Alcoholic steatohepatitis

Alkoholni steatohepatitis predstavlja oblik alkoholom uzrokovanog oštećenja jetre, jedne od najčešćih jetrenih bolesti današnjice, koja se javlja kao posljedica dugotrajne i prekomjerne konzumacije alkohola. Alkoholna bolest jetre obuhvaća nekoliko entiteta, od najblaže steatoze preko alkoholnog hepatitisa s progresivnom fibrozom, do najtežeg oblika, ciroze. Redovita konzumacija štetnih količina alkohola rezultira masnom promjenom jetre koja može progredirati u upalu, fibrozu i cirozu. Alkoholni hepatitis akutna je upala jetre povezana s visokim morbiditetom i mortalitetom koja se može pojaviti u bolesnika sa steatozom ili cirozom uzrokovanom alkoholom. Patogeneza alkoholne bolesti jetre je multifaktorijalna, a uključuje genetske čimbenike, oštećenje hepatocita alkoholom, reaktivnim kisikovim metabolitima i utjecaj crijevne mikrobiote. Rezultat je steatoza te regrutiranje i aktivacija makrofaga i neutrofila u jetri koji pokreću sekundarnu ozljedu jetre. Na koncu, alkohol i proupalni citokini stimuliraju stelatne stanice, odnosno razvija se progresivna fibroza. Alkoholni steatohepatitis karakteriziraju simptomi poput naglog nastupa ikterusa, anoreksije, umora, slabosti, hepatomegalije i blagih znakova sistemske upale. Iako biopsija pruža definitivnu dijagnozu, alkoholni steatohepatitis obično se dijagnosticira pomoću kliničke slike, laboratorijskih nalaza i slikovnih metoda, od kojih je najčešći ultrazvuk abdomena. Osim konzervativne terapije, kao što su apstinencija, nutritivna podrška i glukokortikoidi, zbog loših ishoda stalno se ispituju nove eksperimentalne mogućnosti. Istražuju se lijekovi koji ciljaju jetrenu upalu, kao što su antagonisti različitih proupalnih citokina i lijekovi koji smanjuju oksidativni stres, poput n-acetilcisteina i metodoksina. Razvijaju se i nove terapijske mogućnosti za indukciju jetrene regeneracije, te tvari koji utječu na osovinu crijeva-jetra kako bi se smanjio dotok štetnih metabolita i bakterija iz crijeva u jetru. Prognoza bolesti oslanja se na numeričke vrijednosti bodovnih sustava, a najčešće korišteni su Maddrey diskriminantna funkcija za određivanje težine bolesti i Glasgow skor za alkoholni hepatitis za uvođenje kortikosteroidne terapije.Alcoholic steatohepatitis is part of the spectrum of alcohol-related liver disease, one of the most common liver diseases nowadays, which occurs as a result of long-term and excessive alcohol consumption. Alcoholic liver disease encompasses several entities, from steatosis to alcoholic hepatitis with progressive fibrosis, and the most severe form, cirrhosis. Regular alcohol abuse results in fatty changes of the liver that can progress into inflammation, fibrosis and cirrhosis. Alcoholic hepatitis represents an acute inflammation of the liver that is associated with high morbidity and mortality. The pathogenesis of alcoholic liver disease is multifactorial and includes genetic factors, alcohol-induced hepatocyte damage, reactive oxygen species and intestinal microbiota. The result is steatosis and the recruitment and activation of macrophages and neutrophils in the liver, which initiate secondary liver injury. Finally, alcohol and proinflammatory cytokines stimulate hepatic stellate cells, leading to progressive fibrosis. Alcoholic steatohepatitis is characterized by symptoms such as sudden onset of jaundice, anorexia, fatigue, weakness, hepatomegaly and mild signs of systemic inflammation. Although liver biopsy provides a definitive diagnosis, alcoholic steatohepatitis is usually diagnosed based on clinical presentation, laboratory and imaging (most commonly ultrasound) findings. In addition to standard therapy, such as abstinence, nutritional support and corticosteroids, new experimental options are emerging. Agents targeting liver inflammation, such as antagonists of various proinflammatory cytokines and drugs reducing oxidative stress, such as n-acetylcysteine and methodoxin, are being investigated. New therapeutic options for induction of liver regeneration are also being explored, and substances intended to target the gut-liver axis to reduce the translocation of harmful metabolites and bacteria from the gut to the liver. The prognosis of the disease relies on the numerical values of scoring systems, the most commonly used being Maddrey's Discriminant Function for determining the severity of the disease and the Glasgow Alcoholic Hepatitis Score for the introduction of corticosteroid therapy