Application of ursodeoxycholic acid at non-alcoholic and alcohol-induced steatohepatitis

The aim of review. To cite the literature data, confirming efficacy of ursodeoxycholic acid (UDCA) at alcoholic and non-alcoholic steatohepatitis (NASH).

Original positions. Prevalence of liver steatosis as pathomorphologic substrate of various liver diseases is quite high, however the special attention is given to patients with signs of inflammation and fibrosis, i.e. with confirmed alcohol-induced and non-alcoholic steatohepatitis. Article presents pathogenic mechanisms of the most important lesions of the liver – alcoholic and non-alcoholic steatohepatitis in pathogenesis of which the leading part belongs to accumulation of fat in cells of the organ and enhancement of lipid peroxidation processes with development of necrosis of hepatic cells. At assessment of management approach of steatohepatitis patients main etiological factors and background diseases are taken into account. In the case of NASH itself, developed on a background of obesity, diabetes mellitus, keeping a diet in a combination with the adequate physical activity is effective, that results in gradual normalization of body weight. If these means will give no required results, prescription of intestinal triglyceride-lipase inhibitors or anorexigenic agents is rational. Disorders of carbohydrate metabolism (including insulin resistance) serve as the indication for prescription of drugs, that sensitize peripheral tissues to insulin. At alcohol-induced steatohepatitis abstinence is categorical. Corticosteroids are drugs of choice at treatment of severe decompensated forms of alcoholic liver disease, that reduce level of circulating proinflammatory cytokines and promote histological improvement with a short period. UDCA has antiapoptotic, cytoprotective, immunomodulating, anti-oxidative effect, so it can be used as pathogenic therapy at alcohol-induced and non-alcoholic steatohepatitis. Potential of combination of glucocorticoids with anti-oxidative agents, including UDCA, that is especially promising for clinical practice, continues to be studied as well. Prescription of UDCA is recommended at cholestatic variant of acute alcoholic hepatitis for essential decrease of pruritus and improvement of biochemical scores. Cytoprotective effect of UDCA allows to apply it at severe steatosis in absence of inflammation, especially if the patient continues to consume alcohol.

Conclusion. Ursodeoxycholic acid has antiapoptotic and anti-inflammatory effect and good safety profile. Application of UDCA can be recommended for patients with steatohepatitis of various etiology. At alcoholic lesion of the liver complete abstinence of alcohol intake is mandatory. Combination of corticosteroids with anti-oxidative drugs, including UDCA that look most perspective for clinical practice continues to be studied. In the case of NASH itself on a background of obesity UDCA can be prescribed as a drug with cytoprotective, antiapoptotic action, retarding fibrosis.

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