Ashwani Kumar Singal
University of Alabama School of Medicine, USA
Dr. Singal recently joined the UAB as an Assistant Professor in the Division of Gastroenterology and Hepatology of the Department of Medicine. After receiving his medical degree from the University College of Medical Sciences, Delhi, India, Dr. Singal worked overseas in the Kingdom of Saudi Arabia and NewZealand before moving to the United States in 2005. To complete the requirements of ABIM he underwent retraining by completing residency at the Mount Sinai School of Medicine Bronx Program followed by fellowship training in Gastroenterology at the University of Texas-Medical Branch, Galveston, TX, and AASLD sponsored advanced fellowship in Transplant Hepatology at the Mayo Clinic, Rochester, MN where he was awarded the rank of Assistant Professor. He also obtained Masters degree in Clinical Sciences during his stay at the UTMB, Galveston, TX. Dr. Singal is active in the Faculty practice treating patients with all liver diseases both within and outside the setting of liver transplantation. His clinical and research interests include steatohepatitis (due to alcohol use as well as due to non-alcohol fatty liver disease) and porphyria cutanea tarda.
Alcoholic liver disease (ALD) accounts for significant economic burden and is the second most common cause for liver transplantation (LT) in the US. Factors other than chronic alcohol abuse are important in the development of ALD. Comorbidities such as hepatitis C virus (HCV) infection and/or metabolic syndrome with visceral adiposity act synergistically with alcohol abuse in causing liver disease. Severe acute alcoholic hepatitis, a distinct subset of ALD has a potential for mortality in about 20-25% within about 1 month despite treatment with available specific agents such as corticosteroids and /or pentoxifylline. Data are emerging on the worse outcome of alcoholic hepatitis in the presence of HCV infection and efficacy of anti-oxidants such as N-acetylcysteine amongst severe alcoholic hepatitis. In the background of encouraging emerging data (retrospective data from the UNOS database and data from a case matched prospective French study ) on the beneficial effects of LT amongst patients with alcoholic hepatitis who are non-responders to current medical treatments, this presentation would deal with controversies surrounding the role and use of LT in patients with alcoholic hepatitis. Patients with ALD after LT need strategies for maintaining alcohol abstinence, diagnose relapse to alcohol abuse, and surveillance for malignancies. Although, mortality from ALD is decreasing over the last 2-3 decades, about 25,000 deaths annually occur in the US. Hence, there is a clear need for newer agents for managing this disease. This presentation would also discuss emerging newer targets including intestinal decontamination, caspase inhibitors, antioxidants, and interlukins.