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Review
. 2019 Jul 1;54(4):408-416.
doi: 10.1093/alcalc/agz036.

Alcoholic Hepatitis: A Review

Nooshin Hosseini  1 , Julia Shor  1 , Gyongyi Szabo  2
Affiliations
Review

Alcoholic Hepatitis: A Review

Nooshin Hosseini et al. Alcohol Alcohol. .

Abstract

Alcoholic liver disease (ALD) represents a spectrum of injury, ranging from simple steatosis to alcoholic hepatitis to cirrhosis. Regular alcohol use results in fatty changes in the liver which can develop into inflammation, fibrosis and ultimately cirrhosis with continued, excessive drinking. Alcoholic hepatitis (AH) is an acute hepatic inflammation associated with significant morbidity and mortality that can occur in patients with steatosis or underlying cirrhosis. The pathogenesis of ALD is multifactorial and in addition to genetic factors, alcohol-induced hepatocyte damage, reactive oxygen species, gut-derived microbial components result in steatosis and inflammatory cell (macrophage and neutrophil leukocyte) recruitment and activation in the liver. Continued alcohol and pro-inflammatory cytokines induce stellate cell activation and result in progressive fibrosis. Other than cessation of alcohol use, medical therapy of AH is limited to prednisolone in a subset of patients. Given the high mortality of AH and the progressive nature of ALD, there is a major need for new therapeutic intervention for this underserved patient population.

Keywords: ABIC score; MELD score; alcoholic hepatitis; alcoholic liver disease; alcoholic steatohepatitis; glascow alcoholic hepatitis score; lille score; maddrey score; pro-inflammatory cytokines; stellate cell activation.

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Figures

Fig. 1.
Fig. 1.
Pathomechanisms of alcohol-induced liver injury involving the gut-liver access.
Fig. 2.
Fig. 2.
Treatment algorithm for corticosteroids in alcoholic hepatitis using Maddrey, GAH, and Lille scores.
Fig. 3.
Fig. 3.
Maddrey Discriminant Function (MDF). Scores are used to predict mortality and for guiding treatment with coritcosteroids.
Fig. 4.
Fig. 4.
Model for End-stage liver disease (MELD) scoring system.
See this image and copyright information in PMC

References

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MeSH terms

Substances