mechanisms of HCV infection associated with alcohol abuse. Recent findings have centred on the synergistic effect of alcohol and HCV on viral replication, hepatocyte apoptosis, oxidative stress, alcohol-induced 'leaky gut', miR-122 and immune dysregulation. Clinical and basic research findings presented here summarize key scientific findings with the aim of highlighting potential areas for new therapies and identifying ways of optimizing current treatments for alcoholics with HCV infection.
Topics: Animals; Comorbidity; Hepatitis C, Chronic; Hepatitis, Alcoholic; Humans; Liver; Prevalence
PubMed: 25754333
DOI: 10.1111/jvh.12399 -
Current Opinion in Organ Transplantation Apr 2022The aim of this review is to provide a critical analysis of liver transplantation for alcoholic hepatitis, with an emphasis on barriers to long-term success in current... (Review)
Review
PURPOSE OF REVIEW
The aim of this review is to provide a critical analysis of liver transplantation for alcoholic hepatitis, with an emphasis on barriers to long-term success in current implementation strategies across the United States.
RECENT FINDINGS
Alcohol-associated liver disease is the most rapidly increasing indication for liver transplantation in the USA. Its most severe form, acute alcoholic hepatitis, has a rising incidence particularly in the young, and is associated with a high mortality risk. Although excellent outcomes following liver transplantation for alcoholic hepatitis can be achieved, several barriers limit its routine use. These constraints include risk of allograft dysfunction, the recognition of alcohol use disorder as a multisystem disease and ethical considerations.
SUMMARY
Although liver transplantation is an important option in a carefully selected group of candidates, it should not be considered the standard of care in this condition. Consistency, transparency and consensus are necessary to formulate and implement policy changes at the national level. Following liver transplantation, wraparound services are important for relapse prevention, and to ensure long-term success and survival in this challenging group of patients.
Topics: Contraindications; Hepatitis, Alcoholic; Humans; Liver Diseases, Alcoholic; Liver Transplantation; Patient Selection; Recurrence; United States
PubMed: 35166269
DOI: 10.1097/MOT.0000000000000974 -
Alimentary Pharmacology & Therapeutics Feb 2021Liver biopsy may be of diagnostic and prognostic value but its role in alcoholic hepatitis (AH) has been controversial.
BACKGROUND
Liver biopsy may be of diagnostic and prognostic value but its role in alcoholic hepatitis (AH) has been controversial.
AIM
To assess the utility of liver biopsy in the assessment of clinically severe AH METHODS: The histological features of alcoholic steatohepatitis (ASH) were recorded and scored in patients enrolled in the Steroids or Pentoxifylline for Alcoholic Hepatitis (STOPAH) trial who underwent liver biopsy. These features were then assessed relative to outcome and established clinical prognostic scores.
RESULTS
The STOPAH trial recruited 1068 patients; biopsies were obtained in 182 (17%). One hundred and sixty-one biopsies were adequate for histological assessment and 140 (87%) were diagnostic for ASH. Only three biopsies (2%) did not have histological features of alcohol-related liver injury. In biopsies performed prior to randomisation, ASH was identified in 92.5% of patients meeting clinical trial definitions of severe AH. In biopsies with ASH, taken before or within 48 hours of randomisation, survival differences between Alcoholic Hepatitis Histological Score (AHHS) groups were not significant: comparison of mild / moderate (91%: 21 of 23 patients) with severe (78%: 29 of 37 patients) groups: P = 0.18. The AHHS was not superior to clinical scores of prognosis: area under the curve for 28-day mortality was 0.728, compared with 0.799 for the Glasgow alcoholic hepatitis score and 0.728 for the MELD score.
CONCLUSION
Liver histology taken before treatment rarely changes the diagnosis in patients meeting strict criteria for a clinical diagnosis of AH. The AHHS is similar to clinical scores in determining prognosis. Clinical trial registration EudraCT reference number: 2009-013897-42. ISRCTN reference number: 88782125. MREC number: 09/MRE09/59.
UKCRIN ID
9143.
Topics: Fatty Liver, Alcoholic; Hepatitis, Alcoholic; Humans; Liver; Pentoxifylline; Prognosis; Randomized Controlled Trials as Topic; Severity of Illness Index
PubMed: 33326633
DOI: 10.1111/apt.16157 -
Nature Reviews. Drug Discovery Jan 2020
Topics: Bacteriophages; Hepatitis, Alcoholic; Humans; Liver Diseases, Alcoholic
PubMed: 31907420
DOI: 10.1038/d41573-019-00198-2 -
JAAPA : Official Journal of the... Apr 2024Alcoholic hepatitis is a form of inflammation of the liver caused by alcohol use. Data on the best treatment are conflicting. Treatment guidelines include the use of... (Review)
Review
Alcoholic hepatitis is a form of inflammation of the liver caused by alcohol use. Data on the best treatment are conflicting. Treatment guidelines include the use of prednisolone and supportive care, although this is controversial. This article reviews the guidelines for treating alcoholic hepatitis and current recommendations.
Topics: Humans; Hepatitis, Alcoholic; Prednisolone; Glucocorticoids; Treatment Outcome
PubMed: 38531032
DOI: 10.1097/01.JAA.0001007356.14309.d8 -
Clinical and Molecular Hepatology Dec 2018Severe acute alcoholic liver disease (SAAH) unresponsive to medical therapy shows one-year-mortality rates of up to 90%. Most transplant centers request six months of... (Review)
Review
Severe acute alcoholic liver disease (SAAH) unresponsive to medical therapy shows one-year-mortality rates of up to 90%. Most transplant centers request six months of alcohol abstinence prior to transplantation, the so-called "6-month rule." This regulation is not based on strong evidence, repeatedly making it a topic of controversial debates. The majority of patients with SAAH will die before fulfilling the 6-month rule. Therefore, liver transplantation (LT) protocols are becoming more flexible towards the rigid abstinence regulation, especially concerning SAAH patients. We conducted a literature review regarding LT in SAAH and its outcomes, including post-transplant mortality and recidivism. We studied available data on PubMed from 2011 and onwards whilst including articles dealing with genetic components, medical therapy and historic snapshots of alcoholism. Emerging studies recommend LT in SAAH not responding to medical therapies even without realizing the required abstinence period, since the majority of these patients would die within 6 months. SAAH without response to medical therapy has one-year-mortality rates of up to 90%. The 6-month rule is not based on strong evidence and is repeatedly a topic of controversial debates. There is genetic linkage to alcoholism and medical therapy is not as effective as estimated, yet. The 6-months-regulation has not shown to evidently decrease the risk of recidivism post-LT, which is a lifesaving treatment in SAAH patients. Insisting on rigid sobriety rules results in excluding patients with a low risk of recidivism from being transplanted. Moreover, the genetic linkage of alcoholism must be recognized.
Topics: Alcohol Dehydrogenase; Alcoholism; Hepatitis, Alcoholic; Humans; Liver Transplantation; Pentoxifylline; Phosphodiesterase Inhibitors; Severity of Illness Index
PubMed: 30360030
DOI: 10.3350/cmh.2018.0044