Corticosteroids and pentoxifylline for the treatment of alcoholic hepatitis:Current status

The treatment of choice for patients with severe alcoholic hepatitis (AH) is use of corticosteroids.Many randomized well designed studies have been reported from all over the world on the use of corticosteroids in the treatment of AH.However,the data on the efficacy of corticosteroids in these patients have been conflicting.Initial meta-analyses also failed to show beneficial effects of corticosteroids.Based on individual data meta-analysis showing clear benefit of corticosteroids amongst patients with severe AH (modified discriminant function of 32 or more),led American College of Gastroenterology to recommend use of corticosteroids as the first line treatment option amongst patients with severe AH.However,corticosteroids are relatively contraindicated amongst patients with severe AH and coexistent sepsis,gastrointestinal bleeding,and acute pancreatitis.These patients may be candidates for second line treatment with pentoxifylline.Further,specific treatment of AH with corticosteroids far from satisfactory with as many as 40%-50% of patients failing to respond to steroids,thus classified as nonresponsive to steroids.The management of these patients is a continuing challenge for physicians.Better treatment modalities need to be developed for this group of patients in order to improve the outcome of patients with severe AH.This article describes at length the available trials on use of corticosteroids and pentoxifylline with their current status.Route of administration,dosage,adverse effects,and mechanisms of action of these two drugs are also discussed.Finally,an algorithm with clinical approach to management of patients who present with clinical syndrome of AH is described.

Management practices of hepatitis C virus infected alcoholic hepatitis patients:A survey of physicians

AIM:To survey gastroenterologists and hepatologists regarding their current views on treating hepatitis C virus(HCV) infected alcoholic hepatitis(AH) patients.METHODS:A sixteen item questionnaire was electronically mailed to gastroenterologists and hepatologists.A reminder was sent after 2 mo to increase the response rate.Participation of respondents was confidential.Accessing secured web site to respond to the questionnaire was considered as informed consent.Responses received on the secured website were downloaded in an excel sheet for data analysis.RESULTS:Analyzing 416 responses to 1556(27% response rate) emails,57% respondents(56% gastroenterologists) reported HCV prevalence > 20% amongst AH patients.Sixty nine percent often treated AH and 46% preferred corticosteroids(CS).Proportion of respondents with consensus(75% or more respondents agreeing on question) on specific management of HCV infected AH were:routine HCV testing(94%),HCV not changing response to CS(80%) or pentoxifylline(91%),no change in approach to treating HCV infected AH(75%).None of respondent variables:age,specialty,annual number of patients seen,and HCV prevalence could predict respondent to be in consensus on any of or all 4 questions.Further,only 4% would choose CS for treating HCV infected AH as opposed to 47% while treating HCV negative AH.CONCLUSION:Gastroenterologists and hepatologists believe that AH patients be routinely checked for HCV.However,there is lack of consensus on choice of drug for treatment and outcome of HCV positive AH patients.Studies are needed to develop guidelines for management of HCV infected AH patients.