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Histological Analyses of Acute Alcoholic Liver Injury in Zebrafish
Published on: May 25, 2017
Alcoholic Hepatitis
Kaushik Agarwal1, Nickolas Kontorinis, Nickolas Kontorinis
1Department of Medicine, Mount Sinai Medical Center, One Gustave Levy Place, New York, NY 10029-6574, USA.
Insights
Alcoholic hepatitis (AH) is a severe liver condition. While corticosteroids are controversial, they may help selected patients, and new targeted therapies show promise for managing this alcohol-related liver disease.
Area of Science:
- Hepatology
- Gastroenterology
- Internal Medicine
Background:
- Alcoholic hepatitis (AH) is a prevalent liver disease linked to substantial illness and death.
- Diagnosis often involves a history of heavy alcohol use and signs of liver decompensation.
- AH is histologically defined as acute hepatic inflammation due to alcohol exposure.
Purpose of the Study:
- To review current understanding and treatment of alcoholic hepatitis.
- To discuss the role of corticosteroids and emerging targeted therapies.
- To clarify management strategies based on disease severity.
Main Methods:
- Review of existing literature on alcoholic hepatitis pathogenesis and treatment.
- Analysis of therapeutic interventions, particularly for severe AH.
- Assessment of diagnostic criteria and prognostic indicators like the Maddrey score.
Main Results:
- Corticosteroids, though debated, are recommended for specific AH patients.
- Emerging therapies targeting disease pathogenesis, including anti-TNF-α monoclonals and pentoxifylline, are under investigation.
- The Maddrey score is crucial for determining prognosis and guiding treatment decisions.
Conclusions:
- Long-term alcohol abstinence, nutrition, and lifestyle changes are primary treatment goals.
- Corticosteroids remain a treatment option for selected severe AH cases.
- Orthotopic liver transplantation is generally not advised for severe AH patients with uncertain long-term alcohol abstinence.
Abstract:
Alcoholic hepatitis (AH) is a common disease associated with significant morbidity and mortality. Most often the diagnosis is suggested by a history of heavy alcohol excess in a patient with features of hepatic decompensation. In its purest form, AH is a histologic diagnosis of acute hepatic inflammation in response to alcohol. The primary objective of treatment for AH is to support long-term alcohol abstinence and to achieve adequate nutrition with lifestyle modification; goal setting and education are integral to long-term medical management. Severity at presentation (calculated by way of the Maddrey score) determines outcome. Patients with AH represent a heterogeneous group with regard to severity and pathogenesis, with various therapeutic interventions assessed in patients with severe AH. To date, corticosteroids have been studied most, and despite remaining controversial, warrant a place in the treatment of selected patients. Recent advances in unraveling the aspects of disease pathogenesis in AH have raised the possibility of targeted therapies, such as anti-tumor necrosis factor-a monoclonals and pentoxifylline. Orthotopic liver transplantation is not recommended for patients with severe acute AH, as most have an unclear long-term prognosis in the context of ongoing excess alcohol ingestion at presentation.
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