The Mexican consensus on alcoholic hepatitis
Por:
Velarde-Ruiz Velasco J.A., Higuera-de la Tijera M.F., Castro-Narro G.E., Zamarripa-Dorsey F., Abdo-Francis J.M., Aiza Haddad I., Aldana Ledesma J.M., Bielsa-Fernández M.V., Cerda-Reyes E., Cisneros-Garza L.E., Contreras-Omaña R., Reyes-Dorantes A., Fernández-Pérez N.J., García-Jiménez E.S., Icaza-Chávez M.E., Kershenobich-Stalnikowitz D., Lira-Pedrín M.A., Moreno-Alcántar R., Pérez-Hernández J.L., Ramos-Gómez M.V., Rizo-Robles M.T., Solana-Sentíes S., Torre-Delgadillo A.
Publicada:
1 ene 2020
Categoría:
Gastroenterology
Resumen:
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. © 2020 Asociación Mexicana de Gastroenterología
Filiaciones:
Servicio de Gastroenterología
Servicio de Gastroenterología, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, Mexico
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
Asociación Mexicana de Gastroenterología, Ciudad de México, Mexico
Hospital Ángeles Acoxpa, Ciudad de México, Mexico
Clínica de Enfermedades Hepáticas, Hospital Ángeles Lomas, Estado de México, Mexico
Universidad Autónoma de Guadalajara, Guadalajara, Jalisco, Mexico
Hospital Central Militar, Ciudad de México, Mexico
Hospital San José Tec Salud, Monterrey, Nuevo León, Mexico
Centro de Investigación en Enfermedades Hepáticas y Gastroenterología, Pachuca, Hidalgo, Mexico
Hospital San Ángel Inn Chapultepec, Ciudad de México, Mexico
Hospital Ángeles León, León, Guanajuato, Mexico
Hospital Star Médica, Mérida, Yucatán, Mexico
Servicio de Medicina Interna y Gastroenterología. Hospital y Centro Médico del Prado, Tijuana, Baja California, Mexico
Unidad Médica de Alta Especialidad, Hospital de Especialidades CMN SXXI, Ciudad de México, Mexico
Hospital Central Sur de Alta Especialidad Petróleos Mexicanos, Ciudad de México, Mexico
Centro Médico Nacional 20 de Noviembre, Ciudad de México, Mexico
Hospital Lomas de San Luis, San Luis Potosí, SLP, Mexico
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