Almacenar vitaminas A, D, K y B Mantener los niveles adecuados de glucosa en la sangre. Produce hormonas. Produce la urea la sustancia principal de la orina. No todas las formas de hepatitis son infecciosas, por lo que no todas se pueden propagar de persona a persona.
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It is associated with high short-term mortality, economic burden, and hospital resources utilization. We performed this systematic review to a describe clinical characteristics and genomics associated with the risk of alcoholic hepatitis; b discuss role and limitations of liver biopsy and prognostic scoring systems; c summarize evidence regarding the currently available therapies including liver transplantation; and d outline emerging therapies with areas of unmet need.
Literature search was performed for studies published in English language January through - March For the treatment section, only randomized controlled studies were included for this review. A total of studies 59 randomized, 22 systematic reviews or meta-analyses, 7 surveys or guidelines, 7 population based, and 43 prospective cohort were cited.
There are over , annual admissions with alcoholic hepatitis contributing to about 0. Corticosteroids with or without N-acetylcysteine remains the only available therapy for severe episode. Data are emerging on the role of liver transplantation as salvage therapy for select patients. Abstinence remains the most important factor impacting long-term prognosis. Results from the ongoing clinical trials within the National institute on Alcohol Abuse and Alcoholism funded consortia are awaited for more effective and safer therapies.
Alcoholic hepatitis is a potentially lethal condition with a significant short-term mortality. A high index of suspicion is required. There remains an unmet need for non-invasive biomarkers for diagnosis, and predicting prognosis and response to therapy. Delker E, A third of individuals with chronic and active heavy alcohol use develop alcoholic hepatitis AH , a clinical syndrome presenting with jaundice or hyperbilirubinemia and often features of the systemic inflammatory response syndrome.
Altamirano et al. Singal, , Singal et al. This contributes to 0. Jinjuvadia et al. Hardy et al. Duvoux et al. Singal and Shah, , Maddrey et al.
Singal et al. Hmoud et al. Thursz et al. Data are emerging on the benefits of liver transplantation as a therapeutic option for select severe AH patients who do not respond to available pharmacological interventions. Mathurin et al. Hasanin et al. A combination of keyword variants, synonyms and database subject headings was used for the concepts of alcoholic hepatitis, therapy, and various pharmacological and non-pharmacological treatments.
These were then combined to form the final searches. For the complete PubMed search strategy and MeSH words, please see details in the supplement section. Clinical Trials. Additionally, the reference lists of selected articles and key systematic reviews were scanned. Study Selection Two investigators SK and AKS independently reviewed the studies identified on initial search to select studies for this systematic review. Studies were limited to English language, and only publications including human subjects were included.
Medline records were excluded in the Embase search strategy. Any discrepancy was resolved by discussion and consensus. Data Extraction and Quality Assessment One independent investigator reviewed the selected studies KS on diagnosis and liver transplantation sections and AKS on pathophysiology with clinical features and treatment sections for data synthesis. Only randomized controlled studies were included for treatment section. For the other sections, prospective cohort and population based studies were included.
Retrospective studies were not included. Abstracts were included for critical data and if the full papers on that issue were unavailable. Data Synthesis and Analysis Studies published in the last five years and seminal landmark studies were focused to develop the current status in each section.
RESULTS Potentially relevant articles on AH were reviewed 49 on clinical and genomics, 15 on diagnosis, on treatment, and 11 on liver transplantation to select articles for writing this manuscript Supplemental Figure 1.
Of these, references 59 randomized, 22 systematic reviews or meta-analyses, 7 surveys or guidelines, 7 population based, and 43 prospective cohort were cited.
Pathophysiology of Alcoholic Hepatitis Alcohol has been used for centuries, but it was recognized as a direct hepatotoxin only in the s. Rubin and Lieber, Keshavarzian et al. Singal, , Salameh et al. Llopis et al. Cytokines especially interleukin-8 and chemokines recruit neutrophils to the liver, a characteristic histological finding in AH patients Supplemental Figure 2.
Neutrophils recruited to the liver increase hepatocyte growth factor and help in tissue repair and recovery from AH. Taieb et al. Hepatic macrophages also cross talk with hepatic stellate cells activating collagen tissue formation and altering hepatic hemodynamics with resultant portal hypertension. Oxidative stress occurs from multiple sources including acetaldehyde from metabolism of alcohol, inflammatory cytokines and neutrophils, apoptotic cells, and alcohol-induced nitrosative stress.
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Hepatitis alcohólica: causas, diagnóstico y tratamiento