Some recent proposals in management of
alcoholic liver disease are discussed focusing on early diagnosis and treatment of
alcohol abuse itself,
alcoholic hepatitis early mortality, clinical meaning of nutritional
therapy, serological approach and treatment of hepatic
fibrosis, and problems in
liver transplantation for end stage
alcoholic liver cirrhosis. CAGE or similar systematized brief questionnaires, and desialylated
transferrin/total
transferrin ratio as serological marker, seems to be interesting contributions to "hidden"
alcohol abuse diagnosis and abstinence control while psycho-social support and voluntary incorporation to self-aid groups are the best weapons to reach persistent abstinence.
Corticosteroids seems to improve survival in a selected group of patients with severe
alcoholic hepatitis, specially in those presenting
encephalopathy but free of GI
bleeding, decompensated diabetes, active
infections,
pancreatitis, and other
contraindications or adverse effects of these drugs. Relationship between direct toxicity and
nutritional deficiencies in pathogenesis of alcoholic liver injury are not clear enough, but
malnutrition is generally present in patients requiring hospitalization, and related to clinical severity; oral, enteral or parenteral nutritional supplementation in this order of preference according to patients condition, associated or not with
steroid anabolics, are useful in cases with moderate to severe
alcoholic hepatitis or decompensated
cirrhosis to eliminate the catabolic state, reaching a better
nitrogen balance and liver function tests, without special adverse effects. A special role on liver regeneration is discussed.
Antioxidants and supernutrients are special "modern" aspects of nutritional
therapy in
alcoholic liver disease generally related to the
MEOS activation in chronic
alcoholism, the excessive production of
free radicals, and the depletion of
glutathione, membrane
phospholipids (specially phosphatidycholine), and
vitamin A, E, and C. Natural supplements as soybean polyunsaturated
lecithin, with high concentration of phosphatidycholine, or oral supplementation with natural metabolic products depleted from the liver of chronic heavy drinkers, such SAMe, have an interesting rationale based on experimental and clinical findings besides availability and costs.
Carotenoids and
tocopherols supplementation seems to be an useful tool, but are limited in the case of
vitamin A because its special toxicity in chronic
alcoholism. Serological markers of metabolism of liver connective tissue are clearly involved in fibrogenesis process and other inflammatory connected events; standardization of laboratory methods surely will result in new possibilities of non-invasive valuation of liver injury, evolution and therapeutic response; special histological damage such as sinusoidal "cappilarization" (type i.v.
collagen and
laminin), endothelial sinusoidal cell function (seric hyaluronate), or
collagenase activity (TIMP-1 or
tissue inhibitor of metalloproteinases-1) seems to be valuable by these new technologies.(ABSTRACT TRUNCATED AT 400 WORDS)