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Review
. 2016 Jun;150(8):1823-34.
doi: 10.1053/j.gastro.2016.02.074. Epub 2016 Mar 4.

Treatment of Severe Alcoholic Hepatitis

Mark Thursz  1 , Timothy R Morgan  2
Affiliations
Review

Treatment of Severe Alcoholic Hepatitis

Mark Thursz et al. Gastroenterology. 2016 Jun.

Abstract

Alcoholic hepatitis (AH) is a syndrome of jaundice and liver failure that occurs in a minority of heavy consumers of alcohol. The diagnosis usually is based on a history of heavy alcohol use, findings from blood tests, and exclusion of other liver diseases by blood and imaging analyses. Liver biopsy specimens, usually collected via the transjugular route, should be analyzed to confirm a diagnosis of AH in patients with an atypical history or presentation. The optimal treatment for patients with severe AH is prednisolone, possibly in combination with N-acetyl cysteine. At present, only short-term increases in survival can be expected-no treatment has been found to increase patient survival beyond 3 months. Abstinence is essential for long-term survival. New treatment options, including liver transplantation, are being tested in trials and results eagerly are awaited.

Keywords: Alcoholism; Cirrhosis; NAC; Steroid.

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Conflict of interest statement

Conflicts of interest

The authors disclose no conflicts.

Figures

Figure 1
Figure 1
Strategy for treatment of patients with AH. Patients first must be diagnosed accurately with AH, based on history, physical examination, and analyses of blood samples, and, in some cases, biopsy specimens collected via the transjugular route. Alcohol dependence should be determined and treatment initiated at this point. Patients then should be assessed for complications such as infections, upper gastrointestinal bleeding, and renal failure. Patients’ nutritional needs then should be addressed; patients should be given 35–40 cal/kg/day orally or enterally, as well as 1.2–1.5 g protein/kg/day. The severity of AH then should be assessed. Patients with a DF of 32 or higher or a MELD score greater than 20 should receive prednisolone (40 mg/day) with or without NAC for 7 days, and then bilirubin level should be measured. Patients with Lille scores less than 0.45 should continue treatment for 28 days. Patients with Lille scores greater than 0.45 should stop treatment. There are no specific treatments for patients with DF less than 32 or a MELD score of 20 or less.
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