New treatment options for alcoholic hepatitis.
The burden of alcoholic liver disease has rapidly grown in the past two decades and is expected to increase further in the coming years. Alcoholic hepatitis, the most florid presentation of alcoholic liver disease, continues to have high morbidity and mortality, with significant financial and healthcare burden with limited treatment options. Steroids remain the current standard of care in severe alcoholic hepatitis in carefully selected patients. No specific treatments are available for those patients who are steroid ineligible, intolerant or unresponsive. Liver transplant has shown good short-term outcome; however, feasibility, ethical and economic concerns remain. Modification of gut microbiota composition and their products, such as lipopolysaccharide, nutritional interventions, immune modulation, increasing steroid sensitivity, genetic polymorphism and epigenetic modification of alcohol induced liver damage, augmenting hepatic regeneration using GCSF are potential therapeutic avenues in steroid non-responsive/ineligible patients. With better understanding of the pathophysiology, using "Omics" platforms, newer options for patients with alcoholic hepatitis are expected soon.
Saggere Muralikrishna Shasthry, Shiv Kumar Sarin, Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India.
Saggere Muralikrishna
SM
Shasthry
Saggere Muralikrishna Shasthry, Shiv Kumar Sarin, Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India.
Shiv Kumar
SK
Sarin
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004351:Drug Resistance; D000069196:Gastrointestinal Microbiome; D041981:Gastrointestinal Tract / Q000382:microbiology; D015316:Genetic Therapy; D006519:Hepatitis, Alcoholic / Q000235:genetics / Q000276:immunology / Q000382:microbiology / Q000628:therapy*; D006801:Humans; D016031:Liver Transplantation; D018529:Nutritional Support; D010431:Pentoxifylline / Q000009:adverse effects / Q000627:therapeutic use*; D056692:Prebiotics; D019936:Probiotics; D013256:Steroids / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D056692:Prebiotics; D013256:Steroids; D010431:Pentoxifylline
Alcoholic hepatitis; Alcoholic liver disease; Alcoholic steatosis; Gut microbiota; Lipopolysaccharide; Steroid non-response