Review Article

Review Article: Recent Insights Into Clinical Decision-making in Severe Alcoholic Hepatitis

P. D. J. Dunne; E. H. Forrest

Disclosures

Aliment Pharmacol Ther. 2017;46(3):274-281. 

In This Article

Abstract and Introduction

Abstract

Background: 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.

Aim: To use these recent studies in order to guide clinical management.

Methods: A MeSH search of Medline was performed to specifically identify recent studies which influenced clinical diagnosis, assessment and management of alcoholic hepatitis.

Results: 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. Corticosteroids improve short-term mortality only (28 day) 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 (such as the Lille Score) define "response". Underlying infection may contribute towards corticosteroid nonresponse and needs to be actively sought out and treated. Liver transplant remains controversial; however, it has been shown to be feasible in alcoholic hepatitis.

Conclusions: 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.

Introduction

Recent reviews in alcoholic hepatitis have provided both extensive and useful insight into the hypothesised pathogenesis, clinical picture and management of such a diagnosis.[1,2] The role of this review is to address the impact of recent studies upon our clinical decision-making and to identify gaps in our understanding which would benefit from further clinical research.

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