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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
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
Mark Thursz, Ewan Forrest, Paul Roderick, Christopher Day, Andrew Austin, John O'Grady, Stephen Ryder, Michael Allison, Dermot Gleeson, Anne McCune, David Patch, Mark Wright, Steven Masson, Paul Richardson, Luke Vale, Jane Mellor, Louise Stanton, Megan Bowers, Ian Ratcliffe, Nichola Downs, Scott Kirkman, Tara Homer, Laura Ternent
BACKGROUND: Alcoholic hepatitis (AH) is a distinct presentation of alcoholic liver disease arising in patients who have been drinking to excess for prolonged periods, which is characterised by jaundice and liver failure. Severe disease is associated with high short-term mortality. Prednisolone and pentoxifylline (PTX) are recommended in guidelines for treatment of severe AH, but trials supporting their use have given heterogeneous results and controversy persists about their benefit. OBJECTIVES: The aim of the clinical effectiveness and cost-effectiveness of STeroids Or Pentoxifylline for Alcoholic Hepatitis trial was to resolve the clinical dilemma on the use of prednisolone or PTX...
December 2015: Health Technology Assessment: HTA
Mark R Thursz, Paul Richardson, Michael Allison, Andrew Austin, Megan Bowers, Christopher P Day, Nichola Downs, Dermot Gleeson, Alastair MacGilchrist, Allister Grant, Steven Hood, Steven Masson, Anne McCune, Jane Mellor, John O'Grady, David Patch, Ian Ratcliffe, Paul Roderick, Louise Stanton, Nikhil Vergis, Mark Wright, Stephen Ryder, Ewan H Forrest
BACKGROUND: Alcoholic hepatitis is a clinical syndrome characterized by jaundice and liver impairment that occurs in patients with a history of heavy and prolonged alcohol use. The short-term mortality among patients with severe disease exceeds 30%. Prednisolone and pentoxifylline are both recommended for the treatment of severe alcoholic hepatitis, but uncertainty about their benefit persists. METHODS: We conducted a multicenter, double-blind, randomized trial with a 2-by-2 factorial design to evaluate the effect of treatment with prednisolone or pentoxifylline...
April 23, 2015: New England Journal of Medicine
Ewan Forrest, Jane Mellor, Louise Stanton, Megan Bowers, Priscilla Ryder, Andrew Austin, Christopher Day, Dermot Gleeson, John O'Grady, Steven Masson, Anne McCune, David Patch, Paul Richardson, Paul Roderick, Stephen Ryder, Mark Wright, Mark Thursz
BACKGROUND: Alcoholic hepatitis is the most florid presentation of alcohol-related liver disease. In its severe form, defined by a Maddrey's discriminant function (DF) ≥32, the 28-day mortality rate is approximately 35%. A number of potential treatments have been subjected to clinical trials, of which two, corticosteroids and pentoxifylline, may have therapeutic benefit. The role of corticosteroids is controversial as trial results have been inconsistent, whereas the role of pentoxifylline requires confirmation as only one previous placebo-controlled trial has been published...
2013: Trials
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