Alcoholic Hepatitis: Current Management

Abstract

Alcoholic hepatitis is an acute manifestation of alcoholic liver disease with mortality as high as 40-50% in severe cases. Patients usually have a history of prolonged alcohol abuse with or without a known history of liver disease. Although there is significant range in severity at presentation, patients with severe alcoholic hepatitis typically present with anorexia, fatigue, fever, jaundice, and ascites. The use of either pentoxifylline or corticosteroids in those with severe disease (Maddrey's discriminate function >32) has significant mortality benefit. The addition of N-acetylcysteine to corticosteroids decreases the incidences of hepatorenal syndrome, infection, and short-term mortality, but does not appear to significantly affect 6-month mortality. Nutritional support with high-calorie, high-protein diet is recommended in all patients screening positive for malnutrition. Liver transplantation for a highly selected group of patients with severe alcoholic hepatitis may be an option in the future, but is not currently recommended or available at most transplant institutions.

Molecular Mechanisms for Alcoholic Hepatitis Based on Analysis of Gene Expression Profile

“…Alcoholic hepatitis (AH) is an acute manifestation of alcoholic liver disease, which has a poor short-term prognosis and high mortality rates (40-50%) in severe cases ( 1 - 3 ). It is often severe and characterized by tender hepatomegaly, hepatocellular damage, steatosis and pericellular fibrosis ( 2 , 3 ). Patients with severe AH generally present with fever, anorexia, fatigue, jaundice, and ascites ( 3 ).…”

“…It is often severe and characterized by tender hepatomegaly, hepatocellular damage, steatosis and pericellular fibrosis ( 2 , 3 ). Patients with severe AH generally present with fever, anorexia, fatigue, jaundice, and ascites ( 3 ). Currently, the main therapy for AH is pharmacological therapy mainly including pentoxifylline or corticosteroids, but the treatment outcomes were poor ( 4 , 5 ).…”

Value of Serum Glypican 3 as a Predictive Tool for Early Diagnosis of Hepatocellular Carcinoma (Hcc)

“…14 HCC HAS poor prognosis of HCC patients when discovered 15 , so simple, accurate and non-invasive diagnostic tools of HCC is a key goal for early diagnosis of the disease hence improving the poor prognosis of this cancer. 16 AFP levels has been dropped from current surveillance guide-lines in Europe and the United States because of its low sensitivity and specificity. 3 Therefore, a novel biomarker with superior diagnostic accuracy than AFP is greatly desired.…”

Diagnosis and treatment of nutritional deficiencies in alcoholic liver disease: Overview of available evidence and open issues

“…As malnutrition correlates with both higher rates of complications (variceal bleeding, ascites, encephalopathy, infections, and hepato-renal syndrome) and mortality, its finding in ALD may identify those patients at higher risk of hepatic decompensation and/or liver-related death [8], as clearly demonstrated by a recent study on 363 AH patients, reporting a one year mortality of 14% and 76% in those with mild or severe malnutrition, respectively [4]. Furthermore, malnutrition has also been associated with a longer stay in intensive care units, longer length of hospital stay, and higher mortality after LT [8].…”

“…Complete alcohol withdrawal represents the key treatment for ALD although possibly insufficient when facing with cirrhosis or severe AH [4]. Several medical approaches have been studied, but evidence about their effect on survival is still lacking [5].…”