Journal article
Alcoholic steatohepatitis.
- 2010-10-20
Published in:
- Best practice & research. Clinical gastroenterology. - 2010
Cytochrome P-450 CYP2E1
Enteral Nutrition
Fatty Liver, Alcoholic
Glucocorticoids
Health Status Indicators
Humans
Lipid Peroxidation
Liver
Liver Transplantation
Prognosis
Tumor Necrosis Factor-alpha
English
Severe alcoholic steatohepatitis has a poor prognosis and is characterized by jaundice and signs of liver failure. Its incidence is unknown, but prevalence is around 20% in cohorts of alcoholics undergoing liver biopsy. Diagnosis is established with elevated liver transaminases, neutrophil counts, serum bilirubin, and impaired coagulation and a history of excessive alcohol consumption, and exclusion of other etiologies. Histology is helpful but not mandatory. Prognostic scores include the Maddrey's discriminant function, the model of end-stage liver disease, and the Glasgow Alcoholic Hepatitis Score. Pathophysiology involves hepatic fat storage, increased hepatic uptake of gut-derived endotoxins triggering Kupffer cell activation and release of proinflammatory triggers, induction of cytochrome P4502E1 producing toxic acetaldehyde and reactive oxygen species, and ethanol-mediated hyperhomocysteinemia causing endoplasmic reticulum stress. Treatment includes abstinence, enteral nutrition, corticosteroids, and possibly pentoxifylline. A debate is ongoing whether certain patients with severe alcoholic steatohepatitis could be eligible for liver transplantation.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.bpg.2010.07.003
- PMID 20955970
- Persistent URL
- https://sonar.ch/global/documents/115923
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