Humans ; Liver Diseases, Alcoholic ; therapy

Humans ; Liver Diseases, Alcoholic ; diagnosis ; etiology ; therapy

Alcohol Drinking ; adverse effects ; Humans ; Liver Diseases, Alcoholic ; therapy

Guidelines as Topic ; Humans ; Liver Diseases, Alcoholic ; diagnosis ; therapy ; United States

A study conducted 15-year ago showed that only 13.5% of chronic alcoholics developed alcohol-induced liver damage, which misled some people to believe a lack of relationship between the amount of alcohol and the occurrence of liver disease. However, it is true that a significant correlation exists between per capita consumption and the prevalence of cirrhosis. Alcoholic fatty liver is observed in most of chronic alcoholics even though the severity is not uniform. Abstinence remains the cornerstone of therapy for alcoholic liver disease (ALD). There is also consensus for the use of corticosteroids and pentoxifylline in severe alcoholic hepatitis maintaining good nutritional status to treat comorbidities in all forms of ALD, and liver transplantation in the end-stage ALD patients who can stop drinking for 6 months pre-transplantation period. Several clinical trials targeting tumor necrosis factor (TNF-alpha) and reducing oxidative stress have not been successful at this time. There is still a large field of alcohol research to explore in order to go farther in the area of pathophysiology. We need to understand a role of various cytokines and immune cells in the development of ALD to have more treatment tools to cope with ALD.
Alcohols/metabolism ; Cytochrome P-450 CYP2E1/metabolism ; Fatty Liver, Alcoholic/pathology/therapy ; Humans ; Liver Cirrhosis, Alcoholic/pathology/therapy ; Liver Diseases, Alcoholic/*etiology/pathology/therapy ; Oxidative Stress

Severe alcoholic hepatitis has very high short term mortality and corticosteroids have been the mainstay of treatment for decades. Patients with Lille score >0.45 are considered non-responders to steroids and have poor outcome. Recently Orthotopic Liver Transplantation (OLT) is being increasingly used as rescue treatment for these patients, without waiting for 6 months of abstinence. Liver transplant is the only rescue treatment which can potentially provide long term benefit for patients who are steroid non-responders. However, with scarcity of organs being a concern, all patients of severe alcoholic hepatitis cannot be chosen for transplantation in an arbitrary way. There is a need for development of predictive tools and objective protocols to select patients who can justify the use of precious liver grafts. With a stringent criteria for selection of patients receiving the graft, liver transplantation in severe alcoholic hepatitis can become a viable rescue therapeutic option conferring significant survival advantage of both short- and long-term basis. The optimal criteria for selection will also prevent misuse of the liver donor pool as well as to prevent mortality in salvageable patients. Further research needs to be done to identify subset of patients which are at low risk of recidivism and also cannot be managed with pharmacotherapy alone. We reviewed the current knowledge on role of OLT in patient with acute severe alcoholic hepatitis in the present review.
Adrenal Cortex Hormones ; Alcoholics* ; Drug Therapy ; Fibrosis ; Hepatitis, Alcoholic* ; Humans ; Liver Diseases, Alcoholic ; Liver Transplantation* ; Liver* ; Mortality ; Steroids ; Tissue Donors ; Transplants

OBJECTIVETo study the effect of Qinggan Huoxue recipe (QGHXR) in treating alcoholic liver disease (ALD).

METHODSBy adopting the multi-centered, randomized and controlled method, the patients were divided in to the QGHXR group (60 patients) treated orally by QGHXR, the XCHG group (30 patients) treated orally by Xiaochaihu granule and the control group (30 patients) treated orally by conventional therapy such as glucurolactone, vitamin C. The changes in symptoms, signs, liver function, blood lipid, liver fibrosis markers, cytokines, lipid superoxidation parameters and B-untrasonographic figure after treatment of the two groups were observed.

RESULTSThe total therapeutic efficacy of QGHXR, improvements in anorexia, nausea, vomiting and jaundice as well as effect in reducing blood levels of alanine transaminase (ALT), aspartate aminotransferase (AST) and triglyceride (TG) were superior in the QGHXR group to those in the other two groups (P < 0.01), and the effect in decreasing gamma-glutamyl transferase (GGT) and very low-density lipoprotein (VLDL) in the QGHXR group was more significant than that in the control group (P < 0.01). QGHXR also showed effects in lowering levels of liver fibrosis markers and cytokines, alleviating the anti-lipid superoxidation damage in liver, and could markedly improve the degree of fatty liver.

CONCLUSIONQGHXR shows obvious therapeutic effect in treating ALD, the mechanism could possibly be related with its effects in antagonizing lipid superoxidation, stabilizing hepatic cell membrane, adjusting the lipid metabolic disturbance of liver, regulating immune function, anti-liver fibrosis and promoting the intrahepatic metabolism of alcohol.

Adult ; Aged ; Aged, 80 and over ; Drugs, Chinese Herbal ; therapeutic use ; Fatty Liver, Alcoholic ; drug therapy ; Female ; Humans ; Liver Cirrhosis, Alcoholic ; drug therapy ; Liver Diseases, Alcoholic ; drug therapy ; Male ; Middle Aged ; Phytotherapy

Along with the aging process, the spectrum of liver disease changes greatly. Nonalcoholic fatty liver disease (NAFLD) in elderly people lead to low liver function and is also the major cause of extrahepatic diseases, such as cardiovascular disease and malignant tumor. This review provides an overview of the morphological structure and function of the liver in aged people, and discusses the characteristics of weakness, malnutrition and limited movement in the elderly, as well as the current status of multiple diseases and multiple drug use. Finally, this article puts forward some appropriate regimens for the diagnosis and treatment of NAFLD in elderly people to provide a reference for clinical practice.
Aged ; Cardiovascular Diseases ; Humans ; Liver ; pathology ; Malnutrition ; Neoplasms ; Non-alcoholic Fatty Liver Disease ; diagnosis ; pathology ; therapy ; Risk Factors

With recent developments, biologic therapies has shown superior efficacy for rheumatic diseases compared with preexisting pharmacologic therapies, which are associated with high costs, non-response in certain patient groups, and severe adverse effects such as infections limiting their wide-spread use and revealing a need for the development of novel treatments. Since discovering the role of bile acid receptors in regulating inflammation, clinical trials evaluating the use of bile acid receptor agonists as a means to potentially treat various inflammatory disorders, such as alcoholic hepatitis, non-alcoholic steatohepatitis, primary biliary cirrhosis, primary sclerosing cholangitis have been ongoing. This review summarizes the results of studies on the anti-inflammatory effects and mechanisms of bile acid receptors and the results of previous to date looking at the use of bile acid receptor agonists in animal models of inflammatory disorders and clinical trials. Furthermore, we present the potentials of the bile acid receptor agonists in the treatment of inflammatory rheumatic diseases, including rheumatoid arthritis.
Arthritis, Rheumatoid ; Bile* ; Biological Therapy ; Cholangitis, Sclerosing ; Fatty Liver ; Hepatitis, Alcoholic ; Humans ; Inflammation ; Liver Cirrhosis, Biliary ; Models, Animal ; Rheumatic Diseases

China ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Hepatitis B ; drug therapy ; Humans ; Liver Cirrhosis ; drug therapy ; Liver Diseases, Alcoholic ; drug therapy ; Phytotherapy