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Review
. 2020 Nov;8(9):995-1002.
doi: 10.1177/2050640620945886. Epub 2020 Jul 27.

Alcoholic hepatitis: Towards an era of personalised management

Delphine Degré  1 , Line C Ntandja Wandji  2 , Christophe Moreno  1 , Alexandre Louvet  2
Affiliations
Review

Alcoholic hepatitis: Towards an era of personalised management

Delphine Degré et al. United European Gastroenterol J. 2020 Nov.

Abstract

Alcoholic hepatitis should be suspected in every patient with excessive chronic alcohol consumption and recent onset of jaundice. Diagnosis of alcoholic hepatitis is based on clinical and laboratory findings, and confirmed by a liver biopsy when available. Several scores are available to assess severity and prognosis of alcoholic hepatitis. The 1-month mortality of patients with severe alcoholic hepatitis, as defined by Maddrey's discriminant function, is 20-30%. Therefore, severe alcoholic hepatitis should be treated with a 28-day course of oral prednisolone after systematic screening for infection. In this review, we discuss diagnosis of alcoholic hepatitis, the different scores to assess severity of the disease, indications for corticosteroid therapy and alternative therapeutic options for non-responders to medical therapy.

Keywords: Alcoholic hepatitis; Lille score; disease severity; liver transplantation; prednisolone.

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Conflict of interest statement

Declaration of conflicting interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DD: has no conflicts to disclose, LCNW: has nothing to disclose, CM: has no conflicts to disclose, AL: has nothing to disclose.

Figures

Figure 1.
Figure 1.
Treatment algorithm for patients with suspected alcoholic hepatitis (AH). AH is diagnosed with liver biopsy or using the National Institute on Alcohol Abuse and Alcoholism (NIAAA) classification. Scoring systems assess disease severity and patients with severe AH should be treated with corticosteroids (CSs). The Lille model for AH predicts mortality in patients with AH treated with CSs, and early liver transplantation may be considered in carefully selected non-responder patients. GAHS: Glasgow Alcoholic Hepatitis Score; MELD: Model for End-stage Liver Disease.
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References

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