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You Are Here » Miscellaneous » Alcoholic Liver Disease » Treatment for Alcoholic Liver Disease
Alcoholic Liver Disease
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Treatment for Alcoholic Liver Disease
Summary
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 patients may want to seek nutritional supplements or complementary and alternative medicine, such as * S-adenosylmethionine (SAMe) for * cirrhosis. Severe ALD is best treated with transplantation in selected abstinent patients.
Treatment
Treatment strategies for ALD include:
- Lifestyle changes to reduce alcohol consumption, cigarette smoking, and obesity
- Nutritional therapy
- Pharmacological therapy
- Possibly liver transplantation (in case of cirrhosis)
Lifestyle Changes
Abstinence from alcohol is vital to prevent further liver injury, scarring, and possibly liver cancer. It appears to benefit patients 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 patients 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 patients can take to reduce or prevent further liver injury.
Nutritional Treatment
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 patients 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 patients 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 patients 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 patients 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 patients with severe alcoholic hepatitis. Akriviadis and colleagues treated 49 patients with PTX and 52 patients with placebo (vitamin B12) for 4 weeks and found that PTX improved survival: 12 PTX patients died (24.5 percent), compared with 24 placebo patients (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 patients, 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 patients 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 patients with alcoholic hepatitis.
Definitions For This Page - In Alphabetical Order
* Cirrhosis
Pronounced - suh-ROH-sis
Cirrhosis is scarring of the liver. Scar tissue forms because of injury or long term disease. More about Cirrhosis
* S-adenosylmethionine (SAMe)
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 patients 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 patients who had received an inactive substance (that is, a placebo). The study detected virtually no harmful side effects of SAMe treatment. This approach appears to hold promise for the treatment of patients with Alcoholic Liver Disease (ALD).
* Wernicke-Korsakoff Syndrome
Wernicke's encephalopathy is a degenerative brain disorder caused by the lack of thiamine (vitamin B1). It may result from alcohol abuse, dietary deficiencies, prolonged vomiting, eating disorders, or the effects of chemotherapy. Symptoms include mental confusion, vision impairment, stupor, coma, hypothermia, hypotension, and ataxia.
Korsakoff's amnesic syndrome, a memory disorder, also results from a deficiency of thiamine, and is associated with alcoholism. The heart, vascular, and nervous system are involved. Symptoms include amnesia, confabulation, attention deficit, disorientation, and vision impairment. The main features of Korsakoff's amnesic syndrome are the impairments in acquiring new information or establishing new memories, and in retrieving previous memories.
Although Wernicke's and Korsakoff's may appear to be two different disorders, they are generally considered to be different stages of the same disorder, which is called Wernicke-Korsakoff syndrome. Wernicke's encephalopathy represents the "acute" phase of the disorder, and Korsakoff's amnesic syndrome represents the "chronic" phase. Treatment involves replacement of thiamine and providing proper nutrition and hydration. In some cases, drug therapy is also recommended. Most symptoms can be reversed if detected and treated promptly. However, improvement in memory function is slow and, usually, incomplete. Without treatment, these disorders can be disabling and life-threatening.
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References:
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
January 2005
pubs.niaaa.nih.gov
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