Alcoholic hepatitis: Difference between revisions
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[[Corticosteroid]]s may help in severe cases, but not all cases according to a [[meta-analysis]]. <ref name="pmid18363896">{{cite journal| author=Rambaldi A, Saconato HH, Christensen E, Thorlund K, Wetterslev J, Gluud C| title=Systematic review: glucocorticosteroids for alcoholic hepatitis--a Cochrane Hepato-Biliary Group systematic review with meta-analyses and trial sequential analyses of randomized clinical trials. | journal=Aliment Pharmacol Ther | year= 2008 | volume= 27 | issue= 12 | pages= 1167-78 | pmid=18363896 | doi=10.1111/j.1365-2036.2008.03685.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18363896 }} </ref> In this study, the [[relative risk ratio]] of [[glucocorticosteroids for patients with severe hepatitis]] for mortality at various times was 0.4 and the [[relative risk reduction]] was 63%. In populations similar to those in this study which had a rate of risk as measured by the mortality at various times of 38% without treatment, the [[number needed to treat]] is 4. <ref name="pmid18363896"/> | [[Corticosteroid]]s may help in severe cases, but not all cases according to a [[meta-analysis]]. <ref name="pmid18363896">{{cite journal| author=Rambaldi A, Saconato HH, Christensen E, Thorlund K, Wetterslev J, Gluud C| title=Systematic review: glucocorticosteroids for alcoholic hepatitis--a Cochrane Hepato-Biliary Group systematic review with meta-analyses and trial sequential analyses of randomized clinical trials. | journal=Aliment Pharmacol Ther | year= 2008 | volume= 27 | issue= 12 | pages= 1167-78 | pmid=18363896 | doi=10.1111/j.1365-2036.2008.03685.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18363896 }} </ref> In this study, the [[relative risk ratio]] of [[glucocorticosteroids for patients with severe hepatitis]] for mortality at various times was 0.4 and the [[relative risk reduction]] was 63%. In populations similar to those in this study which had a rate of risk as measured by the mortality at various times of 38% without treatment, the [[number needed to treat]] is 4. <ref name="pmid18363896"/> | ||
The role of [[pentoxifylline]] is uncertain. "The current available data may indicate a possible positive intervention effect of pentoxifylline on all-cause mortality and mortality due to hepatorenal syndrome, and conversely, an increase in serious and non-serious adverse events" according to a [[meta-analysis]] by the [[Cochrane Collaboration]]. <ref name="pmid19821406">{{cite journal| author=Whitfield K, Rambaldi A, Wetterslev J, Gluud C| title=Pentoxifylline for alcoholic hepatitis. | journal=Cochrane Database Syst Rev | year= 2009 | volume= | issue= 4 | pages= CD007339 | pmid=19821406 | doi=10.1002/14651858.CD007339.pub2 | pmc= | url= }} </ref> In this study, the [[relative risk ratio]] of [[pentoxifylline]] for mortality at various times was 0.6 and the [[relative risk reduction]] was 36.8%. In populations similar to those in this study which had a rate of risk as measured by the mortality at various times of 38% without treatment, the [[number needed to treat]] is 7. <ref name="pmid19821406"/> the mortality during hospitalization of 46% without treatment, the [[number needed to treat]] is 5. | The role of [[pentoxifylline]] is uncertain. "The current available data may indicate a possible positive intervention effect of pentoxifylline on all-cause mortality and mortality due to hepatorenal syndrome, and conversely, an increase in serious and non-serious adverse events" according to a [[meta-analysis]] by the [[Cochrane Collaboration]]. <ref name="pmid19821406">{{cite journal| author=Whitfield K, Rambaldi A, Wetterslev J, Gluud C| title=Pentoxifylline for alcoholic hepatitis. | journal=Cochrane Database Syst Rev | year= 2009 | volume= | issue= 4 | pages= CD007339 | pmid=19821406 | doi=10.1002/14651858.CD007339.pub2 | pmc= | url= }} </ref> In this study, the [[relative risk ratio]] of [[pentoxifylline]] for mortality at various times was 0.6 and the [[relative risk reduction]] was 36.8%. In populations similar to those in this study which had a rate of risk as measured by the mortality at various times of 38% without treatment, the [[number needed to treat]] is 7. <ref name="pmid19821406"/> the mortality during hospitalization of 46% without treatment, the [[number needed to treat]] is 5. | ||
"Although combination therapy with prednisolone plus N-acetylcysteine increased 1-month survival among patients with severe acute alcoholic hepatitis, 6-month survival, the primary outcome, was not improved" according to a [[randomized controlled trial]]. <ref name="pmid22070475">{{cite journal| author=Nguyen-Khac E, Thevenot T, Piquet MA, Benferhat S, Goria O, Chatelain D et al.| title=Glucocorticoids plus N-acetylcysteine in severe alcoholic hepatitis. | journal=N Engl J Med | year= 2011 | volume= 365 | issue= 19 | pages= 1781-9 | pmid=22070475 | doi=10.1056/NEJMoa1101214 | pmc= | url= }} </ref> In this trial, the [[relative risk ratio]] of [[N-acetylcysteine]] for mortality at one month was 0.3 and the [[relative risk reduction]] was 66.7%. In populations similar to those in this study which had a rate of risk as measured by the mortality at one month of 24% without treatment, the [[number needed to treat]] is 6. <ref name="pmid22070475"/> | "Although combination therapy with prednisolone plus N-acetylcysteine increased 1-month survival among patients with severe acute alcoholic hepatitis, 6-month survival, the primary outcome, was not improved" according to a [[randomized controlled trial]]. <ref name="pmid22070475">{{cite journal| author=Nguyen-Khac E, Thevenot T, Piquet MA, Benferhat S, Goria O, Chatelain D et al.| title=Glucocorticoids plus N-acetylcysteine in severe alcoholic hepatitis. | journal=N Engl J Med | year= 2011 | volume= 365 | issue= 19 | pages= 1781-9 | pmid=22070475 | doi=10.1056/NEJMoa1101214 | pmc= | url= }} </ref> In this trial, the [[relative risk ratio]] of [[N-acetylcysteine]] for mortality at one month was 0.3 and the [[relative risk reduction]] was 66.7%. In populations similar to those in this study which had a rate of risk as measured by the mortality at one month of 24% without treatment, the [[number needed to treat]] is 6. <ref name="pmid22070475"/> | ||
{| class="wikitable" | {| class="wikitable" | ||
|+ Treatment of alcoholic hepatitis<ref name=" | |+ Treatment of severe alcoholic hepatitis<ref name="pmid18363896">{{cite journal| author=Rambaldi A, Saconato HH, Christensen E, Thorlund K, Wetterslev J, Gluud C| title=Systematic review: glucocorticosteroids for alcoholic hepatitis--a Cochrane Hepato-Biliary Group systematic review with meta-analyses and trial sequential analyses of randomized clinical trials. | journal=Aliment Pharmacol Ther | year= 2008 | volume= 27 | issue= 12 | pages= 1167-78 | pmid=18363896 | doi=10.1111/j.1365-2036.2008.03685.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18363896 }} </ref><ref name="pmid22070475">{{cite journal| author=Nguyen-Khac E, Thevenot T, Piquet MA, Benferhat S, Goria O, Chatelain D et al.| title=Glucocorticoids plus N-acetylcysteine in severe alcoholic hepatitis. | journal=N Engl J Med | year= 2011 | volume= 365 | issue= 19 | pages= 1781-9 | pmid=22070475 | doi=10.1056/NEJMoa1101214 | pmc= | url= }} </ref><ref name="pmid19821406">{{cite journal| author=Whitfield K, Rambaldi A, Wetterslev J, Gluud C| title=Pentoxifylline for alcoholic hepatitis. | journal=Cochrane Database Syst Rev | year= 2009 | volume= | issue= 4 | pages= CD007339 | pmid=19821406 | doi=10.1002/14651858.CD007339.pub2 | pmc= | url= }} </ref> | ||
! rowspan="2"|Trial!!rowspan="2"| Patients!!rowspan="2"| Intervention!!rowspan="2"|Comparison !!rowspan="2"|Outcome!!colspan="2"|Results!!rowspan="2"|Comment | ! rowspan="2"|Trial!!rowspan="2"| Patients!!rowspan="2"| Intervention!!rowspan="2"|Comparison !!rowspan="2"|Outcome!!colspan="2"|Results!!rowspan="2"|Comment | ||
|-<br/> | |-<br/> | ||
! Intervention!!Control | ! Intervention!!Control | ||
|- | |- | ||
| Cochrane<br/>2008<br/>[[Meta-analysis]]||Six trials<br/>• 249 patients | | Cochrane<ref name="pmid18363896"/><br/>2008<br/>[[Meta-analysis]]||Six trials<br/>• 249 patients|| [[Glucocorticosteroid]]s ||Placebo|| Mortality at various times|| 14%|| 38%||[[Relative risk reduction|RRR]] = 63%<br>(subgroup with severe hepatitis) | ||
|- | |- | ||
| Nguyen-Khac<ref name="pmid22070475"/><br/>2011<br/>[[Randomized controlled trial]]||One trial<br/>• 174 patients | | Nguyen-Khac<ref name="pmid22070475"/><br/>2011<br/>[[Randomized controlled trial]]||One trial<br/>• 174 patients<br>• All patients receiving steroids || N-Acetylcysteine||Placebo|| Mortality at one month|| 8%|| 24%||[[Relative risk reduction|RRR]] = 67%<br/>• No benefit after 3 months | ||
|- | |- | ||
| Cochrane | | Cochrane<br/>2009<br/>[[Meta-analysis]]||Five trials<br/>• 336 patients<br>• Unclear if all patients receiving steroids|| [[Pentoxifylline]]||Placebo|| Mortality at various times|| 24%|| 38%|| [[Relative risk reduction|RRR]] = 35%<br/>• May cause epigastric discomfort | ||
|} | |} | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 08:02, 11 May 2024
In gastroenterology, alcoholic hepatitis is "inflammation of the liver due to alcohol abuse. It is characterized by necrosis of hepatocytes, infiltration by neutrophils, and deposit of mallory hyaline bodies. depending on its severity, the inflammatory lesion may be reversible or progress to liver cirrhosis."[1]A practice guideline is available from the American College of Gastroenterology.[2]
Treatment
Corticosteroids may help in severe cases, but not all cases according to a meta-analysis. [3] In this study, the relative risk ratio of glucocorticosteroids for patients with severe hepatitis for mortality at various times was 0.4 and the relative risk reduction was 63%. In populations similar to those in this study which had a rate of risk as measured by the mortality at various times of 38% without treatment, the number needed to treat is 4. [3]
The role of pentoxifylline is uncertain. "The current available data may indicate a possible positive intervention effect of pentoxifylline on all-cause mortality and mortality due to hepatorenal syndrome, and conversely, an increase in serious and non-serious adverse events" according to a meta-analysis by the Cochrane Collaboration. [4] In this study, the relative risk ratio of pentoxifylline for mortality at various times was 0.6 and the relative risk reduction was 36.8%. In populations similar to those in this study which had a rate of risk as measured by the mortality at various times of 38% without treatment, the number needed to treat is 7. [4] the mortality during hospitalization of 46% without treatment, the number needed to treat is 5.
"Although combination therapy with prednisolone plus N-acetylcysteine increased 1-month survival among patients with severe acute alcoholic hepatitis, 6-month survival, the primary outcome, was not improved" according to a randomized controlled trial. [5] In this trial, the relative risk ratio of N-acetylcysteine for mortality at one month was 0.3 and the relative risk reduction was 66.7%. In populations similar to those in this study which had a rate of risk as measured by the mortality at one month of 24% without treatment, the number needed to treat is 6. [5]
| Trial | Patients | Intervention | Comparison | Outcome | Results | Comment | |
|---|---|---|---|---|---|---|---|
| Intervention | Control | ||||||
| Cochrane[3] 2008 Meta-analysis |
Six trials • 249 patients |
Glucocorticosteroids | Placebo | Mortality at various times | 14% | 38% | RRR = 63% (subgroup with severe hepatitis) |
| Nguyen-Khac[5] 2011 Randomized controlled trial |
One trial • 174 patients • All patients receiving steroids |
N-Acetylcysteine | Placebo | Mortality at one month | 8% | 24% | RRR = 67% • No benefit after 3 months |
| Cochrane 2009 Meta-analysis |
Five trials • 336 patients • Unclear if all patients receiving steroids |
Pentoxifylline | Placebo | Mortality at various times | 24% | 38% | RRR = 35% • May cause epigastric discomfort |
References
- ↑ Anonymous (2024), Alcoholic hepatitis (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ "Alcoholic Liver Disease: Proposed Recommendations", Am J Gastroenterol 105: 14–32, 10 November 2009, DOI:10.1038/ajg.2009.593
- ↑ 3.0 3.1 3.2 3.3 Rambaldi A, Saconato HH, Christensen E, Thorlund K, Wetterslev J, Gluud C (2008). "Systematic review: glucocorticosteroids for alcoholic hepatitis--a Cochrane Hepato-Biliary Group systematic review with meta-analyses and trial sequential analyses of randomized clinical trials.". Aliment Pharmacol Ther 27 (12): 1167-78. DOI:10.1111/j.1365-2036.2008.03685.x. PMID 18363896. Research Blogging.
- ↑ 4.0 4.1 4.2 Whitfield K, Rambaldi A, Wetterslev J, Gluud C (2009). "Pentoxifylline for alcoholic hepatitis.". Cochrane Database Syst Rev (4): CD007339. DOI:10.1002/14651858.CD007339.pub2. PMID 19821406. Research Blogging.
- ↑ 5.0 5.1 5.2 5.3 Nguyen-Khac E, Thevenot T, Piquet MA, Benferhat S, Goria O, Chatelain D et al. (2011). "Glucocorticoids plus N-acetylcysteine in severe alcoholic hepatitis.". N Engl J Med 365 (19): 1781-9. DOI:10.1056/NEJMoa1101214. PMID 22070475. Research Blogging.