Catalogo Articoli (Spogli Riviste)

OPAC HELP

Titolo:
Treatments for acute alcoholic hepatitis
Autore:
Naveau, S;
Indirizzi:
Hop Antoine Beclere, Serv Hepatogastroenterol, F-92141 Clamart, France HopAntoine Beclere Clamart France F-92141 erol, F-92141 Clamart, France
Titolo Testata:
PRESSE MEDICALE
fascicolo: 20, volume: 30, anno: 2001,
pagine: 1024 - 1030
SICI:
0755-4982(20010609)30:20<1024:TFAAH>2.0.ZU;2-B
Fonte:
ISI
Lingua:
FRE
Soggetto:
DOUBLE-BLIND TRIAL; RANDOMIZED CONTROLLED TRIAL; AMINO-ACID SUPPLEMENTATION; LIVER-DISEASE; SHORT-TERM; GLUCAGON-INFUSION; PARENTERAL-NUTRITION; CLINICAL-TRIAL; METHYLPREDNISOLONE THERAPY; CORTICOSTEROID-THERAPY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
73
Recensione:
Indirizzi per estratti:
Indirizzo: Naveau, S Hop Antoine Beclere, Serv Hepatogastroenterol, 157 Rue Porte Trivaux, F-92141 Clamart, France Hop Antoine Beclere 157 Rue Porte Trivaux Clamart France F-92141
Citazione:
S. Naveau, "Treatments for acute alcoholic hepatitis", PRESSE MED, 30(20), 2001, pp. 1024-1030

Abstract

Prognosis: Acute alcoholic hepatitis (AAH) is a severe form of alcohol-related liver disease with a high short-term mortality that can reach 50%. long-term outcome depends on definitive weaning from alcohol and the development of cirrhosis. Essential therapeutic step: Abstention from alcohol is the number one therapeutic measure required for treating AAH. Abstention must be total and definitiveTherapeutic strategies: The pathogenic mechanisms involved in AAH have ledto close assessment of numerous treatment protocols. Thirty-three randomized trials have evaluated drug treatments based on Various strategies: antiinflammatory action using corticosteroids or colchicine; reduction of the hypermetabolism using propylthiouracil; hepatoprotective effect against oxidative stress using cyanidalol, alpha lipoid acid, silymarine, amlopidine, malotilate; vasodilatation to improve oxygenation of the centrolublular region using a calcium channel inhibitor, amlopidine; increased liver regeneration using anabolism steroids, intravenous perfusion combining insulin and glucagon; antifibrosis action using colchicine, D penicillamine; improved microcirculation due to increased deformability of the red cells and inhibition of TNF-alpha using pentoxifyllin. Eleven therapeutic trials have investigated the effect of parenteral or enteral artificial nutrition. Gold standard treatment: Among all these strategies. the only one with a proven efficacy is corticosteroid therapy. Four trials have demonstrated theeffect of corticosteroid therapy on short-term survival and 3 of the 4 meta-analyses devoted to the topic have demonstrated the usefulness of corticosteroid therapy in severe forms defined by a Maddrey index greater than or equal to 32: bilirubin in mu mol per liter/ 17 + 4.6 (patient's PT in seconds - control PT in seconds) and the presence or not of encephalopathy. The gold standard treatment for severe AAH is oral prednisolone 40 mg/d for 1 month (excluding contraindications). Perspectives: Despite the effect of corticosteroid therapy, mortality at 2months in severe AAH is still about 30%. Recent experimental data suggest that monoclonal anti-TN alpha. antibodies could be useful.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 02/10/20 alle ore 01:50:10