Alkoholische Hepatitis – Aktuelle und zukünftige Behandlungskonzepte

Was ist neu?

Aktuelle Therapie. Die Einhaltung einer strikten Alkoholabstinenz, eine Optimierung des Ernährungsstatus, die Vermeidung von Infektionen sowie die Gabe von Kortikosteroiden sind derzeit die Hauptpfeiler der Behandlung von Patienten mit Alkoholischer Hepatitis (AH).

Neue Therapieansätze. Infolge eines verbesserten Verständnisses der zugrundeliegenden Pathomechanismen der AH werden derzeit eine Vielzahl neuer, innovativer Therapiemethoden in klinischen Studien untersucht, welche das Potenzial aufweisen, das Outcome der Betroffenen zu verbessern und die hohe Kurzzeitmortalität dieser Erkrankung zu reduzieren. Neue Ansätze umfassen die Applikation anti-inflammatorischer Substanzen (z.B. Interleukin-1-Inhibitoren), Modifikationen der Darm-Leber-Achse via fäkalem Mikrobiomtransfer oder der Gabe nicht resorbierbarer Antibiotika (z.B. Rifaximin), sowie Medikamente zur Steigerung der hepatischen Regeneration (z.B. Interleukin-22-Agonisten). Zudem stellen Medikamente, die oxidativen Stress reduzieren können (z.B. N-Acetylcystein, Metadoxine), weitere therapeutische Strategien dar. Mittlerweile konnten außerdem mehrere Studien zeigen, dass eine frühzeitige Lebertransplantation als Rescue-Therapie für ausgewählte Patienten mit schwerer AH, die nicht auf eine Steroidbehandlung ansprachen, eine sinnvolle Option darstellen kann und mit einem deutlichen Überlebensvorteil und gutem Outcome einhergeht.

Abstract

Acute severe alcoholic hepatitis is a serious disease with poor prognosis. As a result of an improved understanding of the underlying pathomechanisms, a variety of new, innovative therapeutic modalities are currently being investigated that may help to improve prognosis. New approaches include the application of anti-inflammatory agents (e.g., interleukin-1 inhibitors), modifications of the gut-liver axis via fecal microbiome transfer or the administration of non-absorbable antibiotics (e.g., rifaximin), and drugs to enhance hepatocellular regeneration (e.g., interleukin-22 agonists). This article describes current management concepts of alcoholic hepatitis and provides an overview of new potential treatment approaches.

Schlüsselwörter

Alkoholische Lebererkrankung - Alkoholkonsumstörung - alkoholische Hepatitis - MELD-Score - Glukokortikoide - Maddrey-Score - Lebertransplantation

Keywords

Alcoholic liver disease - alcohol use disorder - MELD score - alcoholic hepatitis - glucocorticoids - Maddrey-Score - liver transplantation

Publication History

Article published online:
23 August 2023

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