[Indications for immunosuppressive therapy in hepatology].

Immunosuppressive, and in particular corticosteroid therapy, has held its firm place in hepatology for many years. With the development of knowledge on the etiology of liver diseases however the spectrum of diseases where this treatment is administered changes. The authors pay attention in particular to autoimmune hepatitis where the indication for immunosuppressive treatment is beyond doubt. They deal also with viral hepatitis, alcoholic hepatitis, primary biliary cirrhosis and primary sclerosing cholangitis where views on the administration of corticosteroids or immunosuppressive drugs are not uniform. In viral hepatitis administration of corticosteroids is nowadays considered contraindicated as it increases the danger of virus replication and the associated higher risk of a protracted course or development of chronicity. In the contemporary literature the view predominates that corticosteroids reduce the mortality in patients with severe alcoholic hepatitis. In some patients with primary biliary cirrhosis and primary sclerosing cholangitis addition of corticosteroids can improve the inadequate effect of monotherapy with ursodeoxycholic acid. The authors emphasize the necessity of individual evaluation of every single patient before selecting optimal treatment.