The Mexican consensus on alcoholic hepatitis

Velarde Ruiz Velasco, José Antonio y Higuera de la Tijera, María de Fátima y Castro Narro, Graciela y Zamarripa Dorsey, F. y Abdo Francis, J.M. y Haddad, I. Aiza y Aldana Ledesma, Juan Manuel y Bielsa Fernandez, M.V. y Cerda Reyes, Eira y Cisneros Garza, Laura Esthela y Contreras Omaña, Raul y Reyes Dorantes, A. y Fernández Pérez, Nicolas Joaquín y García Jiménez, Edgar Santino y Icaza Chávez, M. E. y Kershenobich Stalnikowitz, David y Lira Pedrín, M.A. y Moreno Alcántar, Rosalba y Pérez Hernández, J. L. y Ramos Gómez, Mayra Virginia y Rizo Robles, M.T. y Solana Sentíes, S. y Torre Delgadillo, Adriana (2020) The Mexican consensus on alcoholic hepatitis. Revista de Gastroenterología de México (English Edition), 85 (3). pp. 332-353. ISSN 2255-534X

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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 resultingin 37 recommendations. Alcohol-related liver disease covers a broad spectrum of patholo-gies that includes steatosis, steatohepatitis, different grades of fibrosis, and cirrhosis and itscomplications. Severe alcoholic hepatitis is defined by a modified Maddrey’s discriminant func-tion 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, hyper-bilirubinemia (>3 mg/dl), AST > 50 U/l (< 400 U/l), and an AST/ALT ratio > 1.5-2 can guide thediagnosis. Abstinence from alcohol, together with nutritional support, is the cornerstone oftreatment. Steroids are indicated for severe disease and have been effective in reducing the28-day mortality rate. At present, liver transplantation is the only life-saving option for patientsthat are nonresponders to steroids. Certain drugs, such as N-acetylcysteine, granulocyte-colonystimulating factor, and metadoxine, can be adjuvant therapies with a positive impact on patientsurvival.

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