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Give me details about steroids in alcoholic hepatitis

Answer

Corticosteroids, specifically prednisolone or methylprednisolone, are recommended for the treatment of severe alcoholic hepatitis, as they have been shown to improve short-term survival
1
Guidelines

1.

Corticosteroids

Pathway
ACG 2024
.

Indications for steroid use

Contraindications for steroid use

Monitoring and response assessment

  • The response to corticosteroid therapy is often assessed using the Lille model after 7 days of treatment. A Lille score greater than 0.45 indicates a poor response, and discontinuation of corticosteroids should be considered due to the lack of benefit and potential for adverse effects.
  • The EASL 2017 guidelines recommend close monitoring for tolerability of the drugs and the development of rare side effects such as lactic acidosis or kidney dysfunction
  • Systematic screening for infection before initiating therapy, during corticosteroid treatment, and during the follow-up period in patients with alcoholic hepatitis is recommended by the EASL 2018 guidelines

Efficacy of steroids

In conclusion, corticosteroids are a cornerstone in the treatment of severe alcoholic hepatitis, but their use requires careful patient selection and monitoring for potential side effects and contraindications.

References

1

Alcohol-related liver disease

Medical management

Guidelines

Corticosteroids

Pathway
ACG 2024