Treatment of Alcoholic Liver Disease

From Therapeutic Advances in Gastroenterology

Thomas H. Frazier, MD; Abigail M. Stocker, MD; Nicole A. Kershner, MD; Luis S. Marsano, MD; Craig J. McClain, MD

Abstract

Alcoholic liver disease (ALD) remains a major cause of liver-related mortality in the US and worldwide.
The correct diagnosis of ALD can usually be made on a clinical basis in conjunction with blood tests, and a liver biopsy is not usually required.
Abstinence is the hallmark of therapy for ALD, and nutritional therapy is the first line of therapeutic intervention.
The role of steroids in patients with moderate to severe alcoholic hepatitis is gaining increasing acceptance, with the caveat that patients be evaluated for the effectiveness of therapy at 1 week.
Pentoxifylline appears to be especially effective in ALD patients with renal dysfunction/hepatorenal syndrome.
Biologics such as specific anti-TNFs have been disappointing and should probably not be used outside of the clinical trial setting.
Transplantation is effective in patients with end-stage ALD who have stopped drinking (usually for ≥6 months), and both long-term graft and patient survival are excellent.

Introduction

Alcoholic liver disease (ALD), which ranges from simple steatosis to cirrhosis and hepatocellular carcinoma (HCC), continues to represent a major health issue in the United States and abroad.
Despite significant advances in the understanding of the pathogenesis of alcohol-related liver injury, there are no FDA-approved treatments for ALD.
The purpose of this review is to examine the diagnosis and current modalities of treatment for ALD.
At present, abstinence remains the cornerstone for successful treatment of ALD. Aside from treatment of the underlying addiction, aggressive nutritional intervention and 'off-label' use of various pharmacotherapies aimed at the underlying mechanisms of injury (e.g., cytokine dysregulation, endotoxin translocation and oxidative stress) represent our approach to treating ALD.

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http://www.medscape.com/viewarticle/739272?src=mp&spon=17