With advances in our understanding of the pathophysiology of
alcoholic liver disease, pharmacological treatments of some of the basic disease processes are now in sight. The most notable development has been the introduction of
propylthiouracil for the treatment of
alcoholic hepatitis. In a recent trial the mortality rate of patients treated with this
drug was 62% lower than that of a control group. Its beneficial effects may stem not from its anti-thyroid properties but rather from other actions such as
free radical scavenging.
Corticosteroids now appear to have no place in the treatment of
alcoholic liver disease.
Anabolic steroids, however, show promise, though longer term trials are required before this can be confirmed.
Colchicine, too, has been reported to improve survival in patients with established
cirrhosis. More experience is required with this and other anti-inflammatory and anti-fibrogenic drugs. beta
Adrenergic blocking drugs, such as
propranolol, reduce portal venous pressure. In a trial among patients with
alcoholic cirrhosis who had oesophageal
varices, 39% of those receiving
propranolol had not experienced a haemorrhage by 2 years compared with 74% in the control group. The mortality rates at this time were 28% and 49% respectively. Results of treatment once the first haemorrhage has occurred are less impressive. Treatment of the alcohol withdrawal syndrome in patients with
liver disease is often problematic. The dose of any
sedative should be reduced to 25-50% of the usual dose and
sedatives should be avoided in patients who are encephalopathic. Once the patient has recovered from the acute illness, abstinence from alcohol remains the single most important factor that determines long term survival.