[Established therapies and new therapeutic strategies in alcoholic liver disease]. / Etablierte Therapien und neue therapeutische Ansätze bei der alkoholischen Leberkrankung.
Z Gastroenterol
; 55(3): 291-303, 2017 Mar.
Article
em De
| MEDLINE
| ID: mdl-27923259
ABSTRACT
Chronical alcohol abuse causes more than 200 diseases and/or symptoms and among these alcoholic liver disease (ALD) is of special importance since it occurs frequently and may be life-threatening. In Europe alcohol consumption as well as ALD increased as compared to the rest of the world. It has been estimated that in Europe approximately 500â000 people die every year due to ALD. ALD consists of alcoholic fatty liver, alcoholic steatohepatitis (ASH), alcoholic cirrhosis and hepatocellar cancer (HCC ). Alcohol hepatitis (AH) is a clinical feature with jaundice and liver failure and a high mortality. The course of ALD is variable and depends among others, on genetics, gender, the presence of other liver diseases as well as exposure towards toxic substances and drugs. The treatment of ALD mainly consists of alcohol abstinence which may be difficult to achieve in the alcoholic. The results of the therapy improve by cognitive psychotherapy as well as antigraving medication. The treatment of AH with poor prognosis is limited. Although a number of therapeutic approaches in AH have been tried, the present therapy consists of intensive care in association with the administration of steroids, hyperalimentation and possibly the administration of N-acetylcystein. Presently it is discussed whether liver transplantation is an option for these patients. New therapeutic approaches focuses on pathopyhsiologically identified targets in ALD. This includes elimination of endotoxines, cytokines, and chemokines as well as an inhibition oxidative stress. Antigraving substances, such as Nalmafen also may improve liver function since their administration degreases alcohol consumption. In addition, betain to stimulate methyltransfer as well the inhibition of apoptosis have been investigated. Stimulation of liver regeneration by granulozytecolony stimulating factor as well as mesenchymalcell and bone marrow transplantation have shown some positive results. Nevertheless new therapeutic strategies are urgently needed. Especially in AH with its high mortality.
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Acetilcisteína
/
Esteroides
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Terapia Cognitivo-Comportamental
/
Transplante de Fígado
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Abstinência de Álcool
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Hepatopatias Alcoólicas
Tipo de estudo:
Prognostic_studies
Limite:
Humans
Idioma:
De
Revista:
Z Gastroenterol
Ano de publicação:
2017
Tipo de documento:
Article