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Órgano Oficial de la Asociación Mexicana de Hepatología

2008, Number 1

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Ann Hepatol 2008; 7 (1)

Treatment of alcoholic liver disease

Barve A; Marsano RKL; Ravindra KV; McClain C

Language: English
References: 91
Page: 5-15
PDF size: 77.78 Kb.


Text Extraction

Alcoholic Liver Disease (ALD) is a major cause of morbidity and mortality both in the United States and worldwide. In the United States, it is projected that over 2,000,000 persons have ALD, and the mortality for cirrhosis with superimposed alcoholic hepatitis is much worse than that of many common types of cancer. Unfortunately, there is no FDA approved therapy for ALD. We have made major strides in the last decade in identifying mechanisms for the development of liver injury in ALD, and therapies are evolving directed at specific mechanisms. It is clear that life style modification with abstinence, cessation of smoking and weight loss (if overweight) are beneficial. It is also clear that most patients with advanced liver disease have some form of malnutrition, and nutritional supplementation is of benefit. Patients with alcoholic hepatitis that is relatively severe in nature, but not complicated by issues such as infection or GI bleeding, appear to benefit from steroids. A drop in bilirubin should be monitored in steroid treated patients. Pentoxifylline appears to be beneficial in patients with alcoholic hepatitis, especially those with early hepatorenal syndrome. A variety of other agents such as PTU, lecithin, colchicine, and anabolic steroids are probably not effective. Complementary and alternative medicine agents such as zinc, milk thistle, and SAM have great therapeutic rationale. Results of ongoing NIH studies evaluating agents such as specific anti-TNF’s, SAM and Milk Thistle are eagerly awaited. Transplantation is clearly an option for end stage ALD in patients who are abstinent.


REFERENCES

  1. Department of Mental Health and Substance Abuse. WHO Global Status Report on Alcohol 2004. Geneva: World Health Organization; 2004.

  2. 10th Special Report to the U.S. Congress on Alcohol and Health. In: DHHS Publication No. 00-1583, editor.: U.S. Department of Health and Human Services; June 2000.

  3. Kim WR, Brown RS, Jr., Terrault NA, El-Serag H. Burden of liver disease in the United States: summary of a workshop. Hepatology 2002; 36: 227-242.

  4. Hassan MM, Hwang L-Y, Hatten CJ, Swaim M, Li D, Abbruzzese JL, Beasley P, et al. Risk factors for hepatocellular carcinoma: synergism of alcohol with viral hepatitis and diabetes mellitus.[see comment]. Hepatology 2002; 36: 1206-1213.

  5. Carithers RI, McClain CJ, et al. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease, 8/E, Feldman, Friedman and Brant, 2006; 2: 1771-1792.

  6. Veldt BJ, Laine F, Guillygomarc’h A, Lauvin L, Boudjema K, Messner M, Brissot P, et al. Indication of liver transplantation in severe alcoholic liver cirrhosis: quantitative evaluation and optimal timing. J Hepatol 2002; 36: 93-98.

  7. Powell WJ, Jr., Klatskin G. Duration of survival in patients with Laennec’s cirrhosis. Influence of alcohol withdrawal, and possible effects of recent changes in general management of the disease. Am J Med 1968; 44: 406-420.

  8. Lieber CS, Weiss DG, Groszmann R, Paronetto F, Schenker S. II. Veterans Affairs Cooperative Study of polyenylphosphatidylcholine in ALD. Alcohol Clin Exp Res 2003; 27: 1765-1772.

  9. Naveau S, Giraud V, Borotto E, Aubert A, Capron F, Chaput JC. Excess weight risk factor for ALD. Hepatology 1997; 25: 108-111.

  10. Raynard B, Balian A, Fallik D, Capron F, Bedossa P, Chaput JC, Naveau S. Risk factors of fibrosis in alcohol-induced liver disease. Hepatology 2002; 35: 635-638.

  11. Corrao G, Lepore AR, Torchio P, Valenti M, Galatola G, D’Amicis A, et al. The effect of drinking coffee and smoking cigarettes on the risk of cirrhosis associated with alcohol consumption. A case-control study. Provincial Group for the Study of Chronic Liver Disease. Eur J Epidemiol 1994; 10(6): 657-664.

  12. Mendenhall C, Roselle GA, Gartside P, Moritz T. Relationship of protein calorie malnutrition to ALD: a reexamination of data from two Veterans Administration Cooperative Studies. Alcohol Clin Exp Res 1995; 19: 635-641.

  13. Patek AJ, Post J, Ralnoff OD. Dietary treatment of cirrhosis of the liver. JAMA 1948; 139: 543-549.

  14. Kearns PJ, Young H, Garcia G, Blaschke T, O’Hanlon G, Rinki M, Sucher K, et al. Accelerated improvement of ALD with enteral nutrition. Gastroenterology 1992; 102: 200-205.

  15. Cabre E, Rodriguez-Iglesias P, Caballeria J, Quer JC, JL Sa-L, Pares A, Papo M, et al. Short- and long-term outcome of severe alcohol-induced hepatitis treated with steroids or enteral nutrition: a multicenter randomized trial. Hepatology 2000; 32: 36-42.

  16. Hirsch S, Bunout D, de la MP, Iturriaga H, Petermann M, Icazar G, et al. Controlled trial on nutrition supplementation in outpatients with symptomatic alcoholic cirrhosi. JPEN J Parenter Enteral Nutr 1993; 17(2): 119-124.

  17. Imperiale TF, McCullough AJ. Do corticosteroids reduce mortality from alcoholic hepatitis? A meta-analysis of the randomized trials. Ann Intern Med 1990; 113(4): 299-307.

  18. Mathurin P, Mendenhall CL, Carithers RL, Jr., Ramond M-J, Maddrey WC, Garstide P, Rueff B, et al. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis (AH): individual data analysis of the last three randomized placebo controlled double blind trials of corticosteroids in severe AH. [see comment]. Journal of Hepatology 2002; 36: 480-487.

  19. Christensen E, Gluud C. Glucocorticoids are ineffective in alcoholic hepatitis: a meta-analysis adjusting for confounding variables. Gut 1995; 37: 113-118.

  20. Carithers RL, Jr., Herlong HF, Diehl AM, Shaw EW, Combes B, Fallon HJ, Maddrey WC. Methylprednisolone therapy in patients with severe alcoholic hepatitis. A randomized multicenter trial. Ann Intern Med 1989; 110: 685-690.

  21. Helman RA, Temko MH, Nye SW, Fallon HJ. Alcoholic hepatitis. Natural history and evaluation of prednisolone therapy. Ann Intern Med 1971; 74: 311-321.

  22. Phillips, M, Curtis H, Portmann, B, Donaldson N, Bomford A, O’Grady J. Antioxidants versus corticosteroids in the treatment of severe alcoholic hdpatitis - A randomized clinical trial. Jn of Hepatology 2006; 44: 784-790.

  23. Ramond MJ, Poynard T, Rueff B, Mathurin P, Theodore C, Chaput JC, Benhamou JP. A randomized trial of prednisolone in patients with severe alcoholic hepatitis. N Engl J Med 1992; 326: 507-512.

  24. Mathurin P, Duchatelle V, Ramond MJ, Degott C, Bedossa P, Erlinger S, Benhamou JP, et al. Survival and prognostic factors in patients with severe alcoholic hepatitis treated with prednisolone. Gastroenterology 1996; 110: 1847-1853.

  25. Mathurin P, Abdelnour M, Ramond M-J, Carbonell N, Fartoux L, Serfaty L, Valla D, et al. Early change in bilirubin levels is an important prognostic factor in severe alcoholic hepatitis treated with prednisolone. Hepatology 2003; 38: 1363-1369.

  26. Hozo I, Mise S, Rumboidt Z, Bagatin J, Tonkiæ A. A controlled clinical trial of methylprednisolone in patients with the cholestatic form of alcoholic liver cirrhosis. Med Arch 1996; 50(3-4): 81-3.

  27. Strieter RM, Remick DG, Ward PA, Spengler RN, Lynch JP, 3rd, Larrick J, Kunkel SL. Cellular and molecular regulation of tumor necrosis factor-alpha production by pentoxifylline. Biochemical & Biophysical Research Communications 1988; 155: 1230-1236.

  28. Windmeier C, Gressner AM. Pharmacological Aspects of Pentoxifylline with emphasis on its inhibitory actions on Hepatic fibrogenesis. Gen Pharmac 1997; 29: 181-196.

  29. McClain CJ, Song Z, Barve SS, Hill DB, Deaciuc I. Recent advances in ALD. IV. Dysregulated cytokine metabolism in ALD. American Journal of Physiology - Gastrointestinal & Liver Physiology 2004; 287: G497-502.

  30. McClain CJ, Cohen DA. Increased tumor necrosis factor production by monocytes in alcoholic hepatitis. Hepatology 1989; 9: 349-351.

  31. Gobejishvili L, Barve S, Joshi-Barve S, Uriarte S, Song Z, McClain C. Chronic ethanol-mediated decrease in cAMP primes macrophages to enhanced LPS-inducible NF-kappaB activity and TNF expression: relevance to alcoholic liver disease. Am J Physiol Gastrointest Liver Physiol 2006; 291(4): G681-8.

  32. Akriviadis E, Botla R, Briggs W, Han S, Reynolds T, Shakil O. Pentoxifylline improves short-term survival in severe acute alcoholic hepatitis: a double-blind, placebo-controlled trial. Gastroenterology 2000; 119: 1637-1648.

  33. Iimuro Y, Gallucci RM, Luster MI, Kono H, Thurman RG. Antibodies to tumor necrosis factor alfa attenuate hepatic necrosis and inflammation caused by chronic exposure to ethanol in the rat. Hepatology 1997; 26: 1530-1537.

  34. Akerman PA, Cote PM, Yang SQ, McClain C, Nelson S, Bagby G, Diehl AM. Long-term ethanol consumption alters the hepatic response to the regenerative effects of tumor necrosis factor-alpha. Hepatology 1993; 17: 1066-1073.

  35. Tilg H, Jalan R, Kaser A, Davies NA, Offner FA, Hodges SJ, Ludwiczek O, et al. Anti-tumor necrosis factor-alpha monoclonal antibody therapy in severe alcoholic hepatitis.[comment]. Journal of Hepatology 2003; 38: 419-425.

  36. Menon KVN, Stadheim L, Kamath PS, Wiesner RH, Gores GJ, Peine CJ, Shah V. A pilot study of the safety and tolerability of etanercept in patients with alcoholic hepatitis.[see comment]. American Journal of Gastroenterology 2004; 99: 255-260.

  37. Naveau S, Chollet-Martin S, Dharancy S, Mathurin P, Jouet P, Piquet M-A, Davion T, et al. A double-blind randomized controlled trial of infliximab associated with prednisolone in acute alcoholic hepatitis.[see comment]. Hepatology 2004; 39: 1390-1397.

  38. Rambaldi A, Gluud C. Colchicine for alcoholic and non-alcoholic liver fibrosis and cirrhosis.[update in Cochrane Database Syst Rev 2005; (2): CD002148; PMID: 15846629]. Cochrane Database of Systematic Reviews 2001: CD002148.

  39. Cao Q, Mak KM, Lieber CS. Dilinoleoylphosphatidylcholine prevents transforming growth factor-beta1-mediated collagen accumulation in cultured rat hepatic stellate cells. J Lab Clin Med 2002; 139: 202-210.

  40. Cao Q, Mak KM, Lieber CS. Dilinoleoylphosphatidylcholine decreases LPS-induced TNF-alpha generation in Kupffer cells of ethanol-fed rats: respective roles of MAPKs and NF-kappaB. Biochem Biophys Res Commun 2002; 294: 849-853.

  41. Lieber CS, Weiss DG, Groszmann R, Paronetto F, Schenker S, For the Veterans Affairs Cooperative Study G. II. Veterans Affairs Cooperative Study of polyenylphosphatidylcholine in ALD. Alcoholism: Clinical & Experimental Research 2003; 27: 1765-1772.

  42. Kershenobich D, Vargas F, Garcia-Tsao G, Tamayo RP, Gent M, Rojkind M. Colchicine in the treatment of cirrhosis of the liver. N Engl J Med 1988; 318: 1709-1713.

  43. Morgan TR, Nemchausky N, Schiff E, Anand BS, Bloor J, Kidao J, et al. Colchicine does not prolong life in patients with advanced alcoholic cirrhosis: results of a prospective, randomized, placebo-controlled, multicenter VA trial. Gastro 2002; 122: 641.

  44. Mendendenhall CL, Moritz TE, Roselle GA, Morgan TR, Nemchausky BA, Tamburro CH, Schiff ER, McClain CJ, Marsano LS, Allen JI, et al. Protein energy malnutrition in severe alcoholic hepatitis: diagnosis and response to treatment. The VA Cooperative Study Group #275. JPEN J Parenter Enteral Nutr 1995; 19(4): 258-65.

  45. Rambaldi A, Iaquinto G, Gluud C. Anabolic-androgenic steroids for alcoholic liver disease: a Cochrane review. Am J Gastroenterol 2002; 97(7): 1674-1681.

  46. Hanje AJ, Fortune B, Song M, Hill D, McClain C. The use of selected nutrition supplements and complementary and alternative medicine in liver disease. Nutr Clin Pract 2006; 21(3): 255-72.

  47. Ferenci P, Dragosics B, Dittrich H, Frank H, Benda L, Lochs H, et al. Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver. J Hepatol 1989; 9(1): 105-113.

  48. Pares A, Planas R, Torres M, Caballeria J, Viver JM, Acero D, et al. Effects of silymarin in alcoholic patients with cirrhosis of the liver: results of a controlled, double-blind, randomized and multicenter trial. J Hepatol 1998; 28(4): 615-621.

  49. Lee TD, Sadda MR, Mendler MH, Bottiglieri T, Kanel G, Mato JM, et al. Abnormal hepatic methionine and glutathione metabolism in patients with alcoholic hepatitis. Alcohol Clin Exp Res 2004; 28(1): 173-181.

  50. Sanchez-Gongora E, Ruiz F, Mingorance J, An W, Corrales FJ, Mato JM. Interaction of liver methionine adenosyltransferase with hydroxyl radical. FASEB J. 1997; 11(12): 1013-9.

  51. Chawla RK, Watson WH, Jones DP. Effect of hypoxia on hepatic DNA methylation and tRNA methyltransferase in rat: similarities to effects of methyl-deficient diets. J Cell Biochem 1996; 61(1): 72-80.

  52. McClain CJ, Hill DB, Song Z, Chawla R, Watson WH, Chen T, Barve S. S-Adenosylmethionine, cytokines, and alcoholic liver disease. Alcohol 2002; 27(3): 185-92.

  53. Song Z, McClain CJ, Chen T. S-Adenosylmethionine protects against acetaminophen-induced hepatotoxicity in mice. Pharmacology 2004; 71(4): 199-208.

  54. Mato JM, Camara J, Fernandez dP, Caballeria L, Coll S, Caballero A, et al. S-adenosylmethionine in alcoholic liver cirrhosis: a randomized, placebo-controlled, double-blind, multicenter clinical trial. J Hepatol 1999; 30(6): 1081-1089.

  55. Craig SA. Betaine in human nutrition. Am J Clin Nutr 2004; 80(3): 539-49.

  56. Song Z, Zhou Z, Uriarte S, Wang L, Kang YJ, Chen T, Barve S, McClain CJ. S-adenosylhomocysteine sensitizes to TNF-alpha hepatotoxicity in mice and liver cells: a possible etiological factor in alcoholic liver disease. Hepatology 2004; 40: 989-97.

  57. Barak AJ, Beckenhauer HC, Mailliard ME, Kharbanda KK, Tuma DJ. Betaine lowers elevated s-adenosylhomocysteine levels in hepatocytes from ethanol-fed rats. J Nutr 2003; 133(9): 2845-8.

  58. Ji C, Kaplowitz N. Betaine decreases hyperhomocysteinemia, endoplasmic reticulum stress, and liver injury in alcohol-fed mice. Gastroenterology 2003; 124(5): 1488-99.

  59. Rambaldi A, Gluud C. S-adenosyl-L-methionine for alcoholic liver diseases. Cochrane Database of Systematic Reviews 2006, Issue 2., John Wiley & Sons, Ltd, Chichester, UK.

  60. McClain C, Hill D, Kugelmas M, Marsano L. Nutrition and liver disease. In: Rm B, editor. Present knowledge in nutrition. Washington,D.C.: International Life Sciences Institute, 2001: 483-496.

  61. Hill DB, Devalaraja R, Joshi-Barve S, Barve S, McClain CJ. Antioxidants attenuate nuclear factor-kappa B activation and tumor necrosis factor-alpha production in alcoholic hepatitis patient monocytes and rat Kupffer cells, in vitro. Clin Biochem 1999; 32(7): 563-570.

  62. Lee KS, Buck M, Houglum K, Chojkier M. Activation of hepatic stellate cells by TGF alpha and collagen type I is mediated by oxidative stress through c-myb expression. J Clin Invest 1995; 96(5): 2461-2468.

  63. de la Maza MP, Petermann M, Bunout D, Hirsch S. Effects of long-term vitamin E supplementation in alcoholic cirrhotics. J Am Coll Nutr 1995; 14(2): 192-196.

  64. Mezey E, Potter JJ, Rennie-Tankersley L, Caballeria J, Pares A. A randomized placebo controlled trial of vitamin E for alcoholic hepatitis. J Hepatol 2004; 40(1): 40-46.

  65. Meister A. Glutathione metabolism and its selective modification. J Biol Chem 1988; 263(33): 17205-17208.

  66. Pena LR, Hill DB, McClain CJ. Treatment with glutathione precursor decreases cytokine activity. JPEN J Parenter Enteral Nutr 1999; 23(1): 1-6.

  67. McClain CJ, Antonow DR, Cohen DA, Shedlofsky SI. Zinc Metabolism in Alcoholic Liver Disease. Alcoholism: Clin Exper Res 1986; 10(6): 582-589.

  68. Lambert JC, Zhou Z, Wang L, Song Z, McClain CJ, Kang YJ. Prevention of alterations in intestinal permeability is involved in zinc inhibition of acute ethanol-induced liver damage in mice. J Pharmacol Exp Ther 2003; 305(3): 880-6.

  69. Zhou Z, Wang L, Song Z, Saari JT, McClain CJ, Kang YJ. Zinc supplementation prevents alcoholic liver injury in mice through attenuation of oxidative stress. Am J Pathol 2005; 166(6): 1681-90.

  70. Kang YJ, Zhou Z. Zinc prevention and treatment of alcoholic liver disease. Mol Aspects Med 2005; 26(4-5): 391-404.

  71. Grant B, Debakey S, Zobeck T. Liver cirrhosis mortality in the United States, 1973-1988. Washington, DC, US Department of Health and Human Services, 1991.

  72. Hoofnagle JH, Kresina T, Fuller RK, et al. Liver transplantation for ALD: executive statement and summary of recommendations – summary of a National Institutes of Health workshop held December 6-7, 1996, Bethesda, Maryland. Liver Transpl Surg 1997; 3: 347-50.

  73. Haber PS, McCaughan GW. «I’ll never touch it again, doctor!» - harmful drinking after liver transplantation. Hepatology 2007; 46(4): 1302-1304.

  74. Starzl TE, Van TD, Tzakis AG, et al. Orthotopic liver transplantation for alcoholic cirrhosis. JAMA 1988; 260: 2542-44.

  75. Evans IVR, Belle SH. US trends in liver transplantation, 1988 to 2001, in Transplantation of the liver. 2nd edition, Ed: Busuttil and Klintmalm. Elsevier Saunders, Philadelphia, 2005: 1299-1322.

  76. Liver transplantation for ALD: a systematic review of psychosocial selection criteria. McCallum S, Masterton G. Alcohol & Alcoholism 2006; 41(4): 358-63.

  77. Jain A, DiMartini A, Kashyap R, et al. Long term follow-up after liver transplantation for ALD under Tacrolimus. Transplantation 2000; 70: 1335-1342.

  78. Poynard T, Naveasu S, Doffoel M, et al. Evaluation of efficacy of liver transplantation in alcoholic cirrhosis using matched and simulated controls: 5 year survival. Multi-center group. J Hepatol 1999; 30: 1130-1137.

  79. Dasarathy S, McCullough AJ. ALD, in Diseases of the Liver, (9th edition). Ed: Schiff ER, Sorrell MF, Maddrey WC. Lippincott Williams & Wilkins, Philadelphia, 2003: 1018-1057.

  80. Urbano-Marquez A, Estruch R, Navarro-Lopez F, et al. The effects of alcoholism on skeletal and cardiac muscle. N Engl J Med 1989; 320: 409-419.

  81. Miller WR, Saucedo CF. Assessment of neuropsychological impairment and brain damage in problem drinkers, in Clinical Neuropsychology: Interact with Neurologic and Psychiatric disorders, edited by Golden CJ, Moses JA, Coffman JA, et al. New York, Grune and Stratton, 1983: 141-171.

  82. Walton NH, Bowden SC. Does liver dysfunction explain neuropsychological status in recently detoxifies alcohol-dependent clients? Alcohol Alcohol 1997; 32: 287-295.

  83. Pantiga C, Rodrigo LR, Cuesta M, Lopez L, Arias JL. Cognitive deficits in patients with hepatic cirrhosis and in liver transplant recipients. The Journal of Neuropsychiatry and Clinical Neurosciences 2003; 15: 84-89.

  84. Everhart H, Beresford J. Liver transplantation for ALD: a survey of transplant programs in the United States. Liver Transpl Surg 1997; 3: 220-226.

  85. Paillet C, Chamouard V, Bageotte A, Boillot O, Colin C, Dumortier J. Liver transplantation for chronic liver disease: hospital costs. Presse Med 2007; 36(2): 203-210.

  86. Kumar, S, Stauber R, Gavler J, et al. Orthotopic liver transplantation for ALD. Hepatology 1990; 11: 159-164.

  87. Howard L, Fahy T, Wong P, et al. Psychiatric outcome in alcoholic liver transplant patients. QJM 1994; 87: 731-736.

  88. Pageaux GP, et al. Alcoholic cirrhosis is a good indication for liver transplantation, even for cases of recidivism. Gut 1999; 45: 421-426.

  89. Gottardi AD, Spahr L, Gelez P, et al. A simple score for predicting alcohol relapse after liver transplantation. Arch Intern Med 2007; 167: 1183-1188.

  90. Cowling T, Jennings LW, Goldstein RM, Sanchez EQ, Chinnakotla S, Klintmalm GB, Levy MF. Societal reintegration after liver transplantation: findings in alcohol-related and non-alcohol-related transplant recipients. Ann Surg 2004; 239: 93-98.

  91. Dumortier J, Guillaud O, Adham M, et al. Negative impact of De Novo malignancies rather than alcohol relapse on survival after liver transplantation for alcoholic cirrhosis: a retrospective analysis of 305 patients in a single center. Am J Gastroenterol 2007; 102: 1032-1041.




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