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Velarde-Ruiz Velasco JA, Higuera-de la Tijera MF, Castro-Narro GE, Zamarripa-Dorsey F, Abdo-Francis JM, Aiza Haddad I, Aldana Ledesma JM, Bielsa-Fernández MV, Cerda-Reyes E, Cisneros-Garza LE, Contreras-Omaña R, Reyes-Dorantes A, Fernández-Pérez NJ, García-Jiménez ES, Icaza-Chávez ME, Kershenobich-Stalnikowitz D, Lira-Pedrín MA, Moreno-Alcántar R, Pérez-Hernández JL, Ramos-Gómez MV, Rizo-Robles MT, Solana-Sentíes S, Torre-Delgadillo A. The Mexican consensus on alcoholic hepatitis. Rev Gastroenterol Mex (Engl Ed) 2020; 85:332-353. [PMID: 32532534 DOI: 10.1016/j.rgmx.2020.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/07/2020] [Indexed: 06/11/2023]
Abstract
Alcoholic hepatitis is a frequent condition in the Mexican population. It is characterized by acute-on-chronic liver failure, important systemic inflammatory response, and multiple organ failure. The severe variant of the disease implies elevated mortality. Therefore, the Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Hepatología brought together a multidisciplinary team of health professionals to formulate the first Mexican consensus on alcoholic hepatitis, carried out utilizing the Delphi method and resulting in 37 recommendations. Alcohol-related liver disease covers a broad spectrum of pathologies that includes steatosis, steatohepatitis, different grades of fibrosis, and cirrhosis and its complications. Severe alcoholic hepatitis is defined by a modified Maddrey's discriminant function score ≥ 32 or by a Model for End-Stage Liver Disease (MELD) score equal to or above 21. There is currently no specific biomarker for its diagnosis. Leukocytosis with neutrophilia, hyperbilirubinemia (> 3 mg/dL), AST > 50 U/l (< 400 U/l), and an AST/ALT ratio > 1.5-2 can guide the diagnosis. Abstinence from alcohol, together with nutritional support, is the cornerstone of treatment. Steroids are indicated for severe disease and have been effective in reducing the 28-day mortality rate. At present, liver transplantation is the only life-saving option for patients that are nonresponders to steroids. Certain drugs, such as N-acetylcysteine, granulocyte-colony stimulating factor, and metadoxine, can be adjuvant therapies with a positive impact on patient survival.
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Affiliation(s)
- J A Velarde-Ruiz Velasco
- Servicio de Gastroenterología; Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México.
| | - M F Higuera-de la Tijera
- Servicio de Gastroenterología, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México
| | - G E Castro-Narro
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | | | | | - I Aiza Haddad
- Clínica de Enfermedades Hepáticas, Hospital Ángeles Lomas, Estado de México, México
| | - J M Aldana Ledesma
- Servicio de Gastroenterología; Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México
| | | | | | | | - R Contreras-Omaña
- Centro de Investigación en Enfermedades Hepáticas y Gastroenterología, Pachuca, Hidalgo, México
| | | | | | - E S García-Jiménez
- Servicio de Gastroenterología; Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México
| | | | | | - M A Lira-Pedrín
- Servicio de Medicina Interna y Gastroenterología. Hospital y Centro Médico del Prado, Tijuana, Baja California, México
| | - R Moreno-Alcántar
- Unidad Médica de Alta Especialidad, Hospital de Especialidades CMN SXXI, Ciudad de México, México
| | - J L Pérez-Hernández
- Servicio de Gastroenterología, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México; Hospital Central Sur de Alta Especialidad Petróleos Mexicanos, Ciudad de México, México
| | - M V Ramos-Gómez
- Centro Médico Nacional 20 de Noviembre, Ciudad de México, México
| | - M T Rizo-Robles
- Unidad Médica de Alta Especialidad, Hospital de Especialidades CMN SXXI, Ciudad de México, México
| | | | - A Torre-Delgadillo
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
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Velarde-Ruiz Velasco J, Higuera-de la Tijera M, Castro-Narro G, Zamarripa-Dorsey F, Abdo-Francis J, Haddad IA, Aldana Ledesma J, Bielsa-Fernández M, Cerda-Reyes E, Cisneros-Garza L, Contreras-Omaña R, Reyes-Dorantes A, Fernández-Pérez N, García-Jiménez E, Icaza-Chávez M, Kershenobich-Stalnikowitz D, Lira-Pedrín M, Moreno-Alcántar R, Pérez-Hernández J, Ramos-Gómez M, Rizo-Robles M, Solana-Sentíes S, Torre-Delgadillo A. The Mexican consensus on alcoholic hepatitis. Revista de Gastroenterología de México (English Edition) 2020. [DOI: 10.1016/j.rgmxen.2020.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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