Treatment for Alcoholic Liver Disease (ALD) includes making lifestyle changes, such as stopping or decreasing alcohol use, stopping smoking, and maintaining a healthy weight. Health care providers may prescribe medications, such as pentoxifylline or prednisone, in cases of alcoholic hepatitis. And people may want to seek nutritional supplements or complementary and alternative medicine, such as SAMe – S-adenosylmethionine for cirrhosis. Severe ALD is best treated with a liver transplantation in selected abstinent people.

Treatment for Alcoholic Liver Disease

Treatment strategies for ALD include:

• Lifestyle changes to reduce alcohol consumption, stopping cigarette smoking, and losing weight (obesity).
• Nutritional therapy… vitamin supplementation.
• Pharmacological therapy – use of pentoxifylline (PTX) or prednisone for alcoholic hepatitis.
• Complementary and alternative medicine for cirrhosis – example, SAMe.
• Possibly liver transplantation – in case of cirrhosis.

Lifestyle Changes for Alcoholic Liver Disease

Abstinence from alcohol is vital to prevent further liver injury, scarring, and possibly liver cancer. It appears to benefit people at each stage of the disease. Although only a few studies have looked specifically at the effects of abstinence on the progression of ALD, virtually every one has shown that abstaining from alcohol is beneficial.

Many people who drink alcohol also smoke cigarettes, and European studies have found scarring of the liver occurs more rapidly in ALD people who smoked. Obesity is another factor associated with liver disease – specifically, the development of fatty liver and nonalcoholic steatohepatitis, a disorder similar to alcoholic hepatitis. Stopping smoking and maintaining a healthy weight are two more measures people can take to reduce or prevent further liver injury.

Nutritional Treatment for Alcoholic Liver Disease

Although alcoholic beverages contain calories, research suggests that under certain conditions these calories do not have as much value for the body as those derived from other nutrients. In addition, many alcoholics suffer from malnutrition, which can lead to liver damage and impaired liver function. Many drinkers take in less than the recommended daily amount of carbohydrates, proteins, fats, vitamins A, C, and B, especially thiamine (B1), and minerals such as calcium and iron.

To prevent these deficiencies, clinicians should provide alcoholics with a balanced diet. Dietary supplements may prevent or relieve some of alcohol’s harmful effects. For example, brain damage resulting from a lack of vitamin B1, which can lead to conditions such as Wernicke-Korsakoff Syndrome, can be reversed to some extent. Because vitamin B1 generally can be administered safely, clinicians often recommend that all alcoholics undergoing treatment receive 50 milligrams of thiamine per day (either by injection if the people are hospitalized or by mouth). Alcoholics also should receive supplements of vitamins B2 (riboflavin) and B6 (pyridoxine) in dosages found in standard multivitamins. Vitamin A, however, can be toxic when combined with alcohol and should be given only to those alcoholics who have a well-documented deficiency and who can stop or significantly reduce their drinking.

In addition to dietary supplements, alcoholics with moderate malnutrition might benefit from treatment with anabolic steroids. These compounds, which are derived from the male hormone testosterone, can be used in the short term to promote overall body “buildup” and, therefore, may help the alcoholic better recover from malnutrition.

Emerging Therapies

Studies using animals are helping researchers find other dietary supplements that may help in the treatment of liver disease. For example, eating certain healthy fats (called medium-chain triglycerides, or MCTs) may help to reduce the buildup of harmful fats in the liver. MCTs generally are available only in health food stores as a dietary supplement.

Oxidative stress plays a major role in the development of alcoholic liver disease. Oxidative stress occurs when harmful oxygen molecules, or free radicals, form in the body. These molecules are highly charged and very unstable. They cause cellular changes in their effort to pair with the nearest available molecule, injuring cells and modifying their function. Antioxidants can help prevent this free radical damage.

An important antioxidant, glutathione, or GSH, cannot be used as a supplement because this substance cannot directly enter the cells threatened by oxidative stress. However, researchers are using a precursor compound, the molecule S-adenosylmethionine (SAMe), which can enter the cells and then break down to form the helpful antioxidant. When SAMe was given to people with alcoholic cirrhosis in a clinical trial, they were significantly less likely to die or require a liver transplant within the next 2 years, compared with people who had received an inactive substance (that is, a placebo). Moreover, the study detected virtually no harmful side effects of SAMe treatment. Thus, this approach appears to hold promise for the treatment of people with ALD.

Pharmacological Therapy

No FDA-approved (Food and Drug Administration) therapy exists for either alcoholic cirrhosis or alcoholic hepatitis. However, several drugs have been used “off label,” including pentoxifylline (PTX) and corticosteroids. PTX was shown to be effective in people with severe alcoholic hepatitis. Akriviadis and colleagues treated 49 people with PTX and 52 people with placebo (vitamin B12) for 4 weeks and found that PTX improved survival: 12 PTX people died (24.5 percent), compared with 24 placebo people (46 percent).

Although corticosteroids are the most extensively studied form of therapy for alcoholic hepatitis, their usefulness may be only short-term. Mathurin and colleagues reported significantly improved survival at 28 days (85 percent vs. 65 percent) in severely ill alcoholic hepatitis people, but this survival advantage did not extend much longer than a year. Most investigators agree that if corticosteroids are used, they should be reserved for people with the most severe liver disease. In addition, steroids have well-documented side effects, including increasing the risk of infection, which already is substantial in people with alcoholic hepatitis.

Source: pubs.niaaa.nih.gov – January 2005