Modern approaches to diagnostics and treatment of severe alcoholic hepatitis

Abstract

Among alcohol damages of the internal organs the leading place belongs to the liver, which metabolizes ethanol. In this case alcoholic hepatitis develops in 10–35% of patients with alcoholic liver disease, and according to some data in 8–15% of people suffering from alcoholism. It should be noted, that mortality among patients with severe alcoholic hepatitis can reach 40–50%. Diagnostics of liver disease include evaluation of clinical, laboratory and instrumental signs of liver damage and also the presence of chronic alchoholic intoxication as etiological factor. It is necessary to conduct a liver biopsy and morphological examination if alcoholic hepatitis is severe. Treatment tactics for alcoholic hepatitis depend on the severity of the disease and the prognosis for the patient’s life. A large number of different scales for evaluation of these indicators was developed. The most widely used are: Maddrey index, the Model for End-Stage Liver Disease scale, the Glasgow alcoholic hepatitis score scale. The high risk of death in patients with alcoholic hepatitis determines the choice of aggressive medical management, including the administration of glucocorticoids, which improve survival in patients with severe alcoholic hepatitis. There is a Lille Model, which evaluates the effectiveness of the therapy and predicts six-month survival in patients with severe alcoholic hepatitis. If there is no efficiency after a week course of steroid therapy, the administration of glucocorticoids should be stopped.

Keywords

chronic alcoholic intoxication / severe alcoholic hepatitis / alcohol-related liver disease / glucocorticoids / hepatoprotectors / pentoxifylline / ethanol / liver failure / cirrhosis / hepatorenal syndrome

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