SlideShare a Scribd company logo

From Binge Drinking to Alcoholic Liver Disease - Du Binge Drinking à l'Hépatite Alcoolique

Centre Hepato-Biliaire / AP-HP Hopital Paul Brousse
Centre Hepato-Biliaire / AP-HP Hopital Paul Brousse
Centre Hepato-Biliaire / AP-HP Hopital Paul BrousseCentre Hepato-Biliaire / AP-HP Hopital Paul Brousse

Conférence du Professeur Philippe Mathurin (Hôpital Universitaire Claure Huriez, Lille, France), Juin 2014. Le "Binge Drinking" est un des enjeux de santé publique majeur dans tous les pays occidentaux. Une augmentation de la mortalité par cirrhose alcoolique est constatée dans les pays où l'alcoolisme chronique et le Binge Drinking sont les plus répandus.

From Binge Drinking to Alcoholic Liver Disease - Du Binge Drinking à l'Hépatite Alcoolique

1 of 68
Journée d’Hépatologie du Centre Hépato-Biliaire – 13 juin 2014 - Paris 
DDuu « bbiinnggee ddrriinnkkiinngg » 
àà ll’’hhééppaattiittee aallccoooolliiqquuee 
Pr. Philippe Mathurin 
Hôpital Universitaire Claude Huriez 
Lille, France
Alcohol-attributable deaths as a percentage of total 
deaths
Important variations iinn lliivveerr cciirrrrhhoossiiss 
mmoorrttaalliittyy aaccrroossss EEuurrooppee 
HHiigghheerr rraatteess iinn EEaasstteerrnn ccoouunnttrriieess tthhaann iinn WWeesstteerrnn 
EEuurrooppeeaann ccoouunnttrriieess
Courtesy from D Leon. EASL 2010 Monothematic conference on ALD
Courtesy from D Leon. EASL 2010 Monothematic conference on ALD
COUNTRIES WWIITTHH IIMMPPRROOVVEEMMEENNTTSS 
OOVVEERR PPAASSTT 
1100--2200 YYEEAARRSS

More Related Content

What's hot

Innovations in liver surgery for Hepatocellular Carcinoma
Innovations in liver surgery for Hepatocellular CarcinomaInnovations in liver surgery for Hepatocellular Carcinoma
Innovations in liver surgery for Hepatocellular CarcinomaEric Vibert, MD, PhD
 
How to predict po course before and during surgery for HCC
How to predict po course before and during surgery for HCCHow to predict po course before and during surgery for HCC
How to predict po course before and during surgery for HCCEric Vibert, MD, PhD
 
Les Alternative à la Transplantation Hépatique Cadavérique
Les Alternative à la Transplantation Hépatique CadavériqueLes Alternative à la Transplantation Hépatique Cadavérique
Les Alternative à la Transplantation Hépatique CadavériqueEric Vibert, MD, PhD
 
Liver transplantation vs Resection in cholangiocarcinoma on cirrhosis
Liver transplantation vs Resection in cholangiocarcinoma on cirrhosisLiver transplantation vs Resection in cholangiocarcinoma on cirrhosis
Liver transplantation vs Resection in cholangiocarcinoma on cirrhosisEric Vibert, MD, PhD
 
Traitement Chirurgical HCC Conf Zurich
Traitement Chirurgical HCC Conf ZurichTraitement Chirurgical HCC Conf Zurich
Traitement Chirurgical HCC Conf ZurichEric Vibert, MD, PhD
 
Liver Transplantation with severe steatotic graft and postoperative organ dys...
Liver Transplantation with severe steatotic graft and postoperative organ dys...Liver Transplantation with severe steatotic graft and postoperative organ dys...
Liver Transplantation with severe steatotic graft and postoperative organ dys...Eric Vibert, MD, PhD
 
Liver Transplantation for Cholangiocarcinoma
Liver Transplantation for CholangiocarcinomaLiver Transplantation for Cholangiocarcinoma
Liver Transplantation for CholangiocarcinomaEric Vibert, MD, PhD
 
Surgery at the Borderline in HCC patient - EASL Conference - Vienna 2015
Surgery at the Borderline in HCC patient - EASL Conference - Vienna 2015Surgery at the Borderline in HCC patient - EASL Conference - Vienna 2015
Surgery at the Borderline in HCC patient - EASL Conference - Vienna 2015Eric Vibert, MD, PhD
 
Arterial Lactate Concentration is a major pronostic factor after elective sur...
Arterial Lactate Concentration is a major pronostic factor after elective sur...Arterial Lactate Concentration is a major pronostic factor after elective sur...
Arterial Lactate Concentration is a major pronostic factor after elective sur...Eric Vibert, MD, PhD
 
Portal Vein Embolization and colorectal liver met
Portal Vein Embolization and colorectal liver metPortal Vein Embolization and colorectal liver met
Portal Vein Embolization and colorectal liver metEric Vibert, MD, PhD
 
New Technologies in Liver Laparoscopic Surgery
New Technologies in Liver Laparoscopic SurgeryNew Technologies in Liver Laparoscopic Surgery
New Technologies in Liver Laparoscopic SurgeryEric Vibert, MD, PhD
 
Castera élastométrie:pbh du16
Castera  élastométrie:pbh du16Castera  élastométrie:pbh du16
Castera élastométrie:pbh du16odeckmyn
 

What's hot (20)

Innovations in liver surgery for Hepatocellular Carcinoma
Innovations in liver surgery for Hepatocellular CarcinomaInnovations in liver surgery for Hepatocellular Carcinoma
Innovations in liver surgery for Hepatocellular Carcinoma
 
How to predict po course before and during surgery for HCC
How to predict po course before and during surgery for HCCHow to predict po course before and during surgery for HCC
How to predict po course before and during surgery for HCC
 
Les Alternative à la Transplantation Hépatique Cadavérique
Les Alternative à la Transplantation Hépatique CadavériqueLes Alternative à la Transplantation Hépatique Cadavérique
Les Alternative à la Transplantation Hépatique Cadavérique
 
Chirurgie ouverte ou laparoscopique du foie : comment définir les limites ? -...
Chirurgie ouverte ou laparoscopique du foie : comment définir les limites ? -...Chirurgie ouverte ou laparoscopique du foie : comment définir les limites ? -...
Chirurgie ouverte ou laparoscopique du foie : comment définir les limites ? -...
 
Liver transplantation vs Resection in cholangiocarcinoma on cirrhosis
Liver transplantation vs Resection in cholangiocarcinoma on cirrhosisLiver transplantation vs Resection in cholangiocarcinoma on cirrhosis
Liver transplantation vs Resection in cholangiocarcinoma on cirrhosis
 
Traitement Chirurgical HCC Conf Zurich
Traitement Chirurgical HCC Conf ZurichTraitement Chirurgical HCC Conf Zurich
Traitement Chirurgical HCC Conf Zurich
 
Liver Transplantation with severe steatotic graft and postoperative organ dys...
Liver Transplantation with severe steatotic graft and postoperative organ dys...Liver Transplantation with severe steatotic graft and postoperative organ dys...
Liver Transplantation with severe steatotic graft and postoperative organ dys...
 
Hepatectomie en 2 temps - Pr René Adam
Hepatectomie en 2 temps - Pr René AdamHepatectomie en 2 temps - Pr René Adam
Hepatectomie en 2 temps - Pr René Adam
 
Resection early hcc
Resection early hccResection early hcc
Resection early hcc
 
Liver Transplantation for Cholangiocarcinoma
Liver Transplantation for CholangiocarcinomaLiver Transplantation for Cholangiocarcinoma
Liver Transplantation for Cholangiocarcinoma
 
Quels impact de l'hépatopathie sous jacente? - Dr Andrea Laurenzi
Quels impact de l'hépatopathie sous jacente? - Dr Andrea LaurenziQuels impact de l'hépatopathie sous jacente? - Dr Andrea Laurenzi
Quels impact de l'hépatopathie sous jacente? - Dr Andrea Laurenzi
 
Surgery at the Borderline in HCC patient - EASL Conference - Vienna 2015
Surgery at the Borderline in HCC patient - EASL Conference - Vienna 2015Surgery at the Borderline in HCC patient - EASL Conference - Vienna 2015
Surgery at the Borderline in HCC patient - EASL Conference - Vienna 2015
 
Arterial Lactate Concentration is a major pronostic factor after elective sur...
Arterial Lactate Concentration is a major pronostic factor after elective sur...Arterial Lactate Concentration is a major pronostic factor after elective sur...
Arterial Lactate Concentration is a major pronostic factor after elective sur...
 
Innovation in Liver Surgery
Innovation in Liver SurgeryInnovation in Liver Surgery
Innovation in Liver Surgery
 
Portal Vein Embolization and colorectal liver met
Portal Vein Embolization and colorectal liver metPortal Vein Embolization and colorectal liver met
Portal Vein Embolization and colorectal liver met
 
Suppléance hépatique : comment et pour qui ?- Pr Didier Samuel et Pr Saliba F...
Suppléance hépatique : comment et pour qui ?- Pr Didier Samuel et Pr Saliba F...Suppléance hépatique : comment et pour qui ?- Pr Didier Samuel et Pr Saliba F...
Suppléance hépatique : comment et pour qui ?- Pr Didier Samuel et Pr Saliba F...
 
New Technologies in Liver Laparoscopic Surgery
New Technologies in Liver Laparoscopic SurgeryNew Technologies in Liver Laparoscopic Surgery
New Technologies in Liver Laparoscopic Surgery
 
Nouvellesapprochestherapeutiqueshepatitebmlevrero
NouvellesapprochestherapeutiqueshepatitebmlevreroNouvellesapprochestherapeutiqueshepatitebmlevrero
Nouvellesapprochestherapeutiqueshepatitebmlevrero
 
Omata et al., 2017
Omata et al., 2017Omata et al., 2017
Omata et al., 2017
 
Castera élastométrie:pbh du16
Castera  élastométrie:pbh du16Castera  élastométrie:pbh du16
Castera élastométrie:pbh du16
 

Viewers also liked

Stratégies thérapeutiques dans le petit carcinome hepatocellulaire
Stratégies thérapeutiques dans le petit carcinome hepatocellulaireStratégies thérapeutiques dans le petit carcinome hepatocellulaire
Stratégies thérapeutiques dans le petit carcinome hepatocellulaireEric Vibert, MD, PhD
 

Viewers also liked (20)

Les Tests de Dépistage Rapide de l'Hépatite C : Quel impact sur la pratique m...
Les Tests de Dépistage Rapide de l'Hépatite C : Quel impact sur la pratique m...Les Tests de Dépistage Rapide de l'Hépatite C : Quel impact sur la pratique m...
Les Tests de Dépistage Rapide de l'Hépatite C : Quel impact sur la pratique m...
 
Traitements de l'Hépatite C Chronique en 2014 pour les patients cirrhotiques ...
Traitements de l'Hépatite C Chronique en 2014 pour les patients cirrhotiques ...Traitements de l'Hépatite C Chronique en 2014 pour les patients cirrhotiques ...
Traitements de l'Hépatite C Chronique en 2014 pour les patients cirrhotiques ...
 
La Transplantation hépatique pour les patients cirrhotiques graves (MELD > 35)
La Transplantation hépatique pour les patients cirrhotiques graves (MELD > 35)La Transplantation hépatique pour les patients cirrhotiques graves (MELD > 35)
La Transplantation hépatique pour les patients cirrhotiques graves (MELD > 35)
 
Hémorragie de l'Hypertension Portale : Place du TIPS et de la Prothèse oesoph...
Hémorragie de l'Hypertension Portale : Place du TIPS et de la Prothèse oesoph...Hémorragie de l'Hypertension Portale : Place du TIPS et de la Prothèse oesoph...
Hémorragie de l'Hypertension Portale : Place du TIPS et de la Prothèse oesoph...
 
Les Nouvelles Règles de Transplantation Hépatique pour les patients ayant un ...
Les Nouvelles Règles de Transplantation Hépatique pour les patients ayant un ...Les Nouvelles Règles de Transplantation Hépatique pour les patients ayant un ...
Les Nouvelles Règles de Transplantation Hépatique pour les patients ayant un ...
 
Hépatite B Chronique - Quelle stratégie pour éliminer l'Antigène HBs ?
Hépatite B Chronique - Quelle stratégie pour éliminer l'Antigène HBs ?Hépatite B Chronique - Quelle stratégie pour éliminer l'Antigène HBs ?
Hépatite B Chronique - Quelle stratégie pour éliminer l'Antigène HBs ?
 
Traitement de l'Hépatite C Chronique selon le génotype
Traitement de l'Hépatite C Chronique selon le génotypeTraitement de l'Hépatite C Chronique selon le génotype
Traitement de l'Hépatite C Chronique selon le génotype
 
Hépatite B : Comment prévenir la réactivation virale ?
Hépatite B : Comment prévenir la réactivation virale ?Hépatite B : Comment prévenir la réactivation virale ?
Hépatite B : Comment prévenir la réactivation virale ?
 
Cohorteculpitacoilly
CohorteculpitacoillyCohorteculpitacoilly
Cohorteculpitacoilly
 
Hepatitecnouveauxantivirauxetinteractionsmedicamenteusesgpeytavin
HepatitecnouveauxantivirauxetinteractionsmedicamenteusesgpeytavinHepatitecnouveauxantivirauxetinteractionsmedicamenteusesgpeytavin
Hepatitecnouveauxantivirauxetinteractionsmedicamenteusesgpeytavin
 
Quefairedevantlhyperferritinemiedusyndromemetabolique
QuefairedevantlhyperferritinemiedusyndromemetaboliqueQuefairedevantlhyperferritinemiedusyndromemetabolique
Quefairedevantlhyperferritinemiedusyndromemetabolique
 
Recommandationsafefpecvhcmbourliere
RecommandationsafefpecvhcmbourliereRecommandationsafefpecvhcmbourliere
Recommandationsafefpecvhcmbourliere
 
Quelleplacedelatepdanschcmacastilla
QuelleplacedelatepdanschcmacastillaQuelleplacedelatepdanschcmacastilla
Quelleplacedelatepdanschcmacastilla
 
Nouvellestechniquesimageriecarcinomehepatocellulairelewin
NouvellestechniquesimageriecarcinomehepatocellulairelewinNouvellestechniquesimageriecarcinomehepatocellulairelewin
Nouvellestechniquesimageriecarcinomehepatocellulairelewin
 
Insuffisancehepatiqueaigue
InsuffisancehepatiqueaigueInsuffisancehepatiqueaigue
Insuffisancehepatiqueaigue
 
Quandrechercherresistancevirologiquetantoninishaim
QuandrechercherresistancevirologiquetantoninishaimQuandrechercherresistancevirologiquetantoninishaim
Quandrechercherresistancevirologiquetantoninishaim
 
Nouveauteshepatologiedsamuel
NouveauteshepatologiedsamuelNouveauteshepatologiedsamuel
Nouveauteshepatologiedsamuel
 
Difficultes d'Accès aux Soins pour les migrants
Difficultes d'Accès aux Soins pour les migrantsDifficultes d'Accès aux Soins pour les migrants
Difficultes d'Accès aux Soins pour les migrants
 
Stratégies thérapeutiques dans le petit carcinome hepatocellulaire
Stratégies thérapeutiques dans le petit carcinome hepatocellulaireStratégies thérapeutiques dans le petit carcinome hepatocellulaire
Stratégies thérapeutiques dans le petit carcinome hepatocellulaire
 
Organisation de la Recherche Clinique. France
Organisation de la Recherche Clinique. FranceOrganisation de la Recherche Clinique. France
Organisation de la Recherche Clinique. France
 

Similar to From Binge Drinking to Alcoholic Liver Disease - Du Binge Drinking à l'Hépatite Alcoolique

Analyses of Risk Factors of Diarrhea in Patients with Esophagectomy
Analyses of Risk Factors of Diarrhea in Patients with EsophagectomyAnalyses of Risk Factors of Diarrhea in Patients with Esophagectomy
Analyses of Risk Factors of Diarrhea in Patients with Esophagectomysemualkaira
 
Benjamin Bearnot - New treatments for the infectious complications of substan...
Benjamin Bearnot - New treatments for the infectious complications of substan...Benjamin Bearnot - New treatments for the infectious complications of substan...
Benjamin Bearnot - New treatments for the infectious complications of substan...Benjamin Bearnot, MD
 
Current Management of Non Muscle-Invasive Bladder Cancer
Current Management of Non Muscle-Invasive Bladder CancerCurrent Management of Non Muscle-Invasive Bladder Cancer
Current Management of Non Muscle-Invasive Bladder CancerTheralase Technologies Inc.
 
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...JohnJulie1
 
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...daranisaha
 
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...EditorSara
 
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...NainaAnon
 
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...EditorSara
 
Bacterial infections in cirrhosis
Bacterial infections in cirrhosisBacterial infections in cirrhosis
Bacterial infections in cirrhosisMario Mondelli
 
O. Glehen - HIPEC Colorectal and Gastric
O. Glehen - HIPEC Colorectal and GastricO. Glehen - HIPEC Colorectal and Gastric
O. Glehen - HIPEC Colorectal and GastricGlehen
 
Primary Sclerosing Cholangitis (PSC)
Primary Sclerosing Cholangitis (PSC)Primary Sclerosing Cholangitis (PSC)
Primary Sclerosing Cholangitis (PSC)Kailash Raj
 
Ulcerative colitis protocol presentation
Ulcerative colitis protocol presentationUlcerative colitis protocol presentation
Ulcerative colitis protocol presentationSaurabh Patil
 
Implement clinical guidelines for the
Implement clinical guidelines for theImplement clinical guidelines for the
Implement clinical guidelines for thekrystyne
 
Hiperparathyroid and Kidney Stone
Hiperparathyroid and Kidney StoneHiperparathyroid and Kidney Stone
Hiperparathyroid and Kidney StoneEko indra
 
Pancreatitis - enteral vs paraenteral nutrition
Pancreatitis - enteral vs paraenteral nutritionPancreatitis - enteral vs paraenteral nutrition
Pancreatitis - enteral vs paraenteral nutritionElgha Parambi
 
Management del paziente in lista d'attesa per trapianto di fegato - Gastrolea...
Management del paziente in lista d'attesa per trapianto di fegato - Gastrolea...Management del paziente in lista d'attesa per trapianto di fegato - Gastrolea...
Management del paziente in lista d'attesa per trapianto di fegato - Gastrolea...Gastrolearning
 
Helicobacter Pylori & Gastric Cancer - An Evidence Based Approach for Primary...
Helicobacter Pylori & Gastric Cancer - An Evidence Based Approach for Primary...Helicobacter Pylori & Gastric Cancer - An Evidence Based Approach for Primary...
Helicobacter Pylori & Gastric Cancer - An Evidence Based Approach for Primary...Jarrod Lee
 
Risk factors of chronic liver disease amongst patients receiving care in a Ga...
Risk factors of chronic liver disease amongst patients receiving care in a Ga...Risk factors of chronic liver disease amongst patients receiving care in a Ga...
Risk factors of chronic liver disease amongst patients receiving care in a Ga...iosrjce
 

Similar to From Binge Drinking to Alcoholic Liver Disease - Du Binge Drinking à l'Hépatite Alcoolique (20)

Analyses of Risk Factors of Diarrhea in Patients with Esophagectomy
Analyses of Risk Factors of Diarrhea in Patients with EsophagectomyAnalyses of Risk Factors of Diarrhea in Patients with Esophagectomy
Analyses of Risk Factors of Diarrhea in Patients with Esophagectomy
 
Benjamin Bearnot - New treatments for the infectious complications of substan...
Benjamin Bearnot - New treatments for the infectious complications of substan...Benjamin Bearnot - New treatments for the infectious complications of substan...
Benjamin Bearnot - New treatments for the infectious complications of substan...
 
Current Management of Non Muscle-Invasive Bladder Cancer
Current Management of Non Muscle-Invasive Bladder CancerCurrent Management of Non Muscle-Invasive Bladder Cancer
Current Management of Non Muscle-Invasive Bladder Cancer
 
NAFLD
NAFLDNAFLD
NAFLD
 
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
 
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
 
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
 
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
 
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
Multimodal Prehabilitation in Radioactive Iodine-Refractory Differentiated Th...
 
Bacterial infections in cirrhosis
Bacterial infections in cirrhosisBacterial infections in cirrhosis
Bacterial infections in cirrhosis
 
O. Glehen - HIPEC Colorectal and Gastric
O. Glehen - HIPEC Colorectal and GastricO. Glehen - HIPEC Colorectal and Gastric
O. Glehen - HIPEC Colorectal and Gastric
 
Acute pancreatitis
Acute pancreatitisAcute pancreatitis
Acute pancreatitis
 
Primary Sclerosing Cholangitis (PSC)
Primary Sclerosing Cholangitis (PSC)Primary Sclerosing Cholangitis (PSC)
Primary Sclerosing Cholangitis (PSC)
 
Ulcerative colitis protocol presentation
Ulcerative colitis protocol presentationUlcerative colitis protocol presentation
Ulcerative colitis protocol presentation
 
Implement clinical guidelines for the
Implement clinical guidelines for theImplement clinical guidelines for the
Implement clinical guidelines for the
 
Hiperparathyroid and Kidney Stone
Hiperparathyroid and Kidney StoneHiperparathyroid and Kidney Stone
Hiperparathyroid and Kidney Stone
 
Pancreatitis - enteral vs paraenteral nutrition
Pancreatitis - enteral vs paraenteral nutritionPancreatitis - enteral vs paraenteral nutrition
Pancreatitis - enteral vs paraenteral nutrition
 
Management del paziente in lista d'attesa per trapianto di fegato - Gastrolea...
Management del paziente in lista d'attesa per trapianto di fegato - Gastrolea...Management del paziente in lista d'attesa per trapianto di fegato - Gastrolea...
Management del paziente in lista d'attesa per trapianto di fegato - Gastrolea...
 
Helicobacter Pylori & Gastric Cancer - An Evidence Based Approach for Primary...
Helicobacter Pylori & Gastric Cancer - An Evidence Based Approach for Primary...Helicobacter Pylori & Gastric Cancer - An Evidence Based Approach for Primary...
Helicobacter Pylori & Gastric Cancer - An Evidence Based Approach for Primary...
 
Risk factors of chronic liver disease amongst patients receiving care in a Ga...
Risk factors of chronic liver disease amongst patients receiving care in a Ga...Risk factors of chronic liver disease amongst patients receiving care in a Ga...
Risk factors of chronic liver disease amongst patients receiving care in a Ga...
 

More from Centre Hepato-Biliaire / AP-HP Hopital Paul Brousse

More from Centre Hepato-Biliaire / AP-HP Hopital Paul Brousse (20)

Situations difficiles en chirurgie biliaire : Présentations de trois cas clin...
Situations difficiles en chirurgie biliaire : Présentations de trois cas clin...Situations difficiles en chirurgie biliaire : Présentations de trois cas clin...
Situations difficiles en chirurgie biliaire : Présentations de trois cas clin...
 
Situations difficiles en chirurgie biliaire : Présentations de trois cas clin...
Situations difficiles en chirurgie biliaire : Présentations de trois cas clin...Situations difficiles en chirurgie biliaire : Présentations de trois cas clin...
Situations difficiles en chirurgie biliaire : Présentations de trois cas clin...
 
Situations difficiles en chirurgie biliaire : Présentations de trois cas clin...
Situations difficiles en chirurgie biliaire : Présentations de trois cas clin...Situations difficiles en chirurgie biliaire : Présentations de trois cas clin...
Situations difficiles en chirurgie biliaire : Présentations de trois cas clin...
 
Point de vue du chirurgien hépatique - M.A. Allard
Point de vue du chirurgien hépatique - M.A. AllardPoint de vue du chirurgien hépatique - M.A. Allard
Point de vue du chirurgien hépatique - M.A. Allard
 
Quoi de neuf dans les cancers primitifs du foie? - E. Vibert
Quoi de neuf dans les cancers primitifs du foie? - E. VibertQuoi de neuf dans les cancers primitifs du foie? - E. Vibert
Quoi de neuf dans les cancers primitifs du foie? - E. Vibert
 
Conférence du Président d'honneur : l'échinococcose alvéolaire - G. Mansson
Conférence du Président d'honneur : l'échinococcose alvéolaire - G. ManssonConférence du Président d'honneur : l'échinococcose alvéolaire - G. Mansson
Conférence du Président d'honneur : l'échinococcose alvéolaire - G. Mansson
 
Chirurgie guidée par la fluorescence - N. Golse
Chirurgie guidée par la fluorescence - N. GolseChirurgie guidée par la fluorescence - N. Golse
Chirurgie guidée par la fluorescence - N. Golse
 
Chirurgie de réduction tumorale des métastases hépatique non résécables de fa...
Chirurgie de réduction tumorale des métastases hépatique non résécables de fa...Chirurgie de réduction tumorale des métastases hépatique non résécables de fa...
Chirurgie de réduction tumorale des métastases hépatique non résécables de fa...
 
Déprivation veineuse portale et sus-hépatique. Indications actuelles et résul...
Déprivation veineuse portale et sus-hépatique. Indications actuelles et résul...Déprivation veineuse portale et sus-hépatique. Indications actuelles et résul...
Déprivation veineuse portale et sus-hépatique. Indications actuelles et résul...
 
Point de vue du chirurgien colorectal - S. Benoist
Point de vue du chirurgien colorectal - S. BenoistPoint de vue du chirurgien colorectal - S. Benoist
Point de vue du chirurgien colorectal - S. Benoist
 
Chirurgie hépatique sous perfusion hypothermique - D. Azoulay
Chirurgie hépatique sous perfusion hypothermique - D. AzoulayChirurgie hépatique sous perfusion hypothermique - D. Azoulay
Chirurgie hépatique sous perfusion hypothermique - D. Azoulay
 
Transplantation hépatique pour cancer: quelles tumeurs. A quelles conditions?...
Transplantation hépatique pour cancer: quelles tumeurs. A quelles conditions?...Transplantation hépatique pour cancer: quelles tumeurs. A quelles conditions?...
Transplantation hépatique pour cancer: quelles tumeurs. A quelles conditions?...
 
DPC par chirurgie mini-invasive: Où en sommes-nous? C. Salloum
DPC par chirurgie mini-invasive: Où en sommes-nous? C. SalloumDPC par chirurgie mini-invasive: Où en sommes-nous? C. Salloum
DPC par chirurgie mini-invasive: Où en sommes-nous? C. Salloum
 
Quoi de neuf dans les métastases hépatique?
Quoi de neuf dans les métastases hépatique?Quoi de neuf dans les métastases hépatique?
Quoi de neuf dans les métastases hépatique?
 
Destruction tumorale par écho-guidage optimisé - M.A. Allard
Destruction tumorale par écho-guidage optimisé - M.A. AllardDestruction tumorale par écho-guidage optimisé - M.A. Allard
Destruction tumorale par écho-guidage optimisé - M.A. Allard
 
Obésité et chirurgie HPB? Quels risques? Quelles recommandations? Quelle pris...
Obésité et chirurgie HPB? Quels risques? Quelles recommandations? Quelle pris...Obésité et chirurgie HPB? Quels risques? Quelles recommandations? Quelle pris...
Obésité et chirurgie HPB? Quels risques? Quelles recommandations? Quelle pris...
 
Quoi de neuf dans les cancers du pancréas? - G. Pittau
Quoi de neuf dans les cancers du pancréas? - G. PittauQuoi de neuf dans les cancers du pancréas? - G. Pittau
Quoi de neuf dans les cancers du pancréas? - G. Pittau
 
Quand l'intelligence artificielle s'invite au bloc opératoire Eric VIbert.pdf
Quand l'intelligence artificielle s'invite au bloc opératoire Eric VIbert.pdfQuand l'intelligence artificielle s'invite au bloc opératoire Eric VIbert.pdf
Quand l'intelligence artificielle s'invite au bloc opératoire Eric VIbert.pdf
 
Cas Clinique Sophie SAcleux.pdf
Cas Clinique Sophie SAcleux.pdfCas Clinique Sophie SAcleux.pdf
Cas Clinique Sophie SAcleux.pdf
 
En Recherche Jean Charles Duclos Vallée.pdf
En Recherche Jean Charles Duclos Vallée.pdfEn Recherche Jean Charles Duclos Vallée.pdf
En Recherche Jean Charles Duclos Vallée.pdf
 

Recently uploaded

Nursing process by Joseph s phiri presentation.pptx
Nursing process by Joseph s phiri presentation.pptxNursing process by Joseph s phiri presentation.pptx
Nursing process by Joseph s phiri presentation.pptxJosephPhiri55
 
The Natural Method That Supports Healthy Weight Loss & Steady Blood Sugar Levels
The Natural Method That Supports Healthy Weight Loss & Steady Blood Sugar LevelsThe Natural Method That Supports Healthy Weight Loss & Steady Blood Sugar Levels
The Natural Method That Supports Healthy Weight Loss & Steady Blood Sugar LevelsAman Ullah
 
GLANDS IN THE SKIN,FUNCTIONS AND ABNORMALITIES ..pptx
GLANDS IN THE SKIN,FUNCTIONS AND ABNORMALITIES ..pptxGLANDS IN THE SKIN,FUNCTIONS AND ABNORMALITIES ..pptx
GLANDS IN THE SKIN,FUNCTIONS AND ABNORMALITIES ..pptxWINCY THIRUMURUGAN
 
Seminario BioMol- Aura Cristina Peña Santos
Seminario BioMol- Aura Cristina Peña SantosSeminario BioMol- Aura Cristina Peña Santos
Seminario BioMol- Aura Cristina Peña SantosAuraCristinaPeaSanto
 
Pott's Spine. (Tuberculosis Spine) pptx
Pott's Spine.  (Tuberculosis Spine) pptxPott's Spine.  (Tuberculosis Spine) pptx
Pott's Spine. (Tuberculosis Spine) pptxShashi Prakash
 
Presentation on heADCAHE AND FACIAL PAIN.pptx
Presentation on heADCAHE AND FACIAL PAIN.pptxPresentation on heADCAHE AND FACIAL PAIN.pptx
Presentation on heADCAHE AND FACIAL PAIN.pptxdruttamnepal
 
Feel and Look Years Younger With Nutra IGF 1 Supplement
Feel and Look Years Younger With Nutra IGF 1 SupplementFeel and Look Years Younger With Nutra IGF 1 Supplement
Feel and Look Years Younger With Nutra IGF 1 SupplementWintersBiotechnology
 
Peripheral Vascular Disease (PVD): Physiotherapy assessment and management
Peripheral Vascular Disease (PVD): Physiotherapy assessment and managementPeripheral Vascular Disease (PVD): Physiotherapy assessment and management
Peripheral Vascular Disease (PVD): Physiotherapy assessment and managementTushar Sharma
 
Effects of variation of tube voltage current, filtration..pptx
Effects of variation of tube voltage current, filtration..pptxEffects of variation of tube voltage current, filtration..pptx
Effects of variation of tube voltage current, filtration..pptxDr. Dheeraj Kumar
 
Renal Regulation of Potassium, Calcium, Magnesium and Phosphorus
Renal Regulation of Potassium, Calcium, Magnesium and PhosphorusRenal Regulation of Potassium, Calcium, Magnesium and Phosphorus
Renal Regulation of Potassium, Calcium, Magnesium and PhosphorusMedicoseAcademics
 
pediatrics. epilepsy and seizures in children 8.ppt
pediatrics. epilepsy and seizures in children 8.pptpediatrics. epilepsy and seizures in children 8.ppt
pediatrics. epilepsy and seizures in children 8.pptArun170190
 
Cell locomotion (Ameboid/ciliary/flagellar movement)
Cell locomotion (Ameboid/ciliary/flagellar movement)Cell locomotion (Ameboid/ciliary/flagellar movement)
Cell locomotion (Ameboid/ciliary/flagellar movement)MedicoseAcademics
 
Disorders of white blood cells and related conditions
Disorders of white blood cells and related conditionsDisorders of white blood cells and related conditions
Disorders of white blood cells and related conditionskipsereksolomon
 
ANTI-HYPERTENSIVE DRUG - RAUWOLFIA ROOT.
ANTI-HYPERTENSIVE DRUG - RAUWOLFIA ROOT.ANTI-HYPERTENSIVE DRUG - RAUWOLFIA ROOT.
ANTI-HYPERTENSIVE DRUG - RAUWOLFIA ROOT.Divya Kanojiya
 
odontogenic keratocyst a developmental cyst
odontogenic keratocyst  a developmental cystodontogenic keratocyst  a developmental cyst
odontogenic keratocyst a developmental cystJani253068
 
FEBRUARY 2024 ONCOLOGY CARTOON /95TH VOLUME
FEBRUARY 2024 ONCOLOGY CARTOON /95TH VOLUMEFEBRUARY 2024 ONCOLOGY CARTOON /95TH VOLUME
FEBRUARY 2024 ONCOLOGY CARTOON /95TH VOLUMEKanhu Charan
 

Recently uploaded (20)

Introduction Endocrinology class -2.pptx
Introduction Endocrinology class -2.pptxIntroduction Endocrinology class -2.pptx
Introduction Endocrinology class -2.pptx
 
Nursing process by Joseph s phiri presentation.pptx
Nursing process by Joseph s phiri presentation.pptxNursing process by Joseph s phiri presentation.pptx
Nursing process by Joseph s phiri presentation.pptx
 
Digestants and Carminatives.pdf
Digestants and Carminatives.pdfDigestants and Carminatives.pdf
Digestants and Carminatives.pdf
 
The Natural Method That Supports Healthy Weight Loss & Steady Blood Sugar Levels
The Natural Method That Supports Healthy Weight Loss & Steady Blood Sugar LevelsThe Natural Method That Supports Healthy Weight Loss & Steady Blood Sugar Levels
The Natural Method That Supports Healthy Weight Loss & Steady Blood Sugar Levels
 
GLANDS IN THE SKIN,FUNCTIONS AND ABNORMALITIES ..pptx
GLANDS IN THE SKIN,FUNCTIONS AND ABNORMALITIES ..pptxGLANDS IN THE SKIN,FUNCTIONS AND ABNORMALITIES ..pptx
GLANDS IN THE SKIN,FUNCTIONS AND ABNORMALITIES ..pptx
 
Seminario BioMol- Aura Cristina Peña Santos
Seminario BioMol- Aura Cristina Peña SantosSeminario BioMol- Aura Cristina Peña Santos
Seminario BioMol- Aura Cristina Peña Santos
 
Pott's Spine. (Tuberculosis Spine) pptx
Pott's Spine.  (Tuberculosis Spine) pptxPott's Spine.  (Tuberculosis Spine) pptx
Pott's Spine. (Tuberculosis Spine) pptx
 
Presentation on heADCAHE AND FACIAL PAIN.pptx
Presentation on heADCAHE AND FACIAL PAIN.pptxPresentation on heADCAHE AND FACIAL PAIN.pptx
Presentation on heADCAHE AND FACIAL PAIN.pptx
 
KETO DIET
KETO DIETKETO DIET
KETO DIET
 
Feel and Look Years Younger With Nutra IGF 1 Supplement
Feel and Look Years Younger With Nutra IGF 1 SupplementFeel and Look Years Younger With Nutra IGF 1 Supplement
Feel and Look Years Younger With Nutra IGF 1 Supplement
 
Peripheral Vascular Disease (PVD): Physiotherapy assessment and management
Peripheral Vascular Disease (PVD): Physiotherapy assessment and managementPeripheral Vascular Disease (PVD): Physiotherapy assessment and management
Peripheral Vascular Disease (PVD): Physiotherapy assessment and management
 
Effects of variation of tube voltage current, filtration..pptx
Effects of variation of tube voltage current, filtration..pptxEffects of variation of tube voltage current, filtration..pptx
Effects of variation of tube voltage current, filtration..pptx
 
Respirtory stimulants.pdf
Respirtory stimulants.pdfRespirtory stimulants.pdf
Respirtory stimulants.pdf
 
Renal Regulation of Potassium, Calcium, Magnesium and Phosphorus
Renal Regulation of Potassium, Calcium, Magnesium and PhosphorusRenal Regulation of Potassium, Calcium, Magnesium and Phosphorus
Renal Regulation of Potassium, Calcium, Magnesium and Phosphorus
 
pediatrics. epilepsy and seizures in children 8.ppt
pediatrics. epilepsy and seizures in children 8.pptpediatrics. epilepsy and seizures in children 8.ppt
pediatrics. epilepsy and seizures in children 8.ppt
 
Cell locomotion (Ameboid/ciliary/flagellar movement)
Cell locomotion (Ameboid/ciliary/flagellar movement)Cell locomotion (Ameboid/ciliary/flagellar movement)
Cell locomotion (Ameboid/ciliary/flagellar movement)
 
Disorders of white blood cells and related conditions
Disorders of white blood cells and related conditionsDisorders of white blood cells and related conditions
Disorders of white blood cells and related conditions
 
ANTI-HYPERTENSIVE DRUG - RAUWOLFIA ROOT.
ANTI-HYPERTENSIVE DRUG - RAUWOLFIA ROOT.ANTI-HYPERTENSIVE DRUG - RAUWOLFIA ROOT.
ANTI-HYPERTENSIVE DRUG - RAUWOLFIA ROOT.
 
odontogenic keratocyst a developmental cyst
odontogenic keratocyst  a developmental cystodontogenic keratocyst  a developmental cyst
odontogenic keratocyst a developmental cyst
 
FEBRUARY 2024 ONCOLOGY CARTOON /95TH VOLUME
FEBRUARY 2024 ONCOLOGY CARTOON /95TH VOLUMEFEBRUARY 2024 ONCOLOGY CARTOON /95TH VOLUME
FEBRUARY 2024 ONCOLOGY CARTOON /95TH VOLUME
 

From Binge Drinking to Alcoholic Liver Disease - Du Binge Drinking à l'Hépatite Alcoolique

  • 1. Journée d’Hépatologie du Centre Hépato-Biliaire – 13 juin 2014 - Paris DDuu « bbiinnggee ddrriinnkkiinngg » àà ll’’hhééppaattiittee aallccoooolliiqquuee Pr. Philippe Mathurin Hôpital Universitaire Claude Huriez Lille, France
  • 2. Alcohol-attributable deaths as a percentage of total deaths
  • 3. Important variations iinn lliivveerr cciirrrrhhoossiiss mmoorrttaalliittyy aaccrroossss EEuurrooppee HHiigghheerr rraatteess iinn EEaasstteerrnn ccoouunnttrriieess tthhaann iinn WWeesstteerrnn EEuurrooppeeaann ccoouunnttrriieess
  • 4. Courtesy from D Leon. EASL 2010 Monothematic conference on ALD
  • 5. Courtesy from D Leon. EASL 2010 Monothematic conference on ALD
  • 6. COUNTRIES WWIITTHH IIMMPPRROOVVEEMMEENNTTSS OOVVEERR PPAASSTT 1100--2200 YYEEAARRSS
  • 7. Courtesy from D Leon. EASL 2010 Monothematic conference on ALD
  • 9. Cirrhosis in Europe: AA ppuubblliicc hheeaalltthh iissssuuee Age-adjusted (world population) mortality rates from cirrhosis per 100,000 men Bosetti C, J Hepat 2007
  • 10. COUNTRIES WWIITTHH IINNCCRREEAASSIINNGG RRAATTEESS OOVVEERR PPAASSTT 1100--2200 YYEEAARRSS
  • 11. Courtesy from D Leon. EASL 2010 Monothematic conference on ALD
  • 12. Alcohol and mortality in Russia: prospective observational study of 151 000 adults David Zaridze, …. Peto R. Lancet 2014
  • 13. Alcohol and mortality in Russia: prospective observational study of 151 000 adults David Zaridze, …. Peto R. Lancet 2014
  • 14. TTHHEE EEMMEERRGGIINNGG IISSSSUUEESS:: BBiinnggee ddrriinnkkiinngg,, ““tthhee uunnsseettttlleedd ddaaiillyy ddoossee ooff aallccoohhooll iinnttaakkee”” iinn tthhee ccoonntteexxtt ooff oobbeessiittyy
  • 15. Prevalence of NAFLD in EEuurroopp:: lleessssoonnss ffrroomm tthhee DDiioonnyyssooss ssttuuddyy PPrreevvaalleennccee ooff NNAAFFLLDD aasssseesssseedd bbyy uullttrraassoonnooggrraapphhyy == 2200%% Bedogni G, Hepatology 2005
  • 16. PPrrooggrreessssiioonn ooff oobbeessiittyy oovveerr tthhee ttiimmee 11999977 :: 88..22 %% 22000000 :: 99..66 %% 22000033 :: 1111..33 %% 22000066 :: 1122..44 %% + 17% + 17,7 % + 9,7% Data from Obepi Survey 2009
  • 17. Excess weight risk factor for Alcoholic Liver Disease 60% Overweight Patients Non-Overweight Patients 35% 80% 70% 60% 50% 40% 30% 20% 10% 0% Alcoholic Cirrhosis Naveau S, Hepatology 1997
  • 18. Effect of binge drinking on the liver: An alarming public health issue? • 3 questions on the potential impact of binge drinking in terms of liver disease: 1. Do experimental data suggest a deleterious impact of binge drinking on liver tissue? → Answer: YES 2. Do behavioral studies suggest that adolescent binge drinkers are at higher risk of being heavy drinkers in adulthood, with the consequent risk of alcoholic liver disease? → Answer : YES Probability of becoming a chronic drinker at an adult age was higher in male and female adolescent binge drinkers than in non-bingers: 6.7 % vs 2.3% and 9.6 vs 4.8 % 3. Do epidemiological data support a future increase in the risk of cirrhosis related to binge drinking? → Answer Likely Drastic increase in liver cirrhosis and mortality rates in the UK is particularly alarming Mathurin Gut 2009; McCarty CA Pediatrics 2004
  • 19. Effect of binge drinking on the liver: An alarming public health issue? Binge drinking is a major public heath issue that can no longer be considered simply a momentary risk factor of behavioral concerns, but must now be viewed in light of long-term consequences, such as alcohol-induced liver disease Mathurin Gut 2009 McCarty CA Pediatrics 2004
  • 20. Effect of binge drinking on the liver: An alarming public health issue? Leon DL, Lancet 2006
  • 21. Alcohol a major ppuubblliicc hheeaalltthh iissssuuee TThhee bbiinnggee ddrriinnkkiinngg PPhheennoommeennoonn 11..22 bbiilllliioonnss 11..55 bbiilllliioonnss ↑ 25% Naimi TS, Jama 2003
  • 22. How to reduce the burden of alchohol-attributable deaths: The most efficient public health policies
  • 29. EASL call for EU action – on liver disease • Recognise alcohol consumption as one of the cross-cutting risk factors for non-communicable diseases, including liver disease • Acknowledge liver disease as a public health priority in the EU’s public health and research policies and funding programmes • Ensure liver disease is addressed in future policy developments in the field of non-communicable diseases
  • 30. Public health policy need to use the same concept than type II diabetes  Primary prevention: ● For type II diabetes: - reduction of overweight in general population - modification of lifestyle at population level → Physical activity → behavior changes in terms of alimentation ● For alcoholic liver disease - Decrease of alcohol consumption per inhabitant per year  Like type II diabetes there is a need to promote resarch program on ● better understanding of how cirrhosis develops in people at risk ● how to prevent or delay the development of cirrhosis and its complications
  • 31. Disease progression non-iinnvvaassiivvee mmaarrkkeerrss iinn AALLDD Fibrotest < 0.32 0.32-0.58 >0.58 Naveau S, Hepatology 2009
  • 32. Alcoholic liver disease aanndd bbiioollooggiiccaall mmaarrkkeerrss FFiibbrrootteesstt Naveau S et al., Clin Gastroenterol Hepatol. 2005
  • 33. Le Dépistage améliore la survie CHC sur VHC % des patients à un stade précoce Taux d’accès au dépistage Accès aux traitements curatifs (%) Pas de dépisgge 19% 0% 14,5% Dépistage actuel 42% 57% 25,0% [Observatoire ANGH Chang] 97 % Taux dépistage 42% 97% 32,5% Efficacité CHC 2000 87% 57% 40,5% CHC 2000 + 97% Accès 87% 97% 58,5% dépistage Mourad A, Hepatology 2014
  • 34. O’Shea RS, Hepatology 2010 Journal of Hepatology 2012 • First-line therapy in patients with severe ASH includes corticosteroids or pentoxifylline especially if there are contraindications to steroid therapy
  • 35. MMoovviinngg ttoowwaarrdd tthhee RReessppoonnssee GGuuiiddeedd tthheerraappyy
  • 36. LLiillllee mmooddeell:: aa ttooooll ffoorr nneeww ssttrraatteeggiieess EEvvaalluuaattiioonn ooff LLiillllee mmooddeell oonn oovveerraallll ppaattiieennttss ((nn==443388)) 100 % 75 % 50 % 25 % hhttttpp::////wwwwww..lliilllleemmooddeell..ccoomm Lille score < 0.45 85±2.5% p<0.00001 Lille score ≥ 0.45 25±3.8% 50 days 100 days 150 days 180 days Louvet A et al, Hepatology 2007
  • 37. Complete responders Lille score ≤0.16 [≤35th percentile] Partial responders Lille score 0.16-0.56 [35-70th percentile] P Mathurin, Gut 2011 Null responders Lille score ≥0.56 [≥ 70th percentile]
  • 38. • Current management • Near Future • Distant Future : Arbitrary selection of novel molecules already tested in human beings • Transplantation for non-responders to medical therapy • Future Requirements
  • 39. N-acetylcysteine aanndd ccoorrttiiccoosstteerrooiiddss :: TThhee nneeaarr ffuuttuurree ?? NNAACC aalloonnee iiss iinneeffffiicciieenntt Stewart S, J Hepatol 2007; Moreno C, J Hepatol 2010 Nguyen-Khac E,New Engl J Med 2011
  • 40. Prednisolone With vvss WWiitthhoouutt PPeennttooxxiiffyylllliinnee 15.3% Steroids + pentoxifylline n=133 Steroids + Placebo n=137 EEnndd ppooiinntt == 66 mmoonntthh--ssuurrvviivvaall 227700 ppaattiieennttss iinncclluuddeedd AH biopsy proven Madddrey ≥ 32 Jaundice < 3 months n=270 Mathurin P et al, JAMA 2013 p=0.07 8.4% 11.7% p=0.007 3.1%
  • 41. • Current management • Near Future • Distant Future : Arbitrary selection of novel molecules already tested in human beings • Transplantation for non-responders to medical therapy • Future Requirements
  • 42. PPootteennttiiaall tthheerraappeeuuttiicc ttaarrggeettss iinn tthhee ffuuttuurree Unsuitable molecule ↓ RReeccoovveerryy ↑↑ LLiivveerr FFuunnccttiioonn DDiisseeaassee ↓↓ LLiivveerr FFuunnccttiioonn IInnffllaammmmaattiioonn NNeeccrroossiiss AAppooppttoossiiss ↓ ↑ Infection SSuurrvviivvaall PPrroobbaabbiilliittyy Survival Time
  • 43. What can we learn from anti-TNF-a story TNF-a and ALD McClain CJ, Hepatology 1989 Kamimura Hepatology 1995 Yin M, Gastroenterology 1999 Chang J, Hepatology 2004 Yamada Y et al, PNAS 1997 TNF alpha TTNNFF--a aanndd LLiivveerr RReeggeenneerraattiioonn
  • 44. What can we learn from anti-TNF-a story? Tilg H , J Hepatol 2003 Spahr L J hepatol 2002* SSttuuddyy DDeessiiggnn Mookerjee Gut 2003 SSiinnggllee DDoossee Sharma P, J Hepatol 2009 Inclusion criterion : Meld ≥15 Inclusion criterion : Maddrey SSttuuddyy DDeessiiggnn OOff RRCCTTSS MMuullttiippllee DDoosseess NC Boetticher, Gastroenterology 2008 ≥32 Naveau S Hepatology 2004 ↑risk of Infections
  • 45. - RReeccoovveerryy ↑↑ LLiivveerr FFuunnccttiioonn DDiisseeaassee ↓↓ LLiivveerr FFuunnccttiioonn Ideal molecule IInnffllaammmmaattiioonn NNeeccrroossiiss AAppooppttoossiiss + - Infection SSuurrvviivvaall PPootteennttiiaall tthheerraappeeuuttiicc ttaarrggeettss iinn tthhee ffuuttuurree SSuurrvviivvaall PPrroobbaabbiilliittyy
  • 46. Potential therapeutic ttaarrggeettss iinn tthhee ffuuttuurree IL-1 receptor antagonist (IL-1Ra) human IL-1ra [Anakinra®] ↓↓ AAllccoohhooll lliivveerr iinnjjuurryy Petrasek J, J Clin Invest 2012 BBRRDDUU IInnccoorrppoorraattiioonn human IL-1ra [Anakinra®] ↑↑ LLiivveerr rreeggeenneerraattiioonn Sgroi A, PlosOne 2011 Boulton Ra, Hepatology 1997
  • 47. Potential therapeutic ttaarrggeettss iinn tthhee ffuuttuurree Interleukin 22 [F-652] in phase I study ↓↓ AAllccoohhooll lliivveerr iinnjjuurryy Ki SH, Hepatology 2010 ↑↑ LLiivveerr rreeggeenneerraattiioonn Feng D, Gastroenterology 2012 Park O, Hepatology 2010
  • 48. Potential therapeutic ttaarrggeettss iinn tthhee ffuuttuurree Eculizumab [Soliris®] Antibody against C5 ↓↓ AAllccoohhooll lliivveerr iinnjjuurryy Pritchard MT, Gastroenterology 2007 Cohen JI, Gastroenterology 2010 BBlloocckkiinngg CC55 iimmpprroovveess oouuttccoommee iinn SSeeppssiiss Woehrl B, J Clin Invest 2011
  • 49. • Current management • Near Future • Distant Future : Arbitrary selection of novel molecules already tested in human beings • Transplantation for non-responders to medical therapy • Future Requirements
  • 50. SSeevveerree AAllccoohhoolliicc HHeeppaattiittiiss LLiivveerr TTrraannssppllaannttaattiioonn:: aa lloonngg wwaayy ttoo ggoo WWhheerree DDoo WWee AAllll CCoommee FFrroomm ?? • RReecceenntt ffoorrmmaall rreeccooggnniittiioonn tthhaatt AAHH iiss aann aabbssoolluuttee ccoonnttrraaiinnddiiccaattiioonn bbyy UUKK ttrraannssppllaanntt cceennttrreess ((BBaatthhggaattee AAJJ,, LLaanncceett 2000066)) • AAbbssttiinneennccee pprree--ttrraannssppllaanntt iiss nneecceessssaarryy ttoo eexxcclluuddee tthhoossee wwhhoo wwiillll iimmpprroovvee aanndd nnoott nneeeedd ttrraannssppllaannttaattiioonn • AAbbssttiinneennccee iiss uusseeffuull ttoo aallllooww ttiimmee ffoorr aasssseessssiinngg aanndd vveerriiffyyiinngg aallccoohhooll aaddddiiccttiivvee bbeehhaavviioouurr bbuutt « 6-month rule » is not a robust criterion Foster PF, Hepatology 1997 Liver transplantation for alcoholic liver disease: bias, beliefs, 6-month rule, and relapse- but where are the data. Beresford TP, Everson GT Liver Transpl 2000
  • 51. Where Do We Come From ? SSEEVVEERREE AALLCCOOHHOOLLIICC HHEEPPAATTIITTIISS LLIIVVEERR TTRRAANNSSPPLLAANNTTAATTIIOONN Where Do I Come From ? • Atterbury CE. The alcoholic in the lifeboat. Should drinkers be candidates for liver transplantation? J Clin Gastroenterol 1986 The Jury stated: - wait-and-watch strategy using the 6-month criterion may be unfair for some non-responders with 70- 80% probability of dying during this period - recommended pilot studies evaluating early liver transplantation in non-responders • Lucey MR J Hepatol 2002; Is liver transplantation an appropriate treatment for acute alcoholic hepatitis?
  • 52. Early liver transplantation: The French and Belgium Experience Philippe Mathurin1, Christophe Moreno2, Didier Samuel3, Jérôme Dumortier4, Julia Salleron5, François Durand6, Hélène Castel1, Alain Duhamel5, Georges-Philippe Pageaux7, Vincent Leroy8, Sébastien Dharancy1, Alexandre Louvet1, Emmanuel Boleslawski1, Valerio Lucidi2, Thierry Gustot2, Claire Francoz6, Christian Letoublon8, Denis Castaing3, Jacques Belghiti6, Vincent Donckier2, François-René Pruvot1, Jean-Charles Duclos-Vallée3 Brussels, Grenoble, Lille, Lyon, Montpellier, Beaujon, Villejuif New EnglJ Med 2011
  • 53. EEaarrllyy LLTT iinn AAllccoohhoolliicc hheeppaattiittiiss • Early liver transplantation in non-responders undergoing their ffiirrsstt event of liver disease • Non responders were identified using Lille score ≥0.45 or worsening of liver function by day 7.
  • 54. Early LLTT iinn AAllccoohhoolliicc hheeppaattiittiiss SSeelleeccttiioonn pprroocceessss== 44 TTeeaamm cciirrcclleess Family structure Patient Time toward complete consensus = nurses, i.e. one resident and one fellow specialist in addiction = senior hepatologists senior anesthetist and surgeons
  • 55. EEaarrllyy LLTT iinn AAllccoohhoolliicc hheeppaattiittiiss Transplanted non responders N=26 Male gender no. [%] 15 [57.7%] Age (years) median [95%CI] 47.4 [42.7-52.4] Duration of corticosteroids treatment (days) Median [95%CI] 11.5 [7-18] Hepatorenal syndrome, no. [%] 15 [57.7%] Hemodiafiltration or MARS® system no. [%] 10 [38.5 %] Infection before transplantation no [%] 18 [69.2%] Mechanical ventilation no [%] 4 [15.4%]
  • 56. Median [95%CI] Lille score 0.88 [0.76 – 0.95] MELD on first day of therapy 30.1 [27.7 - 33.4] MELD day 7 28.5 [26.2 – 33.7] MELD at listing 34.2 [29 – 37] MELD day 0 - MELD Listing - 5.44 [-7.3 – 2] MELD day 7 - MELD Listing - 1.9[-6 – 0] Time (days) from end of therapy to 13 [6 – 17] listing Time (days) from listing to LT 8.5 [3 – 11] * MMaaxxiimmuumm ooff LLiillllee ssccoorree iiss 11 ** EEaarrllyy LLTT iinn AAllccoohhoolliicc hheeppaattiittiiss
  • 57. Early Transplantation sshhiifftt ssuurrvviivvaall ooff uunnrreessppoonnssiivvee ttoo rreessppoonnddeerrss • Final combined database included a total of 651 patients. Matching was performed using the global optimal algorithm • For matching criteria, we used the following pre-established ranges: age (+/- 10 years), gender, Maddrey function (<60; 60-90 and >90) and Lille score (+/-0.15) • The overall optimal algorithm was able to select 3 unresponsive matched controls for 20 transplanted patients, 2 unresponsive matched controls for 3 transplanted patients and only 1 unresponsive matched control for 3 transplanted patients. • The overall optimal algorithm was able to select 4 responsive matched controls for 21 transplanted patients, 2 responsive matched controls for 3 transplanted patients and only 1 responsive matched control for 2 transplanted patients
  • 58. EEaarrllyy LLTT iinn AAllccoohhoolliicc hheeppaattiittiiss
  • 59. EEaarrllyy LLTT iinn AAllccoohhoolliicc hheeppaattiittiiss • No alcohol relapse within the 6 month period • 3 patients resumed alcohol consumption during data collection - at 720, 740 and 1140 days [2 daily consumers and 1 had occasional consumption (approximately 10g/week)] • 2 centers have prospective data base of severe alcoholic hepatitis only 4 (1.83%) were directly selected by the 2 centers from their own recruitment • Proportions of eLT among the total number of procedures, and number of procedures for alcoholic liver disease, were 26/891 [2.92%]) and 26/315, [8.25%], respectively
  • 60. Outcomes After Liver Transplantation for Alcoholic Hepatitis Are Similar to Alcoholic Cirrhosis Graft Survival Patient Survival Singal AK et al., Hepatology 2011
  • 61. 1. In patients with severe ASH not responding to medical therapy, early LT need to be further evaluated in carefully-selected patients Journal of Hepatology 2012
  • 62. PPHHRRCC QQuuiicckkTTrraannss--HHAAAA AAHH nnoott rreessppoonnddiinngg ttoo mmeeddiiccaall tthheerraappyy AAllggoorriitthhmm bbaasseedd oonn oobbjjeeccttiivvee ccrriitteerriiaa RRaannggee ooff SSccoorree ffrroomm 00 ttoo 225500 GO AAllggoorriitthhmm ssccoorree ≥≥ 222200 GO AAllggoorriitthhmm ssccoorree << 222200GO Not selected SSeelleecctteedd CCoonnttrrooll ggrroouupp AAllccoohhoolliicc ccaannddiiddaatteess ffoorr lliivveerr ttrraannssppllaannttaattiioonn Classical selection 6-month criteria Primary objective Non inferiority in terms of alcohol relapse Secondary endpoint survival benefit Non responders Not Transplanted
  • 63. • Current management • Near Future • Distant Future : Arbitrary selection of novel molecules already tested in human beings • Transplantation for non-responders to medical therapy • Future Requirements
  • 64. Better KKnnoowwlleeddggee ooff tthhee NNaattuurraall HHiissttoorryy 66 mmoonntthhss Deaths due to liver injury in > 90 % of cases No impact of alcoholism behavior 66--MMOONNTTHH PPEERRIIOODD SSUURRVVIIVVIINNGG TTHHEE 66 MMOONNTTHH PPEERRIIOODD OOPPTTIIMMAALL PPEERRIIOODD FFOORR SSTTUUDDIIEESS TTEESSTTIINNGG DDRRUUGG PPRREEVVEENNTTIINNGG LLIIVVEERR IINNJJUURRYY AAlliivvee RReessppoonnddeerrss ttoo mmeeddiiccaall tthheerraappyy GGoooodd LLiivveerr FFuunnccttiioonn Abstainers during 5 years Risk of Liver-Related death ≈ 15% Relapsers during 5 years Risk of Liver-Related death ≈ 50% AAFFTTEERR 66 MMOONNTTHHSS AAVVOOIIDD SSTTUUDDIIEESS TTEESSTTIINNGG DDRRUUGG PPRREEVVEENNTTIINNGG LLIIVVEERR IINNJJUURRYY AAlliivvee NNoonn--RReessppoonnddeerrss ttoo mmeeddiiccaall tthheerraappyy IInntteerrmmeeddiiaattee LLiivveerr ddyyssffuunnccttiioonn Abstainers during 5 years Risk of Liver-Related death ≈ 50% Relapsers during 5 years Risk of Liver-Related death ≈ 90% Louvet A, AASLD 2010
  • 65. UUnnmmeett nneeeeddss • Animal models mimicking better liver Injury in human beings (liver dysfunction and regeneration) • Better network between basic and clinician researchers • Official recommendations from experts of scientific societies on the criteria that need to be fulfilled for an optimal study design • Development and validation of surrogate markers of survival (like the RECIST criteria in cancers) for testing of new molecules in phase I and/or II • Bring pharmaceutical companies to test and develop molecules
  • 66. NIAAA Announces Request for Applications oonn AAllccoohhoolliicc HHeeppaattiittiiss “Integrated Approaches for Identifying Molecular Targets in Alcoholic Hepatitis”