Do corticosteroids reduce mortality from alcoholic hepatitis?

Article Abstract:

Alcoholic hepatitis is a serious, acute liver disease in which the liver becomes inflamed. The symptoms include fever, an enlarged liver, and a yellowing of the whites of the eyes and skin, which is called jaundice. This form of hepatitis is associated with a hospital mortality as high as 65 percent. Management involves abstinence from alcohol, the correction of dietary deficiencies, and general supportive care. Other potentially therapeutic agents such as steroids, which reduce inflammation, have been tried, but their overall effectiveness remains to be established. One class of drugs called corticosteroids has been studied extensively and may help, but use of these drugs for alcoholic hepatitis remains controversial. This study is an analysis of 11 previous studies, published from 1966 to 1989, which assessed the mortality in hospitalized patients diagnosed with acute alcoholic hepatitis and treated with corticosteroids. The steroids decreased the mortality in patients with impaired brain function resulting from their diseased livers (hepatic encephalopathy) by an average of 34 percent. However, corticosteroids did not reduce mortality in patients with alcoholic hepatitis who did not suffer from hepatic encephalopathy. Patients who were not bleeding from their gastrointestinal tracts during their hospital stay had a greater reduction in mortality than patients who did bleed. These results suggest that corticosteroids reduce short-term mortality in patients with acute alcoholic hepatitis who have hepatic encephalopathy, but offer no benefits in those without encephalopathy. Patients not currently bleeding from their digestive tracts are also more likely to benefit from corticosteroids than patients with bleeding. (Consumer Summary produced by Reliance Medical Information, Inc.)

Corticosteroids, Adrenocortical hormones, Hepatic encephalopathy, Liver encephalopathy, Hepatitis, Alcoholic, Alcoholic hepatitis

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A cost analysis of alternative treatments for duodenal ulcer

Article Abstract:

Eradicating Helicobacter (H.) pylori infection in duodenal ulcer may be the most cost-effective strategy. The lack of protective lining in a portion of the small intestines, the duodenum, causes pain in duodenal ulcer. It is now thought that infection by H. pylori contributes to duodenal ulcer. Researchers analyzed the cost of suppressing gastric acid versus treating H. pylori infection in a population model. Probability estimates using a decision model compared the initial therapy with secondary treatment costs and overall expense. The combination of antibiotics and H2-receptor antagonists cured H. pylori infection at the lowest cost regardless of subsequent interventions. The need for costly procedures, such as endoscopy, may decrease substantially. Recent data suggest the recurrence of duodenal ulcer may be as low as 3% in patients without H. pylori infection.

Antibiotics, Helicobacter infections, Antiulcer agents, Duodenal ulcer, Antiulcer drugs

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Somatostatin or octreotide compared with H2 antagonists and placebo in the management of acute nonvariceal upper gastrointestinal hemorrhage: a meta-analysis

Article Abstract:

Research suggests that somatostatin may be useful as part of the treatment plan for patients with stomach or intestinal ulcers. Fourteen studies published between 1966 and 1996 that compared somatostatin or octreotide with H2 blockers or placebo as a treatment for stomach or intestinal ulcers were analyzed. Of the 1,829 patients studied, patients treated with somatostatin were significantly less likely to experience further bleeding and moderately less likely to need surgery.

Evaluation, Prevention, Gastrointestinal bleeding, Gastrointestinal hemorrhage, Peptic ulcer, Somatostatin, Octreotide acetate

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