Alcoholic hepatitis is a severe acute manifestation of alcoholic liver disease with a high mortality.
Management of patients with this condition has been a matter of controversy for many years.
However, recent clinical studies have sought to improve the clinical approach to these patients.
Drs Dunne and Forrest used these recent studies in order to guide clinical management.
|Underlying infection may contribute towards corticosteroid nonresponse|
|Alimentary Pharmacology & Therapeutics|
A MeSH search of Medline was performed to specifically identify recent studies which influenced clinical diagnosis, assessment and management of alcoholic hepatitis.
Fulfilment of clear clinical criteria including a minimum threshold of bilirubin, defined periods of jaundice and alcohol ingestion negates the need for liver biopsy in most patients.
The research team noted that corticosteroids improve short-term mortality only with other factors such as abstinence likely to be significant in long-term outcome.
Pentoxifylline is not an effective treatment.
The Glasgow Alcoholic Hepatitis Score (GAHS) score can identify those patients likely to benefit from corticosteroids, but scores that include the evolution of bilirubin over 1 week of such treatment define “response”.
The researchers noted that underlying infection may contribute towards corticosteroid nonresponse, and needs to be actively sought out and treated.
The team reports that liver transplant remains controversial, however, it has been shown to be feasible in alcoholic hepatitis.
Dr Dunne and colleague comments, "Recent studies have helped to define patients who may benefit from corticosteroid treatment."
"However, there remains a need for more accurate scores of prognosis and treatment response, and a clear need for alternative treatments for those patients not responding to corticosteroid therapy."