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- W3148020014 abstract "Alcoholism results in about 2.5 million deaths annually worldwide,representing 4%of all mortality.Although alcoholism is associated with more than 60 diseases,most mortality from alcoholism results from alcoholic liver disease(ALD).ALD includes alcoholic steatosis,alcoholic hepatitis,and alcoholic cirrhosis,in order of increasing severity.Important scoring systems of ALD severity include:Child-Pugh,a semi-quantitative scoring system useful to roughly characterize clinical severity;model for end-stage liver disease,a quantitative,objective scoring system used for prognostication and prioritization for liver transplantation;and discriminant function,used to determine whether to administer corticosteroids for alcoholic hepatitis.Abstinence is the cornerstone of ALD therapy.Psychotherapies,including twelve-step facilitation therapy,cognitive-behavioral therapy,and motivational enhancement therapy,help support abstinence.Disulfiram decreases alcohol consumption by causing unpleasant sensations after drinking alcohol from accumulation of acetaldehyde in serum,but disulfiram can be hepatotoxic.Adjunctive pharmacotherapies to reduce alcohol consumption include naltrexone,acamprosate,and baclofen.Nutritional therapy helps reverse muscle wasting,weight loss,vitamin deficiencies,and trace element deficiencies associated with ALD.Although reduced protein intake was previously recommended for advanced ALD to prevent hepatic encephalopathy,a diet containing1.2-1.5 g of protein/kg per day is currently recommended to prevent muscle wasting.Corticosteroids are firstline therapy for severe alcoholic hepatitis(discriminant function≥32),but proof of their efficacy in decreasing mortality remains elusive.Pentoxifylline is an alternative therapy.Complications of advanced ALD include ascites,spontaneous bacterial peritonitis,esophageal variceal bleeding,hepatic encephalopathy,hepatorenal syndrome,hepatopulmonary syndrome,and portopulmonary hypertension.Alcoholic cirrhotics have increased risk of developing hepatomas.Liver transplanta" @default.
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- W3148020014 date "2014-01-01" @default.
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- W3148020014 title "Therapy for alcoholic liver disease" @default.
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