The rising burden of alcoholic hepatitis in North America is a cause for concern, according to a recent study published in the journal Medical Clinics of North America. The study highlights the need for a better understanding of how to manage and evaluate AH patients.
Alcoholic hepatitis (AH) is a severe liver disease caused by heavy alcohol consumption, and it’s on the rise in North America. According to a recent study published in the Medical Clinics of North America, hospitalizations due to AH increased by 28% from 2007-14. Additionally, the COVID-19 pandemic has further exacerbated the situation, with Canada reporting higher average monthly hospitalizations for AH.
To better manage and evaluate AH patients, it’s essential to understand the diagnosis and treatment of this serious liver condition.
Diagnosing and Treating AH
AH is characterized by jaundice, fever, malaise, anorexia, and tender hepatomegaly, and its severity is classified using Model for end-stage liver disease (MELD) and Maddrey Discriminant Function (mDF) scores. Corticosteroid treatment is the first-line therapy for patients with severe AH, but its efficacy remains conflicting across studies. To improve corticosteroid treatment, biomarkers can be used for personalized use in those likely to respond.
Other therapeutic options are being examined, including fecal microbiota transplant (FMT) and N-acetylcysteine (NAC) combined with corticosteroids. Furthermore, early liver transplantation (eLT) is recommended for select patients with severe AH, offering survival benefits at six months.
Examining Other Therapeutic Options
Other therapeutic options are being examined to help manage and treat alcoholic hepatitis (AH). These options include fecal microbiota transplant (FMT) and N-acetylcysteine (NAC) combined with corticosteroids.
FMT is a procedure that transfers fecal bacteria from a healthy donor to the gut of the patient. It is promising for improving alpha diversity and modulating the gut-liver axis, which is associated with the overgrowth of intestinal bacteria in heavy alcohol users. NAC, when combined with corticosteroids, has been found to effectively reduce one-month mortality and the risk of hepatorenal syndrome and infection. However, it failed to achieve the primary outcome of six-month survival.
The study also found that early liver transplantation (eLT) is recommended for select patients with severe AH, offering survival benefits at six months. Previously, transplant centers required at least six months of alcohol abstinence before liver transplantation (LT). Still, recent studies have concluded that this minimum period is a poor predictor of alcohol use recurrence after LT.
While the efficacy of corticosteroid treatment remains conflicting across studies, biomarkers can be used for personalized use in those likely to respond. Several therapeutic strategies focusing on multiple targets are under investigation, given the limitations of available treatment approaches.
The authors of the study concluded that understanding the severity and treatment options for AH can help healthcare professionals provide better care for patients and decrease the burden of this disease on society. By examining and developing other therapeutic options for AH, it may be possible to offer more effective treatments and improve outcomes for patients.
The Importance of Alcohol Abstinence
Alcohol abstinence is critical in managing and treating alcoholic hepatitis (AH). The most critical determinant of patient survival among survivors of the initial episode of AH is alcohol abstinence. A prospective study concluded that alcohol relapse was associated with an increased mortality risk six months after the initial AH diagnosis.
However, alcohol abstinence is difficult to maintain, with only 37% of patients abstaining at one year of follow-up. The mounting healthcare burden associated with AH in the past decade and subsequent acceleration during the ongoing COVID-19 pandemic has led to its emergence as an epidemic in the young population.
Therefore, efforts are underway to develop newer therapies/strategies targeting alcohol use. It is essential to develop and promote integrated care models to regulate alcohol consumption and improve long-term outcomes in AH patients. By encouraging and supporting patients to maintain alcohol abstinence, healthcare professionals can improve the prognosis for AH patients and reduce the burden of this disease on society.
Conclusion
In conclusion, alcoholic hepatitis (AH) is a growing burden in North America, with a 28% increase in AH hospitalizations recorded during 2007-2014. This disease burden elevates healthcare costs, morbidity, and mortality and is disproportionately affecting specific demographic groups. The ongoing COVID-19 pandemic has exacerbated the situation with increased alcohol consumption, alcohol-associated liver disease, and alcohol use disorder.
Understanding the severity and treatment options for AH can help healthcare professionals provide better care for patients and decrease the burden of this disease on society. The study reviewed the recent progress in diagnosing, pathophysiology, and treatment options for AH, including the use of corticosteroids, non-invasive biomarkers, fecal microbiota transplant, and early liver transplantation.
Alcohol abstinence is the most critical determinant of patient survival among survivors of the initial episode of AH. Efforts are underway to develop newer therapies/strategies targeting alcohol use. It is essential to develop and promote integrated care models to regulate alcohol consumption and improve long-term outcomes in AH patients. By encouraging and supporting patients to maintain alcohol abstinence, healthcare professionals can improve the prognosis for AH patients and reduce the burden of this disease on society.
