Alcoholic Hepatitis  

Oleh:

Lucey, Michael R. ; Mathurin, Philippe ; Morgan, Timothy R.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 360 no. 26 (Jun. 2009), page 2758-2769.
Topik: Alcoholic Hepatitis

Ketersediaan

Perpustakaan FK Nomor Panggil: N08.K.2009.03 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

The diagnosis of alcoholic hepatitis is based on a history of heavy alcohol use, jaundice, and the absence of other possible causes of hepatitis. Liver biopsy is a valuable diagnostic aid but is not required either to determine the prognosis or to establish the timeline of previous drinking or abstinence. Abstinence from alcohol is the cornerstone of recovery. Malnourished subjects should be given adequate caloric and protein support. Patients with severe alcoholic hepatitis (Maddrey's discriminant function, 32; or MELD score, 21) who do not have sepsis should be given a trial of prednisolone at a dose of 40 mg per day for 28 days. After 7 days of corticosteroid treatment, patients with a Lille score of more than 0.45 may have disease that will not respond to continued treatment with corticosteroids or to an early switch to pentoxifylline. When the clinical situation is such that clinicians are reluctant to prescribe corticosteroids, pentoxifylline appears to be useful in preventing the hepatorenal syndrome, which can lead to death. The efficacy of combined treatment with pentoxifylline and corticosteroids has not been studied and warrants a randomized, controlled trial. Patients with less severe alcoholic hepatitis, whose short-term survival approaches a rate of 90%, should not be treated with corticosteroids, since the risks of complications such as systemic infections outweigh the benefits. Finally, there is a need for well-conducted studies of liver transplantation in carefully selected patients with severe alcoholic hepatitis that is not responding to medical management.

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