ABSTRACT
Malnutrition is a common cause of impeding recovery in patients with acute alcoholic hepatitis (AAH). Previous reports have shown that appropriate nutritional supplementation reduce short and long-term mortality in patients with AAH. Despite these clear recommendations, the element of nutrition in AAH is often neglected. We designed a quality improvement project to evaluate and improve compliance with appropriate nutrition in patients presenting with AAH at our institution. Patients admitted with AAH between December 2015 to December 2016 were included. Our primary outcome was compliance with appropriate nutrition. Secondary outcomes included nutrition consultation and hepatology consultation. A total of fifty-four patients were included. Nine of the 53 patients (17%) received high calorie and high protein diets. Hepatology was consulted in 72% (38/53) of the patients, and 21% (8/38) of these patients received appropriate nutrition as compared to only 8.3% (1/12) in whom hepatology was not consulted. Nutrition was consulted in 55% (29/53) of these patients and 67% (19/28) of those patients received appropriate nutrition. In conclusion, our compliance of appropriate nutrition in AAH is low. Our initial investigation suggests that hepatology and nutrition consultation improved compliance with appropriate nutrition. The next step will be to implement protocolized care for appropriate nutrition in AAH by incorporating consultation of hepatology and nutrition services, assess the effect on adherence to appropriate nutrition, and determine the impact on patient outcomes.
Subject(s)
Diet, Healthy/standards , Gastroenterologists/standards , Hepatitis, Alcoholic/diet therapy , Malnutrition/diet therapy , Nutritional Status , Nutritionists/standards , Practice Patterns, Physicians'/standards , Acute Disease , Diet, High-Protein/standards , Energy Intake , Female , Hepatitis, Alcoholic/complications , Hepatitis, Alcoholic/diagnosis , Hepatitis, Alcoholic/physiopathology , Humans , Male , Malnutrition/diagnosis , Malnutrition/etiology , Malnutrition/physiopathology , Middle Aged , Nutritive Value , Quality Improvement/standards , Quality Indicators, Health Care/standards , Referral and Consultation/standards , Time Factors , Treatment OutcomeSubject(s)
Humans , Adult , Middle Aged , Aged , Pentoxifylline/administration & dosage , Pentoxifylline/adverse effects , Prednisolone/administration & dosage , Hepatitis, Alcoholic/complications , Hepatitis, Alcoholic/physiopathology , Hepatitis, Alcoholic/drug therapy , Severity of Illness Index , Prednisolone/adverse effects , Chile , Survival Rate , Reproducibility of Results , Drug Monitoring , Evidence-Based Medicine , Republic of Korea , Hepatitis, Alcoholic/mortality , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/adverse effectsABSTRACT
ABOUT THE UPDATE: This article updates the June 2014 Living FRISBEE (Living FRISBEE: Living FRIendly Summary of the Body of Evidence using Epistemonikos). It incorporates a new systematic review identifying one study not included in previous reviews. The new evidence leads to substantial changes in the existing evidence. ASBTRACT: Pentoxifylline is an inhibitor of tumor necrosis factor, and has been proposed as treatment for alcoholic hepatitis. However, it is not clear if it is effective, or if it adds benefit to the treatment with corticosteroids. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified three systematic reviews including eight randomized controlled trials addressing the question of this article. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded pentoxifylline probably leads to little or no difference in mortality in alcoholic hepatitis.
ACERCA DE LA ACTUALIZACIÓN: Este resumen Epistemonikos (Living FRISBEE: Living FRIendly Summary of the Body of Evidence using Epistemonikos) es una actualización del resumen publicado en Junio de 2014. Incorpora una nueva revisión sistemática que identificó un estudio no incluido en las revisiones previas. La incorporación de esta nueva evidencia lleva a cambios sustantivos en la evidencia existente. RESUMEN: La pentoxifilina, un inhibidor del factor de necrosis tumoral oral, se ha planteado como un posible tratamiento para la hepatitis alcohólica. Sin embargo, no está claro si es efectiva o si su adición al tratamiento con corticoides agrega beneficios. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos tres revisiones sistemáticas que en conjunto incluyen ocho estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que la pentoxifilina probablemente no disminuye la mortalidad en pacientes con hepatitis alcohólica.
Subject(s)
Hepatitis, Alcoholic/drug therapy , Pentoxifylline/therapeutic use , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adrenal Cortex Hormones/administration & dosage , Hepatitis, Alcoholic/mortality , Hepatitis, Alcoholic/physiopathology , Humans , Pentoxifylline/administration & dosage , Phosphodiesterase Inhibitors/administration & dosage , Phosphodiesterase Inhibitors/therapeutic use , Randomized Controlled Trials as Topic , Treatment OutcomeABSTRACT
The burden of alcoholic liver disease continues to be a major public health problem worldwide. The spectrum of disease ranges from fatty liver to cirrhosis and hepatocellular carcinoma. Alcoholic hepatitis (AH) is a type of acute-on-chronic liver failure and the most severe form of alcoholic liver disease. Severe AH carries a poor short-term prognosis and its management is still challenging, with scarce advances in the last decades. Corticosteroids are still the first line of therapy in severe cases. Unfortunately, many patients do not respond and novel targeted therapies are urgently needed. Liver transplantation has shown extraordinary results in non-responders to corticosteroids however; its applicability is very low. This review summarizes the epidemiology, natural history, risk factors and pathogenesis of alcoholic liver disease with special focus on the latest advances in prognostic stratification and therapy of patients with alcoholic hepatitis.
Subject(s)
Acute-On-Chronic Liver Failure/physiopathology , Fatty Liver, Alcoholic/physiopathology , Hepatitis, Alcoholic/physiopathology , Acute-On-Chronic Liver Failure/epidemiology , Acute-On-Chronic Liver Failure/therapy , Adrenal Cortex Hormones/therapeutic use , Fatty Liver, Alcoholic/epidemiology , Fatty Liver, Alcoholic/therapy , Hepatitis, Alcoholic/epidemiology , Hepatitis, Alcoholic/therapy , Humans , Liver Cirrhosis, Alcoholic/epidemiology , Liver Cirrhosis, Alcoholic/physiopathology , Liver Cirrhosis, Alcoholic/therapy , Liver Transplantation , Prognosis , Risk FactorsABSTRACT
O alcoolismo corresponde a um distúrbio altamente prevalente, que é apontado como fator etiológico e(ou) fator de risco importante de vários tipos de patologias orgânicas graves. Tais características o tornam um problema de saúde pública, incitando a necessidade de atitudes eficazes por parte dos profissionais de saúde em relação ao seu diagnóstico e à prevenção. Infelizmente, inquéritos demonstram que o Brasil está na categoria de grande consumidor de bebidas alcoólicas, traduzindo o fácil acesso ao consumo e o incentivo exaustivo por parte da mídia. Com base nessas considerações, o objetivo do presente estudo é discutir os aspectos mais relevantes dessa patologia enfatizando o diagnóstico e a abordagem terapêutica.
Subject(s)
Humans , Alcoholism , Hepatitis, Alcoholic/diagnosis , Hepatitis, Alcoholic/physiopathology , Hepatitis, Alcoholic/therapy , Adrenal Cortex Hormones , Liver Cirrhosis/diagnosis , Liver Cirrhosis/therapy , Fatty Liver/physiopathology , Glucagon , Pentoxifylline , Propylthiouracil/therapeutic use , S-AdenosylmethionineABSTRACT
La apoptosis es una forma de muerte celular que ocurre en una amplia variedad de enfermedades hepáticas. En ésta revisión se presentan generalidades del proceso y métodos de detección; la apoptosis como generadora de enfermedad en la hepatitis alcohólica, hepatitis virales, hepatocarcinoma, colestasis, rechazo de transplantes, enfermedad de Wilson y consideraciones sobre la posible implementación de terapéuticas que modulen la apoptosis en las enfermedades hepáticas (AU)
Subject(s)
Humans , Apoptosis/physiology , Liver Diseases , Hepatitis, Alcoholic/physiopathology , Hepatitis, Viral, Human/physiopathology , Carcinoma, Hepatocellular/physiopathology , Cholestasis/physiopathology , Hepatolenticular Degeneration/physiopathology , Graft Rejection , Liver Transplantation , Hepatitis, Autoimmune , Liver Cirrhosis, Biliary , Cholangitis, Sclerosing/physiopathology , Cholangiocarcinoma/physiopathology , Hepatitis B/physiopathology , Hepatitis C/physiopathology , Reperfusion Injury/physiopathology , Liver/physiopathologyABSTRACT
La apoptosis es una forma de muerte celular que ocurre en una amplia variedad de enfermedades hepáticas. En ésta revisión se presentan generalidades del proceso y métodos de detección; la apoptosis como generadora de enfermedad en la hepatitis alcohólica, hepatitis virales, hepatocarcinoma, colestasis, rechazo de transplantes, enfermedad de Wilson y consideraciones sobre la posible implementación de terapéuticas que modulen la apoptosis en las enfermedades hepáticas