<p>Severe alcoholic hepatitis: current perspectives</p>

Abstract

Severe acute alcoholic hepatitis (AH) is a catastrophic disease in the natural history of alcoholic liver disease with a very high 180-day mortality. It can present as acute on chronic liver failure with worse prognosis in the presence of infections and higher grades of liver disease severity. The clinical scenario involves a patient with a recent history of heavy alcohol consumption within three months of presentation with jaundice and characteristic liver enzyme elevation pattern with coagulopathy, hepatic encephalopathy, variceal bleeding and sepsis that results in extrahepatic organ failures. Several liver disease severities and therapy response indicators are in clinical use. Even though not approved, the only recommended treatment option for patients with severe AH is corticosteroids, which is without long term survival benefit. Novel efficacious treatment options awaiting high-quality multi-center studies include liver transplantation (involves strict selection criteria), growth factor therapy and fecal microbiota transplantation. In this exhaustive review, we discuss the definitions, disease severity, histopathology, and treatment options – past, present, and future, in patients with severe alcoholic hepatitis.

Alcohol use disorder and the liver

“…It typically, but not exclusively, occurs in people with underlying liver cirrhosis (see Fig. 2) [21].…”

“…AH was first clinically defined in 1961 by clinicians working at the Royal Free Hospital in London [57]. It is a distinct clinical syndrome from DC and can occur in patients without established liver cirrhosis [21]. Patients typically present to medical services with jaundice following a recent escalation in alcohol consumption.…”

Alcohol-associated liver disease: A review on its pathophysiology, diagnosis and drug therapy

“…The severe alcohol-associated liver disease has a very poor prognosis. The mortality of patients with alcohol-associated hepatitis who have related cirrhosis is more than 65 % at 5 years [ [6] , [7] , [8] ]. Even though alcohol is considered to be a direct hepatotoxin, it is just around 20 % of all patients with alcohol use disorder, who subsequently develop into alcohol-associated hepatitis [ [9] , [10] , [11] ].…”

Oxidative stress in alcohol-related liver disease

“…Alcoholic hepatitis (AH) is an acute inflammatory condition that occurs on the background of ALD. Severe AH has a mortality rate of 30% within 3 mo[ 5 ] but even non-severe AH has a significant 7% mortality within 3 mo[ 6 ]. The established treatment for AH is corticosteroids, which improve short-term survival but do not affect long-term survival[ 5 ].…”