Affiliation:
1. Volgograd State Medical University
2. Medsi-Volgograd LLC
Abstract
Alcoholic hepatitis is a progressive inflammatory-dystrophic lesion of the liver, the pathogenetic mechanism of which is based on alcoholic damage. Acute alcoholic hepatitis is defined primarily as an exacerbation of the chronic process of alcoholic liver disease. Two mechanisms are defined as the basis for the formation of alcohol-associated liver damage: primary (direct effect of ethanol on hepatocytes and oxidative stress provoked by it) and secondary (through changes in the gut-liver axis with dysbacteriosis and increased permeability of the intestinal wall). For the treatment of acute alcoholic hepatitis, mainly glucocorticosteroids are used, the action of which is directed at cytotoxic and inflammatory mechanisms of the pathogenesis of this disease. Also, phosphodiesterase inhibitors, broad-spectrum antibiotics (rifaximin), probiotics, prebiotics, synbiotics, enterosorbents and hepatoprotectors are actively used. Choosing a hepatoprotector that is effective and safe for patients is still a challenge. At the moment one of the most promising and optimal in terms of “price-quality” ratio drug from this group is a domestic drug from the group of combined hepatoprotectors – Remaxol (inosine + meglumine + methionine + nicotinamide + succinic acid). A clinical case of application of this drug in a patient diagnosed with acute alcoholic hepatitis combined with chronic alcoholic hepatopathy is presented. Not severe course (MELD: 16. Maddrey’s index: 14.04). Ademetionine was prescribed. On the background of the prescribed treatment slight improvements were noted, no significant changes in laboratory data were registered (MELD: 16, Maddrey index: 12.54). After replacement of the hepatoprotector by Remaxol, the following was observed: correction of the general condition, correction of the mental status, reduction of the severity of hepatosplenomegaly, normalization of laboratory parameters (MELD: 10. Maddrey’s index: 6.06). Based on the review of Russian and foreign literature, as well as personal experience in the use of Remaxol, we can conclude that this pharmacological agent contributes to a more favorable course of acute alcoholic hepatitis, a significant reduction in the risk of complications, as well as reducing the length of hospital stay and the cost of treatment.
Reference34 articles.
1. Lazebnik LB, Golovanova EV, Turkina SV, Raikhelson KL, Okovityy SV, Drapkina OM et al. Non-alcoholic fatty liver disease in adults: clinic, diagnostics, treatment. Guidelines for therapists, third version. Experimental and Clinical Gastroenterology. 2021;1(1):4–52. (In Russ.) https://doi.org/10.31146/1682-8658-ecg-185-1-4-52.
2. Maev IV, Abdurakhmanov DT, Andreev DN, Dicheva DT. Alcoholic liver disease: State-of-the-art. Terapevticheskii Arkhiv. 2014;86(4):108–116. (In Russ.) Available at: https://cyberleninka.ru/article/n/alkogolnaya-boleznpecheni-sovremennoe-sostoyanie-problemy?ysclid=lvw45yyez886359409.
3. Ivashkin VT, Mayevskaya MV, Pavlov ChS, Sivolap YuP, Lunkov VD, Zharkova MS, Maslennikov RV. Management of adult patients with alcoholic liver disease: clinical guidelines of the Russian Scientific Liver Society. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2017;27(6):20–40. (In Russ.) Available at: https://www.gastro-j.ru/jour/article/view/190/164.
4. Лазебник ЛБ, Голованова ЕВ, Еремина ЕЮ, Кривошеев АБ, Сас ЕИ, Тарасова ЛВ и др. Алкогольная болезнь печени (АБП) у взрослых: клинические рекомендации. 2021. Режим доступа: https://cr.minzdrav.gov.ru/schema/711_1.
5. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of alcohol-related liver disease. J Hepatol. 2018;69(1):154–181. https://doi.org/10.1016/j.jhep.2018.03.018.