Management of severe acute alcoholic hepatitis in France: results of a national survey: R1.

Fiche publication

Date publication

mai 2026

Journal

Clinics and research in hepatology and gastroenterology

Auteurs

Membres identifiés du Cancéropôle Est :
Pr BRONOWICKI Jean-Pierre

Tous les auteurs :
Cadranel JFD, Zougmoré HT, Thévenot T, Dao T, Nousbaum JB, Rudler M, Carbonell N, Abergel A, Coilly A, Bideau K, Nguyen-Khac E, Mathurin P, Barrault C, Paupard T, Sogni P, Durand F, Lemaitre C, de Lédinghen V, Heluwaert F, Richardet JP, Pageaux GP, Costentin C, Bronowicki JP, Boursier J, Heurgué A, Mutumwinka NM, Medmoun M, Fantognon G, Cattelan J, Ouizeman DJ, Magoarou TL, Pulwermacher P

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/42162837

Résumé

Since 2010, little data have been available in France on the management of severe acute alcoholic hepatitis (sAH). In order to obtain a current "mapping" of the management of sAH in France, a practice survey was conducted from 04/2022 to 07/2023. A Google questionnaire pre-established by a working group was sent to all the hepatogastroenterology departments of general hospitals (nUH) and hepatology departments of university hospitals (UH). The results are expressed as means ± SD. The data included demographics, number of sAH treated per centre with corticosteroids (C) or N-acetylcysteine (NAC) combined with C, existence of an sAH treatment protocol, systematic use of transjugular liver biopsy (LB) and treatment modalities. Treatment: use of C alone or C -NAC. A total of 457 physicians responded (R): mean age 40 years (12.5); UH 53.3%, nUH 46.7%, hepatologists 57%, gastroenterologists 39%, juniors 21%. The number of sAH cases treated with C or C-NAC per center was 25 (0 to 300); this number was higher in UH than in nUH: 34 (29) vs nUH 15.4 (13.4), p < 0.001. A treatment protocol existed in 62% of UH vs 42% of nUH, p < 0.001. LB was systematically performed in 98% of UH vs 50% of others, p < 0.001. The time to obtain LB was 3.4 days (UH) vs 4.9 days (nUH), p < 0.001. 83% of respondents waited 4 days (2-6) before starting treatment in the event of a documented bacterial infection. The treatment administered was: C alone in 70% of patients (UH vs nUH,ns), NAC use: UH 40% vs nUH 47.3% (ns). 70% of respondents were responsible for initiating treatment (65% in UH vs 72% in nUH (p<0.01). The treatment was much more often initiated by senior doctors (80.6% vs 20.4% junior doctors,p<0.001). 62% of respondents used preemptive treatment before corticosteroid treatment in the event of a positive HBs antigen; 59.4% in UH vs 65% in nUH (p=0.004) . 76% performed an upper gastrointestinal endoscopy if none had been previously performed (77% in UH vs 75% in nUH,ns). The results of this national practice study,carried out in a large sample of doctors practising in university and non -university hospitals show a disparity in the use of LB in cases of suspected sAH, since 50% of respondents outside university hospitals do not use LB, mainly due to the lack of local availability. Dual C-NAC therapy is used fairly frequently.