Current Medical Treatment for Alcohol-Associated Liver Disease

Ayares, Gustavo; Idalsoaga, Francisco; Díaz, Luis Antonio; Arnold, Jorge; Arab, Juan Pablo

doi:10.1016/j.jceh.2022.02.001

Cited by 29 publications

(15 citation statements)

References 192 publications

(219 reference statements)

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“…As ALD is the main cause of cirrhosis in LA, excessive alcohol consumption should be actively sought to limit and regulated [14,96]. A recent ecological study showed that the establishment of public health policies on alcohol consumption in LA is extremely heterogeneous; however, a higher number of public policies was associated with lower mortality due to ALD and AUD prevalence [12].…”

Section: Unmet Needs In Liver Diseases and Future Perspectivesmentioning

confidence: 99%

Liver Diseases in Latin America: Current Status, Unmet Needs, and Opportunities for Improvement

Díaz

Ayares

Arnold

et al. 2022

Curr Treat Options Gastro

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Purpose of review To assess the current challenges regarding liver diseases, including the burden of disease, access to care, screening, and treatment needs in Latin America. Recent findings Latin America is a region with a rich multicultural heritage and important socioeconomic differences. The burden of liver diseases is high and mainly determined by a high level of alcohol intake and the surge of risk factors associated with NAFLD (i.e., sedentary lifestyles, broader access to highly processed foods, obesity, and type 2 diabetes mellitus). Hepatotropic viruses also play a role in the development of chronic liver diseases, although their comparative frequency has been decreasing over the last decades. There are important disparities in access to screening and treatment for liver diseases in Latin America, which are reflected in low accessLiver (E Tapper, Section Editor) to critical treatments such as direct-acting antiviral agents and drugs to treat hepatocellular carcinoma. Also, important barriers to liver transplantation are present in multiple countries, including a low deceased donors' rate and a lack of availability in several countries (especially in Central America). Our region also has disadvantages in research and education in liver diseases, which limits regional academic development and improvement in quality of care of liver diseases. Summary In order to tackle an increasing health burden due to liver diseases, Latin America urgently needs tailored interventions aiming to control the main risk factors for these disorders through the establishment of effective public health policies. Also, development of liver transplantation programs and improvement of medical education and research capabilities as well as extensive collaboration between all stakeholders are keys to address the liver disease agenda in the region. AbbreviationsACLF Acute-on-chronic liver failure ALD Alcohol-associated liver disease ALF Acute liver failure AUD Alcohol use disorder DALYs Disability-adjusted life-years DILI Drug-induced liver injury GDP Gross domestic product HBV Hepatitis B virus HCV Hepatitis C virus HDV Hepatitis delta virus HCC Hepatocellular carcinoma LT Liver transplantation MAFLD Metabolic dysfunction-associated fatty liver disease NAFLD Non-alcoholic fatty liver disease NASH Non-alcoholic steatohepatitis PHP Public health policies PNPLA3 Patatin-like phospholipase domain-containing 3 US United States USD United States Dollars WHO World Health Organization * Updated to 2019 + Updated to 2020 Country Population in 2019 GDP + Gini index* Life expectancy from birth (years)* Deceased donors' rate* DDLT rate* LDLT rate* Argentina 44,938,712

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Section: Unmet Needs In Liver Diseases and Future Perspectivesmentioning

confidence: 99%

Liver Diseases in Latin America: Current Status, Unmet Needs, and Opportunities for Improvement

Díaz

Ayares

Arnold

et al. 2022

Curr Treat Options Gastro

Self Cite

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“…178 Although some studies have shown prophylactic antibiotic use in ACLF to be associated with lower mortality, others are conflicting and do not demonstrate survival benefit. 179 180 181…”

Section: Infectionsmentioning

confidence: 99%

“…178 Although some studies have shown prophylactic antibiotic use in ACLF to be associated with lower mortality, others are conflicting and do not demonstrate survival benefit. [179][180][181] Due to high prevalence and increased mortality associated with infections in patients with cirrhosis, a high index of suspicion is paramount. 172 All patients admitted with ACLF should undergo complete sepsis workup.…”

Section: Infectionsmentioning

confidence: 99%

Cirrhosis Management in the Intensive Care Unit

2023

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Patients with cirrhosis frequently require admission to the intensive care unit as complications arise in the course of their disease. These admissions are associated with high short- and long-term morbidity and mortality. Thus, understanding and characterizing complications and unique needs of patients with cirrhosis and acute-on-chronic liver failure helps providers identify appropriate level of care and evidence-based treatments. While there is no widely accepted critical care admission criteria for patients with cirrhosis, the presence of organ failure and primary or nosocomial infections are associated with particularly high in-hospital mortality. Optimal management of patients with cirrhosis in the critical care setting requires a system-based approach that acknowledges deviations from canonical pathophysiology. In this review we discuss appropriate considerations and evidence-based practices for the general care of patients with cirrhosis and critical illness.

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“…Alcohol abstinence decreases mortality and constitutes one of the best predictors of survival in ALD and AH. 14,19 In addition, recent evidence suggested that the unique level of consumption that minimizes health consequences is zero consumption. 20 Several characteristics and conditions could increase the risk of health consequences from alcohol misuse, including ethnicity, sex, and income level, among others.…”

Section: Impact Of Harmful Alcohol Consumptionmentioning

confidence: 99%