Published online May 21, 2011. doi: 10.3748/wjg.v17.i19.2454
Revised: February 15, 2011
Accepted: February 22, 2011
Published online: May 21, 2011
Glucocorticosteroids have been used as the only treatment for a long time which significantly reduced the mortality of the patients with severe alcoholic hepatitis. The efficacy of transplantation has been recently addressed in a pilot study. The result seems promising but needs larger multicenter trials.
- Citation: Braillon A. Severe alcoholic hepatitis: Glucocorticoid saves lives and transplantation is promising. World J Gastroenterol 2011; 17(19): 2454-2454
- URL: https://www.wjgnet.com/1007-9327/full/v17/i19/2454.htm
- DOI: https://dx.doi.org/10.3748/wjg.v17.i19.2454
Amini and Runyon conclude that “the routine use of glucocorticoids for severe alcoholic hepatitis (SAH) poses significant risk with equivocal benefit”[1]. They refer to a 2008 Cochrane review but did not cite the authors’ results that “Glucocorticosteroids significantly reduced the mortality of the patients with Maddrey’s score of at least 32 or hepatic encephalopathy and with low-bias risk in a group of trials”.
They also did not cite a recent review in a major journal which concluded that “Five patients need to be treated with corticosteroids to prevent one death”[2]. A more recent meta-analysis of individual patient data (221 allocated to corticosteroids vs 197 controls) confirms that corticosteroids significantly improve the 28-d survival in patients with SAH[3].
The conclusion “Histologic diagnosis of alcoholic hepatitis rules out the possibility of liver transplantation” is exaggerated according to the current literature. A teenager who develops liver failure after a deliberate overdose of paracetamol, or after contracting hepatitis B through irresponsible behaviour, has open access to liver transplantation[4]. Alcoholic patients must not be discriminated: after the transplantation, appropriate support measures must be taken with the alcohol services in the patient’s locality. The efficacy of transplantation has been addressed in a study of 18 patients with SAH. Non-responders to steroids were identified by a Lille score: the 6-mo survival was 83% (compared with 44% in case-matched control) and none of the patients relapsed in the first year[5]. The result seems promising but needs larger multicenter trials.
Peer reviewer: Tsianos Epameinondas, MD, PhD, Professor, 1st Division Of Internal Medicine and Hepato-Gastroenterology Unit, Medical School University of Ioannina, PO Box 1186 Ioannina 45110, Greece
S- Editor Tian L L- Editor Ma JY E- Editor Zheng XM
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| 2. | Lucey MR, Mathurin P, Morgan TR. Alcoholic hepatitis. N Engl J Med. 2009;360:2758-2769. [Cited in This Article: ] |
| 3. | Mathurin P, O'Grady J, Carithers RL, Phillips M, Louvet A, Mendenhall CL, Ramond MJ, Naveau S, Maddrey WC, Morgan TR. Corticosteroids improve short-term survival in patients with severe alcoholic hepatitis: meta-analysis of individual patient data. Gut. 2011;60:255-260. [Cited in This Article: ] |
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| 5. | Castel H, Moreno C, Antonini T, Duclos-Vallée JC, Dumortier J, Leroy V, Dharancy S, Boleslawski E, Lucidi V, Letoublon C. Early transplantation improves survival of non-responders to steroids in severe alcoholic hepatitis: a challenge to the 6 month rule of abstinence. Hepatology. 2009;50:307A. [Cited in This Article: ] |