Severe alcoholic hepatitis: An effective combination of two treatments

November 10, 2011, INSERM (Institut national de la santé et de la recherche médicale)

A French multi-center study has shown that a treatment combining an antioxidant with an anti-inflammatory was effective on 174 patients suffering from severe alcoholic hepatitis. The study was coordinated by the Hepato-Gastroenterology department at the Amiens University Hospital Centre and the "Early exposure to alcohol and dependency vulnerability," INSERM 24 research team. Their findings were published in the New England Journal of Medicine on Nov. 10 2011.

Acute alcoholic hepatitis is one of the most serious forms of , affecting individuals with chronic , which generally equates to more than 50 grams of alcohol per day (roughly five drinks), over a period of more than three to six months. The disease is characterized by liver failure (hepatic insufficiency) and acute jaundice (icterus), which may induce a coma through (hepatic encephalopathy) and an ensuing death rate of between 40-45% within the first six months. Conventional treatment involves stopping alcohol consumption (alcohol abstinence) and administering cortisone (corticosteroid therapy over a one-month period) to fight the highly inflammatory nature of the disease. Despite this treatment, 30-35% of patients with acute alcoholic hepatitis still die within a six month period, since the cortisone-based treatment remains insufficient.

Given the given the frequent deficiency in the of the alcoholic liver (described above), combined with associated with the disease, the aim of the study coordinated by Professor Nguyen-Khas (Amiens University Hospital Centre and the Inserm research team) was to combine an antioxidant treatment with the conventional anti-inflammatory treatment. The results show an improved survival rate for patients suffering from acute alcoholic hepatitis who were given both medication types, with significantly less deaths within one month of treatment compared to the group who received the cortisone- only treatment. Tolerance levels to the treatment were good. The new, very low-cost medicine (N-acetylcysteine) is a molecule that has long been used in the treatment of hepatitis caused by drugs such as paracetamol, or mucolytic to fluidify bronchial secretion.

These results improve the prognosis for severe alcoholic hepatitis patients.

More information: "Glucocorticoids plus N-acetylcysteine in Severe Alcoholic Hepatitis". Nguyen-Khac and coll. The New England Journal of Medicine 2011; 365 10 November 2011.

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ironjustice
not rated yet Nov 10, 2011
Alcohol consumption causes increased iron in the liver.
"On the basis of these presentations, it is concluded that heavy alcohol intake can result in increased accumulation of iron in the liver, in both hepatocytes and Kupffer cells"
Hepatitis has been treated by iron reduction therapy when other treatments have failed.
"Long-term phlebotomy effectively exceeds that spontaneously occurring in patients IBT-NR confirming the efficacy of iron depletion in attenuating CHC progression when other therapies have failed"
Would iron reduction therapy be an IMMEDIATE avenue to investigate due to the life shortening nature of this disease ? Iron reduction therapy has led to a reduction of death rate to zero as opposed to fifty-five percent without iron reduction therapy.
"Hypervolemic patients that were followed for a median duration of 719 days, the death rate was almost 55% vs. 0% for
those patients who were normovolemic to slightly hypovolemic"

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