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Diagnóstico y tratamiento de la enfermedad hepática asociada al alcohol: una revisión
Ashwani K Singal1,2, Philippe Mathurin3
1University of South Dakota Sanford School of Medicine, Sioux Falls.
JAMA
|July 13, 2021
Resumen
La enfermedad hepática asociada al alcohol (ALD) puede conducir a la cirrosis, con millones de afectados en los Estados Unidos. La intervención temprana con corticosteroides o trasplante de hígado ofrece una mejor supervivencia para la ELA grave y la cirrosis descompensada.
Área de la Ciencia:
- Hepatología
- Gastroenterología
- Médico interno
Sus antecedentes:
- La enfermedad hepática asociada al alcohol (ALD) es una causa significativa de cirrosis, mortalidad hepática y trasplante de hígado en todo el mundo.
- En 2017, más de 2 millones de personas en los Estados Unidos tenían cirrosis asociada al alcohol, lo que representa una carga sustancial para la salud pública.
- La ALD es una de las principales indicaciones para el trasplante de hígado, representando el 40-50% de los trasplantes en países de altos ingresos.
Objetivo del estudio:
- Resumir la epidemiología, los factores de riesgo y el tratamiento de la enfermedad hepática asociada al alcohol.
- Resaltar las implicaciones del pronóstico de la hepatitis alcohólica y la cirrosis descompensada.
- Para subrayar el papel de los corticosteroides y el trasplante de hígado en el manejo de la ELA grave.
Principales métodos:
- Revisión de los hallazgos patológicos en ALD, incluida la esteatosis, la hepatitis alcohólica y la fibrosis.
- Identificación de factores de riesgo para la progresión de la ELA, como los patrones de consumo de alcohol, el sexo, la obesidad y los polimorfismos genéticos.
- Análisis de los datos de supervivencia basados en la abstinencia alcohólica y la recaída.
- Evaluación de los resultados del tratamiento con corticosteroides y trasplante de hígado.
Principales resultados:
- La hepatitis alcohólica presenta el mayor riesgo de progresión de la cirrosis.
- Los factores de riesgo de ALD incluyen la cantidad / duración del consumo de alcohol, el sexo femenino, la obesidad y las variantes genéticas específicas.
- La abstinencia alcohólica se asocia con una supervivencia a 10 años significativamente mejor (88%) en comparación con la recaída (73%).
- La hepatitis alcohólica sintomática conlleva un riesgo de mortalidad del 30% dentro de un año; los casos graves están relacionados con la insuficiencia hepática aguda-crónica.
- El tratamiento con corticosteroides mejora la supervivencia a 1 mes en la hepatitis alcohólica grave del 65% al 80%.
- El trasplante de hígado es crucial para pacientes seleccionados con hepatitis alcohólica grave que no responden al tratamiento médico y aquellos con cirrosis descompensada (puntuación MELD > 17 después de 3 meses de abstinencia).
- La proporción de candidatos a trasplante de hígado con ELA aumentó del 22% al 40% entre 2014 y 2019.
Conclusiones:
- Las enfermedades hepáticas y la cirrosis asociadas al alcohol son muy frecuentes, afectan a millones de personas y contribuyen significativamente a la mortalidad relacionada con el hígado.
- El tratamiento con corticosteroides es eficaz para mejorar la supervivencia de algunos pacientes con hepatitis alcohólica grave.
- El trasplante de hígado representa la opción terapéutica más eficaz para los pacientes con enfermedad hepática descompensada debida al alcohol.
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