From the Guidelines
For alcoholic cirrhosis with stable peritoneal fluid (ascites), the primary treatment should be spironolactone (50-100 mg/day) as an aldosterone antagonist, which can be increased up to 400 mg/day, and furosemide (20-40 mg/day) as a loop diuretic, which can be increased up to 160 mg/day, in a stepwise manner every 7 days, to achieve a rate of weight loss of no greater than 0.5 kg/day in patients without peripheral edema and 1 kg/day in those with peripheral edema, as recommended by the most recent guidelines 1. The treatment of alcoholic cirrhosis with stable ascites involves a multifaceted approach, including:
- Diuretics, such as spironolactone and furosemide, to reduce sodium and water retention and control ascites
- Abstinence from alcohol, which is crucial for the control of ascites in patients with alcohol-related cirrhosis
- Nutritional support, including vitamin supplementation, particularly B vitamins like thiamine
- Regular monitoring of liver function, electrolytes, and periodic paracentesis if ascites worsens The dosage of diuretics should be adjusted to achieve the recommended rate of weight loss, and patients should be monitored for potential complications such as hypokalemia, hyperkalemia, and acute kidney injury 1. Alcohol abstinence is essential for improving the outcome of patients with alcoholic cirrhosis, and medications like acamprosate or naltrexone can help maintain sobriety 1. It is also important to note that the treatment of underlying liver disease is crucial, and liver transplantation should be considered in patients with cirrhosis and ascites 1. In addition, patients with severe liver inflammation may require prednisolone, and those with variceal bleeding may require beta-blockers like propranolol or carvedilol 1. Overall, the management of alcoholic cirrhosis with stable ascites requires a comprehensive approach that addresses the underlying pathophysiology of the disease, including portal hypertension, inflammation, and fluid retention.
From the Research
Medications for Alcoholic Cirrhosis
- For patients with severe alcoholic hepatitis, pentoxifylline and/or corticosteroids may be offered unless contraindications exist 2
- S-adenosylmethionine (SAMe) may be considered in ambulatory patients with nutritional support 2
- Baclofen has been demonstrated to be effective in inducing and maintaining alcohol abstinence in cirrhotic alcohol-dependent patients with cirrhosis 2, 3
- Corticosteroid therapy is associated with improved 1-month survival in patients with severe alcoholic hepatitis 4
Treatment Approach
- Achieving total alcohol abstinence should represent the main aim in the management of patients affected by any stage of cirrhosis 2, 5
- A multimodal approach, including pharmacological treatments and non-pharmacological interventions, may be necessary for the clinical management of patients with alcoholic cirrhosis 2, 6
- Liver transplantation may be considered in patients with decompensated cirrhosis who do not respond to medical therapy 4
Non-Pharmacological Interventions
- Psychological therapy, specialist clinics, patient education, and low alcohol drinks may be considered as part of a comprehensive treatment plan 3
- Non-randomised studies suggest that psychological therapies and other non-pharmacological interventions may improve clinical outcomes, including abstinence and mortality 3