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Prednisolone or Pentoxifylline for Alcoholic Hepatitis

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https://www.readbyqxmd.com/read/28543549/review-article-recent-insights-into-clinical-decision-making-in-severe-alcoholic-hepatitis
#1
REVIEW
P D J Dunne, E H Forrest
BACKGROUND: Alcoholic hepatitis is a severe acute manifestation of alcoholic liver disease with a high mortality. Management of patients with this condition has been a matter of controversy for many years; however, recent clinical studies have sought to improve the clinical approach to these patients. AIM: To use these recent studies in order to guide clinical management. METHODS: A MeSH search of Medline was performed to specifically identify recent studies which influenced clinical diagnosis, assessment and management of alcoholic hepatitis...
May 21, 2017: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/28282320/alcoholic-hepatitis-current-trends-in-management
#2
Ariel W Aday, Mack C Mitchell, Lisa C Casey
PURPOSE OF REVIEW: Alcohol consumption is increasing globally, as are complications of alcohol-related liver disease, including the most severe manifestation, alcoholic hepatitis. Despite the increased prevalence, many patients hospitalized with alcoholic hepatitis are either not diagnosed or inadequately treated leading to significant morbidity and high mortality rates. The purpose of this review is to discuss current challenges in the diagnosis and management of this frequently fatal condition...
May 2017: Current Opinion in Gastroenterology
https://www.readbyqxmd.com/read/28247264/new-paradigms-in-management-of-alcoholic-hepatitis-a-review
#3
REVIEW
Sandeep Singh Sidhu, Omesh Goyal, Harsh Kishore, Simran Sidhu
Severe alcoholic hepatitis (SAH) is defined by modified Maddrey discriminant function ≥32 or Model for End-Stage Liver Disease (MELD) >21 and/or hepatic encephalopathy. It has a 3-month mortality rate ≥30-70 %. Patients with severe alcoholic hepatitis need combined, i.e., static (MELD score) and dynamic (Lille's score), prognostication. Systemic inflammation and poor regeneration are hallmarks of SAH, rather than intrahepatic inflammation. SAH is characterized by dysregulated and uncontrolled systemic inflammatory response followed by weak compensatory antiinflammatory response that leads to increased susceptibility to infection and multiple organ failure...
May 2017: Hepatology International
https://www.readbyqxmd.com/read/28161471/homozygosity-for-rs738409-g-in-pnpla3-is-associated-with-increased-mortality-following-an-episode-of-severe-alcoholic-hepatitis
#4
Stephen R Atkinson, Michael J Way, Andrew McQuillin, Marsha Y Morgan, Mark R Thursz
BACKGROUND & AIMS: Carriage of rs738409:G in PNPLA3 is associated with an increased risk of developing alcohol-related cirrhosis and has a significant negative effect on survival. Short-term mortality in patients with severe alcoholic hepatitis is high; drinking behaviour is a major determinant of outcome in survivors. The aim of this study was to determine whether carriage of rs738409:G has an additional detrimental effect on survival in this patient group. METHODS: Genotyping was undertaken in 898 cases with severe alcoholic hepatitis, recruited through the UK Steroids or Pentoxifylline for Alcoholic Hepatitis (STOPAH) trial, and 1188 White British/Irish alcohol dependent controls with no liver injury, recruited via University College London...
July 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/28096540/alcoholic-liver-disease-alcoholic-hepatitis-a-warning-for-prednisolone-and-infection-risk
#5
Katrina Ray
No abstract text is available yet for this article.
February 2017: Nature Reviews. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28043903/in-patients-with-severe-alcoholic-hepatitis-prednisolone-increases-susceptibility-to-infection-and-infection-related-mortality-and-is-associated-with-high-circulating-levels-of%C3%A2-bacterial-dna
#6
RANDOMIZED CONTROLLED TRIAL
Nikhil Vergis, Stephen R Atkinson, Suzanne Knapp, James Maurice, Michael Allison, Andrew Austin, Ewan H Forrest, Steven Masson, Anne McCune, David Patch, Paul Richardson, Dermot Gleeson, Stephen D Ryder, Mark Wright, Mark R Thursz
BACKGROUND & AIMS: Infections are common in patients with severe alcoholic hepatitis (SAH), but little information is available on how to predict their development or their effects on patients. Prednisolone is advocated for treatment of SAH, but can increase susceptibility to infection. We compared the effects of infection on clinical outcomes of patients treated with and without prednisolone, and identified risk factors for development of infection in SAH. METHODS: We analyzed data from 1092 patients enrolled in a double-blind placebo-controlled trial to evaluate the efficacy of treatment with prednisolone (40 mg daily) or pentoxifylline (400 mg 3 times each day) in patients with SAH...
April 2017: Gastroenterology
https://www.readbyqxmd.com/read/27979049/medical-management-of-severe-alcoholic-hepatitis-expert%C3%A2-review-from-the-clinical-practice-updates-committee-of%C3%A2-the-aga-institute
#7
REVIEW
Mack C Mitchell, Lawrence S Friedman, Craig J McClain
The purpose of this clinical practice update is to review diagnostic criteria for severe acute alcoholic hepatitis and to determine the current best practices for this life-threatening condition. The best practices in this review are based on clinical trials, systematic reviews including meta-analysis and expert opinion to develop an approach to diagnosis and management. Best Practice Advice 1: Abstinence from drinking alcohol is the cornerstone of treatment for alcohol hepatitis (AH). Best Practice Advice 2: Patients with jaundice and suspected AH should have cultures of blood, urine, and ascites, if present, to determine the presence of bacterial infections regardless of whether they have fever...
January 2017: Clinical Gastroenterology and Hepatology
https://www.readbyqxmd.com/read/27965666/critical-roles-of-kupffer-cells-in-the-pathogenesis-of-alcoholic-liver-disease-from-basic-science-to-clinical-trials
#8
REVIEW
Tao Zeng, Cui-Li Zhang, Mo Xiao, Rui Yang, Ke-Qin Xie
Alcoholic liver disease (ALD) encompasses a spectrum of liver injury ranging from steatosis to steatohepatitis, fibrosis, and finally cirrhosis. Accumulating evidences have demonstrated that Kupffer cells (KCs) play critical roles in the pathogenesis of both chronic and acute ALD. It has become clear that alcohol exposure can result in increased hepatic translocation of gut-sourced endotoxin/lipopolysaccharide, which is a strong M1 polarization inducer of KCs. The activated KCs then produce a large amount of reactive oxygen species (ROS), pro-inflammatory cytokines, and chemokines, which finally lead to liver injury...
2016: Frontiers in Immunology
https://www.readbyqxmd.com/read/27922027/a-day-4-lille-model-predicts-response-to-corticosteroids-and-mortality-in-severe-alcoholic-hepatitis
#9
Mauricio Garcia-Saenz-de-Sicilia, Chitharanjan Duvoor, Jose Altamirano, Roberta Chavez-Araujo, Veronica Prado, Ana de Lourdes Candolo-Martinelli, Patricia Holanda-Almeida, Bernardo Becerra-Martins-de-Oliveira, Simony Fernandez-de-Almeida, Ramón Bataller, Juan Caballeria, Andres Duarte-Rojo
OBJECTIVES: Prednisolone therapy increases the risk of infections in patients with severe alcoholic hepatitis (SAH). We evaluated whether the use of the Lille Model at day 4 (LM4) is useful to predict response to prednisolone compared with the classic day 7 (LM7) in order to limit a futile exposure to corticosteroids. METHODS: We performed a retrospective analysis of a large multinational cohort of patients with SAH with Maddrey's discriminant function (DF) ≥32...
February 2017: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/27646933/current-and-upcoming-pharmacotherapy-for-non-alcoholic-fatty-liver-disease
#10
REVIEW
Yaron Rotman, Arun J Sanyal
Given the high prevalence and rising incidence of non-alcoholic fatty liver disease (NAFLD), the absence of approved therapies is striking. Although the mainstay of treatment of NAFLD is weight loss, it is hard to maintain, prompting the need for pharmacotherapy as well. A greater understanding of disease pathogenesis in recent years was followed by development of new classes of medications, as well as potential repurposing of currently available agents. NAFLD therapies target four main pathways. The dominant approach is targeting hepatic fat accumulation and the resultant metabolic stress...
January 2017: Gut
https://www.readbyqxmd.com/read/27636406/treatment-of-severe-alcoholic-hepatitis-with-corticosteroid-pentoxifylline-or-dual-therapy-a-systematic-review-and-meta-analysis
#11
Young-Sun Lee, Hyun Jung Kim, Ji Hoon Kim, Yang Jae Yoo, Tae Suk Kim, Seong Hee Kang, Sang Jun Suh, Moon Kyung Joo, Young Kul Jung, Beom Jae Lee, Yeon Seok Seo, Hyung Joon Yim, Jong Eun Yeon, Jae Seon Kim, Jong-Jae Park, Soon Ho Um, Young-Tae Bak, Kwan Soo Byun
BACKGROUND AND AIMS: Although both corticosteroids and pentoxifylline are currently recommended drugs for the treatment of patients with severe alcoholic hepatitis, their effectiveness in reducing mortality remains unclear. In this systematic review, we aimed to evaluate the therapeutic and adverse effects of corticosteroids, pentoxifylline, and combination by using Cochrane methodology and therefore determine optimal treatment for severe alcoholic hepatitis. METHODS: We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from their inauguration until October 2015...
April 2017: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/27404293/corticosteroids-versus-pentoxifylline-for-severe-alcoholic-hepatitis-a-sequential-analysis-of-randomized-controlled-trials
#12
Basile Njei, Albert Do, Thomas R McCarty, Brett E Fortune
INTRODUCTION: Despite the significant morbidity and mortality associated with alcoholic hepatitis, a consensus or generally accepted therapeutic strategy has not yet been reached. The purpose of this analysis was to evaluate the effects of corticosteroids and pentoxifylline on short-term mortality, incidence of hepatorenal syndrome, and sepsis in patients with severe alcoholic hepatitis. MATERIALS AND METHODS: We conducted a comprehensive search of the Cochrane library, PUBMED, Scopus, EMBASE, and published proceedings from major hepatology and gastrointestinal meetings from January 1970 to June 2015...
November 2016: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/27373613/acute-alcoholic-hepatitis-therapy
#13
REVIEW
Paulina K Phillips, Michael R Lucey
Alcoholic hepatitis (AH) causes great morbidity and mortality in the United States and throughout the world. Advances in therapy have proven difficult. In part, this reflects challenges in diagnosis, including the distinction between AH and acute-on-chronic liver failure. Liver biopsy is the best method to clarify the cause in circumstances whereby conflicting clinical data confound the diagnosis. All treatment of AH begins with abstinence from alcohol. All patients with AH should be given sufficient nutrition...
August 2016: Clinics in Liver Disease
https://www.readbyqxmd.com/read/27350941/current-management-of-alcoholic-hepatitis-and-future-therapies
#14
REVIEW
Behnam Saberi, Alia S Dadabhai, Yoon-Young Jang, Ahmet Gurakar, Esteban Mezey
Alcohol is one of the most common etiologies of liver disease, and alcoholic liver disease overall is the second most common indication for liver transplantation in the United States. It encompasses a spectrum of disease, including fatty liver disease, alcoholic hepatitis (AH), and alcoholic cirrhosis. AH can range from mild to severe disease, with severe disease being defined as: Discriminant Function (DF) ≥ 32, or Model for End-stage Liver Disease (MELD) ≥ 21, or presence of hepatic encephalopathy. Management of the mild disease consists mainly of abstinence and supportive care...
June 28, 2016: Journal of Clinical and Translational Hepatology
https://www.readbyqxmd.com/read/27170388/pathogenesis-and-management-of-alcoholic-liver-disease
#15
REVIEW
M Omar Farooq, Ramon Bataller
Alcoholic liver disease (ALD) is a leading cause of liver-related morbidity and mortality. ALD encompasses a spectrum of disorders ranging from asymptomatic steatosis, alcoholic steatohepatitis, fibrosis, cirrhosis and its related complications. Moreover, patients can develop an acute-on-chronic form of liver failure called alcoholic hepatitis (AH). Most patients are diagnosed at advanced stages of the disease with higher rates of complications and mortality. The mainstream of therapy of ALD patients, regardless of the disease stage, is prolonged alcohol abstinence...
2016: Digestive Diseases
https://www.readbyqxmd.com/read/27147285/the-worsening-profile-of-alcoholic-hepatitis-in-the-united-states
#16
Tuyet A Nguyen, Jonathan P DeShazo, Leroy R Thacker, Puneet Puri, Arun J Sanyal
BACKGROUND: Alcoholic hepatitis (AH) is a major cause of liver-related hospitalization. The profile, treatment patterns, and outcomes of subjects admitted for AH in routine clinical practice are unknown. Also, it is not known whether these are changing over time. This study is thus aimed to identify temporal trends in hospitalization rates, clinical characteristics, treatment patterns, and outcomes of subjects admitted for AH in a routine clinical setting. METHODS: A retrospective analysis of adults admitted for AH from 2000 to 2011 was performed using an anonymized EMR database of patient-level data from 169 U...
June 2016: Alcoholism, Clinical and Experimental Research
https://www.readbyqxmd.com/read/26948886/treatment-of-severe-alcoholic-hepatitis
#17
REVIEW
Mark Thursz, Timothy R Morgan
Alcoholic hepatitis (AH) is a syndrome of jaundice and liver failure that occurs in a minority of heavy consumers of alcohol. The diagnosis usually is based on a history of heavy alcohol use, findings from blood tests, and exclusion of other liver diseases by blood and imaging analyses. Liver biopsy specimens, usually collected via the transjugular route, should be analyzed to confirm a diagnosis of AH in patients with an atypical history or presentation. The optimal treatment for patients with severe AH is prednisolone, possibly in combination with N-acetyl cysteine...
June 2016: Gastroenterology
https://www.readbyqxmd.com/read/26870933/therapeutic-strategies-for-the-treatment-of-alcoholic-hepatitis
#18
REVIEW
Ashwani K Singal, Vijay H Shah
Acute alcoholic hepatitis is a unique clinical syndrome among patients with chronic and active heavy alcohol use. Presenting with acute or chronic liver failure, a severe episode has a potential for 30 to 40% mortality at 1 month from presentation, if not recognized and left untreated. Alcoholic hepatitis patients need supportive therapy for abstinence and nutritional supplementation for those patients with markedly reduced caloric intake. Results of the recently published STOPAH (Steroids or Pentoxifylline for Alcoholic Hepatitis) Study showed only a benefit of corticosteroids on short-term mortality without any benefit of pentoxifylline...
February 2016: Seminars in Liver Disease
https://www.readbyqxmd.com/read/26860769/defective-monocyte-oxidative-burst-predicts-infection-in-alcoholic-hepatitis-and-is-associated-with-reduced-expression-of-nadph-oxidase
#19
Nikhil Vergis, Wafa Khamri, Kylie Beale, Fouzia Sadiq, Mina O Aletrari, Celia Moore, Stephen R Atkinson, Christine Bernsmeier, Lucia A Possamai, Gemma Petts, Jennifer M Ryan, Robin D Abeles, Sarah James, Matthew Foxton, Brian Hogan, Graham R Foster, Alastair J O'Brien, Yun Ma, Debbie L Shawcross, Julia A Wendon, Charalambos G Antoniades, Mark R Thursz
OBJECTIVE: In order to explain the increased susceptibility to serious infection in alcoholic hepatitis, we evaluated monocyte phagocytosis, aberrations of associated signalling pathways and their reversibility, and whether phagocytic defects could predict subsequent infection. DESIGN: Monocytes were identified from blood samples of 42 patients with severe alcoholic hepatitis using monoclonal antibody to CD14. Phagocytosis and monocyte oxidative burst (MOB) were measured ex vivo using flow cytometry, luminometry and bacterial killing assays...
March 2017: Gut
https://www.readbyqxmd.com/read/26709723/pharmacotherapy-of-alcoholic-liver-disease-in-clinical-practice
#20
REVIEW
V Rosato, L Abenavoli, A Federico, M Masarone, M Persico
AIMS: Alcohol is the most commonly used addictive substance and alcoholic liver disease (ALD) is a major cause of chronic liver disease worldwide, responsible for 47.9% of all liver chronic deaths. Despite ALD has a significant burden on the health, few therapeutic advances have been made in the last 40 years, particularly in the long-term management of these patients. METHODS: we searched in PubMed, Scopus, Google Scholar, and MEDLINE databases to identify relevant English language publications focused on long-term therapy of ALD...
February 2016: International Journal of Clinical Practice
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