Alcoholic Hepatitis: Pathogenesis and Approaches to Treatment
- 1 January 1990
- journal article
- review article
- Published by Informa UK Limited in Scandinavian Journal of Gastroenterology
- Vol. 25 (sup175), 118-130
- https://doi.org/10.3109/00365529009093136
Abstract
Alcoholic hepatitis is a necrotizing, often inflammatory, process that is an important precursor to the development of cirrhosis. Acetaldehyde, which is derived from alcohol by the action of alcohol dehydrogenase, is apparently the most important factor leading to alcohol-induced liver injury. Other factors of importance in determining the appearance and rate of progression of liver diseases in patients who are chronic alcoholics include sex, nutritional status, and various immunologic reactions. In addition, there is an incompletely understood genetic predisposition to the development of alcoholic hepatitis. Several histologic features found in patients with alcoholic hepatitis have been evaluated in efforts to determine which are of prognostic value. The predominance of the alcohol-induced injury in zone III of the hepatic lobule; deposition of collagen, IgA, and fibronectin in the space of Disse; defenestration of endothelial cells; and transformation of lipocytes and myofibroblasts to fibroblasts have been investigated. Prolongation of the prothrombin time and marked elevation of serum bilirubin levels are indicators of a subgroup of patients with alcoholic hepatitis who have a poor prognosis, especially if there is also evidence of hepatic encephalopathy. Supportive care and abstinence from alcohol are the foundations of therapy. Corticosteroid therapy appears to decrease the number of early deaths in patients with severe alcoholic hepatitis. Other experimental approaches to therapy include the use of propylthiouracil, anabolic-androgenic steroids, and insulin and glucagon.Keywords
This publication has 82 references indexed in Scilit:
- Alcohol and liver injury: dose‐related or permissive effect?Liver International, 1989
- Biochemical and Molecular Basis of Alcohol-Induced Injury to Liver and Other TissuesNew England Journal of Medicine, 1988
- Colchicine in the Treatment of Cirrhosis of the LiverNew England Journal of Medicine, 1988
- Long-Term Treatment of Alcoholic Liver Disease with PropylthiouracilNew England Journal of Medicine, 1987
- The characteristics of alcoholic liver disease in Japan. Clinicopathologic comparison with alcoholic liver disease in the United StatesLiver International, 1987
- Early alcoholic liver injury: changes of the Disse space in acinar zone 3Liver International, 1985
- Hepatitis B virus antigen and antibodies in alcoholics. Etiological role of HBV in liver diseases of alcoholic patientsLiver International, 1985
- Correlation between liver morphology and haemodynamics in alcoholic liver diseaseLiver International, 1985
- Short-Term and Long-Term Survival in Patients with Alcoholic Hepatitis Treated with Oxandrolone and PrednisoloneNew England Journal of Medicine, 1984
- The SGOT/SGPT ratio?An indicator of alcoholic liver diseaseDigestive Diseases and Sciences, 1979