Short- and long-term outcome of severe alcohol-induced hepatitis treated with steroids or enteral nutrition: A multicenter randomized trial

Steroids are recommended in severe alcohol-induced hepatitis, but some data suggest that artificial nutrition could also be effective. We conducted a randomized trial comparing the short- and long-term effects of total entera l nutrition or steroids in these patients. A total of 71 patients (80% cirr hotic) were randomized to receive 40 mg/d prednisolone (n = 36) or enteral tube feeding (2,000 kcal/d) for 28 days (n = 35), and were followed for 1 y ear or until death. Side effects of treatment occurred in 5 patients on ste roids and 10 on enteral nutrition (not significant). Eight enterally fed pa tients were prematurely withdrawn from the trial, Mortality during treatmen t was similar in both groups (9 of 36 vs. 11 of 35, intention-to-treat) but occurred earlier with enteral feeding (median 7 vs. 23 days; P = .025). Mo rtality during follow-up was higher with steroids (10 of 27 vs, 2 of 24 int ention-to-treat; P = .04). Seven steroid patients died within the first 1.5 months of follow-up. In contrast to total enteral nutrition (TEN), infecti ons accounted for 9 of 10 follow-up deaths in the steroid group. In conclus ion, enteral feeding does not seem to be worse than steroids in the short-t erm treatment of severe alcohol-induced hepatitis, although death occurs ea rlier with enteral nutrition. However, steroid therapy is associated with a higher mortality rate in the immediate weeks after treatment, mainly becau se of infections. A possible synergistic effect of both treatments should b e investigated.